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Imagine that there is a disease that claims more than 30,000 lives in the United States each year. Imagine that countless more people survive this disease, and that many of them have long-lasting effects. Imagine that there are various methods for preventing the disease, but there are social, political, and other barriers to implementing these preventive measures.

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When heads of state and other leaders of 195 nations reached a landmark accord at the recent United Nations COP21 conference on climate change in Paris, they focused primarily on sea level rise, droughts, loss of biodiversity, and ways to decrease greenhouse gas emissions in order to reduce these consequences. But arguably the most serious and widespread impacts of climate change are those that are hazardous to the health of people.

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In 1933 in the midst of Great Depression, President Franklin D. Roosevelt, in his first inaugural address, wisely stated, “The only thing we have to fear is fear itself.” That wisdom has as much relevance today as it did during the Depression.

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The four-year drought in California, which is causing severe water shortages and related problems, is receiving increasingly more attention. It is affecting everyone, causing people to adjust their lifestyles and causing small business owners and entire industries to rethink their use–and misuse–of water.

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In 1971, William Irvin Thompson, a professor at York University in Toronto, wrote an op-ed in the New York Times entitled, “We Become What We Hate,” describing the way in which “thoughts can become inverted when they are reflected in actions.”

He cited several scientific, sociocultural, economic, and political situations where the maxim appeared to be true. The physician who believed he was inventing a pill to help women become pregnant had actually invented the oral contraceptive. Germany and Japan, having lost World War II, had become peaceful consumer societies. The People’s Republic of China had become, at least back in 1971, a puritanical nation.

Today, many of the values that we, as a nation, profess — protection of civil rights and human rights, assistance for the needy, support for international cooperation, and promotion of peace — have become inverted in our actions. As a nation, we say one thing, but often do the opposite.

As a nation, we profess protection of civil rights. But our criminal justice system and our systems for federal, state, and local elections discriminate against people of color and other minorities.

As a nation, we profess protection of human rights. But we have imprisoned “enemy combatants” without charges, stripped them of their rights as prisoners of war, and tortured many of them in violation of the Geneva Conventions.

As a nation, we profess adherence to the late Senator Hubert H. Humphrey’s dictum that the true measure of a government is how it cares for the young, the old, the sick, and the needy. But we set the minimum wage at a level at which working people cannot survive. We inadequately fund human services for those who need them most. And, even after implementation of the Patient Protection and Affordable Care Act, we continue to be the only industrialized country that does not ensure health care for all its citizens.

As a nation, we profess support for international cooperation. But we fail to sign treaties to ban antipersonnel landmines and prevent the proliferation of nuclear weapons. And we, as a nation, contribute much less than our fair share of foreign assistance to low-income countries.

As a nation, we profess commitment to world peace. But we lead all other countries, by far, in both arms sales and military expenditures.

In many ways, we, as a nation, have become what we hate.

Image Credit: Dispersed, Occupy Oakland Move In Day. Photo by Glenn Halog. CC by NC 2.0 via Flickr.

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One hundred years ago, World War I began — the “Great War,” the war “to end all wars.” A war that arose from a series of miscalculations after the assassination of two people. A war that eventually killed 8 million people, wounded 21 million, and disabled millions more — both physically and mentally.

That war sowed the seeds for an even greater war starting two decades later, a war that killed at least 60 million people (45 million of them civilians), wounded 25 million in battle, and disabled many more — a war that led to the development, use, large-scale production, and deployment of nuclear weapons.

Since then, there have been dozens more wars and the continuing threat of thermonuclear war. Statistics reflect the millions of people killed and injured. These statistics are too staggering for us to comprehend, ever more staggering when we realize that these statistics are people with the tears washed off.

It would be nice to think that we, as a global society, had learned the lessons of war and other forms of “collective violence” over the past century. However, although there is evidence that there are fewer major wars today, armed conflict and other forms of collective violence do not seem be abated. The international trade and widespread availability of “conventional weapons,” generations-long ethnic conflict, competition for control of scarce mineral resources, and socioeconomic inequalities and other forms of social injustice fuel this violence.

All too often violence seems to be the default mode of settling disputes between nations. All too often violence, in one form or another, seems to be the way that the powerful maintain power, and the way that the powerless seek it. All too often violence or the threat of violence seems to be the way that national governments — and even law enforcement officers — attempt to maintain security — and the way that “non-state actors” attempt to undermine it.

As we have witnessed over the past several decades, national and international security cannot be maintained over the long term by violence or the threat of violence. National and international security is more likely to be sustained by promoting socioeconomic equalities, social justice, and public participation in government; ensuring educational and employment opportunities for all; protecting human rights and ensuring that the basic needs of everyone are met; and addressing the true enemies of humankind: poverty, hunger, and disease.

Enemy #1: Poverty. More than 46 million people in the United States live below the poverty line, the largest number in the 54 years that the Census has measured poverty. More than 21 million children live in poverty in this country. Globally, about half of the world’s population lives on less than $2.50 a day. Poverty is an insidious enemy that robs people of opportunity and worsens their health.

Enemy #2: Hunger. About one out of seven US households are considered “food insecure.” Globally, more than 800 million — one-fourth of people in sub-Saharan Africa — do not have enough to eat. Hunger is a widespread enemy that saps children and adults of their physical and mental capabilities and predisposes them to disease.

Enemy #3: Disease. In the United States, preventable physical and mental illnesses account for much morbidity and mortality. Globally, this is even more true. For example, each year about four million people die of acute respiratory infections, and 1.5 million children die from diarrheal diseases due to unsafe water, inadequate sanitation, and poor hygiene. New types of infectious agents and micro-organisms resistant to antibiotics continue to emerge. And the Ebola virus is rapidly spreading across several West African countries.

These are the true enemies of humankind.

One hundred years from now, what will people, in 2114, say when they look back on these times? Will they say that we failed to learn the lessons of the previous one hundred years and continued to wage war and other forms of violence? Or will they say that we, as a global society, created a culture of peace in which we resolved disputes non-violently and in which we addressed the true enemies of humankind?

Heading image: Urban Poverty by Nikkul. CC-BY-2.0 via Wikimedia Commons.

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By Barry S. Levy and Victor W. Sidel

Out of sight. Out of mind.

Nine countries, mainly the United States and Russia, possess 17,000 nuclear weapons, many of which are hundreds of times more powerful than the atomic bombs dropped over Hiroshima and Nagasaki almost 70 years ago. An attack and counterattack in which fewer than 1% of these nuclear weapons were detonated could cause tens of millions of deaths and could disrupt climate globally, leading to crop failures and widespread famine. A greater conflagration could cause a “nuclear winter” and threaten the future of life on earth.

The recent tensions concerning Ukraine demonstrate that although 23 years have elapsed since the end of the Cold War, nuclear weapons remain a clear and present danger to humanity. Persistent threats include accidental launch of nuclear warheads, proliferation of nuclear weapons among nations, potential acquisition and use of nuclear weapons by non-state actors, and diversion of human and financial resources in order to maintain and modernize nuclear arsenals in the United States and other nations.

Despite safeguards, accidental detonation remains a real possibility. A few years ago, a US Air Force plane transported six missiles tipped with nuclear warheads, unbeknownst to the pilot and crew. Twice, in recent weeks, it was revealed that as many as half of navy and air force personnel who maintain nuclear-armed missiles and would be responsible for launching them if commanded to do so had cheated on their competency examinations. In 1995, Boris Yeltsin, then president of Russia, had only a few minutes to decide whether to launch Russian nuclear-armed missiles against the United States in response to what, on radar, looked like a US air attack with multiple re-entry vehicles (MERVs); it turned out to be a rocket launched by a team of Norwegian and US scientists to study the aurora borealis.

Another major concern is that the leaders of the nine nations that possess nuclear weapons each have absolute authority — unchecked by other government officials or institutions, even in the United States — to launch an offensive or allegedly defensive nuclear strike.

Furthermore, proliferation remains a serious threat. During the past decade North Korea obtained nuclear technology and fissile materials, and developed and tested one or more nuclear weapons. At least until recently, Iran apparently was — and may still be — on the path to developing nuclear weapons. Given the widespread knowledge about nuclear technology and the potential availability of fissile material, non-state actors could acquire and use nuclear weapons.

U.S. Air Force Staff Sgt. Betty Puma, from the 5th Munitions Squadron, reviews a nuclear weapons maintenance procedures checklist as part of the Nuclear Surety Inspection (NSI) May 19, 2009, at Minot Air Force Base, N.D. An NSI is designed to evaluate a unit’s readiness to execute nuclear operations. Areas to be evaluated during the NSI include operations, maintenance, security and support activities needed to ensure the wing performs its mission in a safe, secure and reliable manner. This no-notice inspection is expected to conclude May 22. (U.S. Air Force photo by Staff Sgt. Miguel Lara III/Released). defenseimagery.mil

Highly-enriched uranium (HEU) — the fissile material used in nuclear weapons — is distributed globally, and used in nuclear reactors to perform research or power aircraft carriers and submarines. Converting to low-enriched uranium would eliminate the possibility of HEU being stolen or otherwise diverted to produce nuclear weapons.

Yet another major concern is the huge diversion of financial resources to maintain and modernize the US nuclear weapons arsenal, estimated over the next 30 years to be about $1 trillion. The proposed nuclear weapons budget of the US Department of Energy for fiscal year 2015 is higher than at any time during the Cold War. Meanwhile, substantial cuts have been proposed in programs to dismantle and prevent proliferation of nuclear weapons — and in programs to reduce poverty and protect human rights.

To most Americans, all of these concerns are out of sight and out of mind. Each of us has a responsibility to become more educated about these issues, increase the awareness of other people about them, and advocate for measures to reduce the dangers associated with nuclear weapons, including the abolition of nuclear weapons.

A longstanding proposal to eliminate all nuclear weapons is the Nuclear Weapons Convention (NWC). In 1997, a consortium of experts in law, science, public health, disarmament, and negotiation drafted a model convention. The Convention would require nations that possess nuclear weapons to destroy them in stages — taking them from high-alert status, removing them from deployment, removing warheads from delivery vehicles, disabling warheads by removing explosive “pits,” and placing fissile material under control of the United Nations. Such a convention has had wide public support throughout the world.

An immediate step that could pave the way to the Nuclear Weapons Convention and the eradication of nuclear weapons is a treaty banning nuclear weapons. Such a treaty could be negotiated with or without the participation of those nations possessing nuclear weapons. It could create an international norm of the illegality of nuclear weapons, similar to the norms that have been established concerning chemical and biological weapons, antipersonnel landmines, and cluster munitions. Such a treaty could put substantial pressure on the nations possessing nuclear weapons to comply with their disarmament obligations — which they have been unwilling to do thus far. The International Campaign to Abolish Nuclear Weapons (ICAN) has mobilized 300 civil-society organizations in 90 countries to campaign, on humanitarian grounds, for such a treaty banning nuclear weapons.

Given resurgent Cold-War-era arguments for revitalizing US nuclear-weapons capabilities to deter Russian actions in Ukraine, we must resist measures that would reset the “Doomsday Clock” to a point that places all humanity — and indeed all life on earth — in great peril of annihilation by nuclear weapons.

Barry S. Levy, M.D., M.P.H., and Victor W. Sidel, M.D., are co-editors of the recently published second edition of Social Injustice and Public Health as well as two editions each of the books War and Public Health and Terrorism and Public Health, all of which have been published by Oxford University Press. They are both past presidents of the American Public Health Association. Dr. Levy is an Adjunct Professor of Public Health at Tufts University School of Medicine. Dr. Sidel is Distinguished University Professor of Social Medicine Emeritus at Montefiore Medical Center and Albert Einstein Medical College and an Adjunct Professor of Public Health at Weill Cornell Medical College. Victor W. Sidel was a member of the 1997 consortium of experts in law, science, public health, disarmament, and negotiation that drafted the model Nuclear Weapons Convention. Read their previous blog posts.

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By Barry S. Levy and Victor W. Sidel

Chemical weapons are horrendous agents. Small amounts can kill and severely injure hundreds of people in a matter of minutes, as apparently occurred recently in Syria. Some analysts consider them “poor countries’ nuclear bombs.” The international community has, with the Chemical Weapons Convention, banned their use, development, production, acquisition, stockpiling, retention, and transfer. Nevertheless, several countries have continued to develop, produce, acquire, stockpile, retain, and transfer these weapons.

Chemical weapons were used on a wide scale during World War I and were also used during World War II. Saddam Hussein used them in Iraq in the 1980s to crush internal opposition to his regime. A terrorist cult in Japan used them twice in the mid-1990s, killing 20 people and injuring hundreds. Now they have been used in Syria — maybe more than once.

Their use in Syria cannot go unchecked. But that is not the issue before the US Congress. The issue is whether or not President Obama should authorize the “limited” use of cruise missiles, launched from US ships in the eastern Mediterranean, to “degrade” Syrian President Assad’s ability to launch additional attacks.

There are three reasons why we oppose such a strike.

First, such an attack by the United States would likely violate international law and undermine the United Nations’ ability to enforce the Chemical Weapons Convention. The report of UN weapons inspectors who investigated the recent attack has not yet been issued. The United States does not have the right to enforce international treaties — militarily or by other means.

Second, a strike by the United States would have uncertain consequences within Syria. It is likely to kill and injure noncombatant women, men, and children. It may lead President Assad or others in Syria to use chemical weapons in retaliation. And it may lead to wider access to the massive store of chemical weapons there, leading to further use of chemical weapons in Syria — and beyond.

Third, and most importantly, such a strike by the United States would have uncertain consequences throughout the Middle East and beyond. It could lead to a much wider war in this region, where there is an overabundance of weapons supplied by the United States, Russia, and other countries. Such a strike would be equivalent to tossing a match into a barrel of gasoline. There is already much conflict in this region within countries, most prominently within Egypt and Iraq, and there is much potential conflict between countries. The reaction by several countries and non-state actors in the Middle East (and beyond) to a US strike cannot be predicted, but there is a predictably high likelihood of a miscalculation, or a whole series of miscalculations, that could easily lead to a much wider conflagration. We should remember that the assassination of one person ignited World War I.

The civil war in Syria, which has already led to more than 100,000 deaths and two million refugees, cries out for a nonmilitary solution. There needs to be a response to the chemical weapons attack there, but it should be an international nonmilitary response — not a US cruise missile attack that is likely do more harm than good. The suddenly increased focus on the civil war in Syria represents an opportunity for the international community to find ways to end this conflict and to promote peace in the region.

Barry S. Levy, MD, MPH, and Victor W. Sidel, MD, are co-editors of the following books, each in its second edition, published by Oxford University Press: War and Public Health, Terrorism and Public Health, and Social Injustice and Public Health. They are both past presidents of the American Public Health Association. Dr. Levy is an Adjunct Professor of Public Health at Tufts University School of Medicine. Dr. Sidel is Distinguished University Professor of Social Medicine Emeritus at Montefiore Medical Center and Albert Einstein Medical College and an Adjunct Professor of Public Health at Weill Cornell Medical College.

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Image credit: Cover of the Chemical Weapons Convention used for the purposes of illustration via opcw.org.

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Barry S. Levy, MD, PHH, is an Adjunct Professor of Public Health at Tufts University School of Medicine and a consultant in occupational and environmental health.  Victor W. Sidel, MD, is Distinguished University Professor of Social Medicine at Montefiore Medical Center and Albert Einstein College of Medicine, and an Adjunct Professor of Public Health at Weill Medical College of Cornell University.  Together they edited, Social Injustice and Public Health, which looks at many aspects of social injustice and their relationship to public health. Major sections of the book focus on population groups affected by social injustice, areas of public health and medical care in which social injustice has an adverse impact, and approaches to the reduction and elimination of social injustice and its adverse effects on public health. In the excerpt below, from the essay “Nutrition” by J. Larry Brown, we learn about malnutrition’s effect in the United States.

While debate about the causes and remedies of hunger is conducted in the political arena, hunger itself is a public health issue.  The adverse consequences of chronic undernutrition, as well as the social sequelae, make hunger a critical problem for the nation.  Moreover, an increasing body of knowledge points to the problem of obesity as a health consequence frequently associated with inadequate income and even hunger.

In the United States, hunger presents quite differently than it does in developing nations. Protein-calorie malnutrition, or marasmas, and kwashiorkor, characterized by adequate calories but extreme protein deficiency, now occur in the United States only rarely.  Rather, hunger in this country typically takes the form of what the World Health Organization called “silent undernutrition.”  It is reflected in young children who are several pounds beneath the low end of the pediatric growth chart.  They may look simply like thin children, but a trained health professional will recognize that they are experiencing growth failure.  Although their symptoms are different from those of malnourished children in developing countries, they are, from a health perspective, in difficulty…

Because children grow and their height and weight gains are plotted on internationally used pediatric growth charts, they are perhaps the easiest population group in which to detect the consequences of inadequate nutrition.  Typically, youngsters who fall below the fifth percentile in weight or height for age on growth charts are candidates for further investigation.  To be certain, it is expected that normally 5 percent of any population would fall in this low end of the range; but in studies of low-income children, 10 to 15 percent do so.  This indicates that what is being observed is not normal genetic variation but rather a “human-made” outcome.  Moreover, this analysis is confirmed in the work of child development clinics in urban teaching hospitals across the United States, where children experiencing growth failure due to poverty are nursed back to health with appropriate nutrition.

While the relationship between inadequate nutritional intake and health status reflected in the