Peace and health: bridging the north-south divide

This issue of Medicine, Conflict & Survival examines ways in which the health sector can promote peace. Peace ought to be considered a sister to health, if not an identical twin (Arya 2003, 2004a). Rights of peace and health are enshrined in various treaties and conventions (United Nations General Assembly 1948, 1959; UNICEF 1996). Peace theoretician Johan Galtung often uses health analogies and distinguishes between ‘negative’ and ‘positive’ peace (Galtung 1969, 1996). Negative peace (by which Galtung means the absence of violence) of course brings health benefits. But positive peace is more than this: it is characterized by what might be seen as ‘healthy’ relationships between entities, linking with a broad understanding of health, as defined by the World Health Organization (WHO) in 1948, as ‘a state of complete physical, mental and social well being’ (WHO 1978). Nobel Peace Prize Laureates such as Henri Dunant, founder of the Red Cross, through to the International Committee of the Red Cross (ICRC), Médecins sans Frontières, the International Campaign to Ban Landmines and International Physicians for the Prevention of Nuclear War (IPPNW), have often come from health backgrounds or have spread a health message.

A history of peace and health

The World Health Organization’s Health as a Bridge to Peace programme began with actions of the Pan American Health Organization (PAHO). Throughout the 1980s, PAHO focused attention on public health systems’ contribution to fostering collaboration among warring countries and factions in Central America. Humanitarian ceasefires, beginning with efforts to establish ‘days of tranquillity’ in El Salvador in the late 1980s, were thought to promote trust-building, helping to create the conditions for peace talks and ultimately sustainable peace (Large 1997; Manenti 2001; Galli 2001; Rodriguez-Garcia et al. 2001; Hess and Pfeiffer 2006; WHO 2017; Quadros and Epstein 2002 ).

In the 1990s, McMaster University, sponsored by Canadian government money, studied the health of children in warzones and spawned the Peace Through Health movement. Along with conducting studies in Sri Lanka, Croatia and Gaza, peace academics explored mechanisms of health-peace action (MacQueen, McCutcheon, and Santa-Barbara 1997). In this work, violence prevention was stratified into primary, (sometimes further subdivided into root or primordial, differentiated from primary) secondary and tertiary prevention, much as is used in medicine and public health (Yusuf, Anand, and MacQueen 1998; MacQueen and Santa Barbara 2000; MacQueen et al. 2001; Santa Barbara and MacQueen 2004). In the early 2000s, McMaster hosted courses and conferences on Peace through Health (Arya 2004b).

Now leadership in the health/peace movement has shifted to Europe, with Medical Peace Work modules (https://www.medicalpeacework.org/) and the Health through Peace conferences (https://www.medact.org/project/forum-2017/), as well as to the US, where the American Public Health Association includes a peace caucus, designed to explore, advocate and educate about the relationship between war, militarism and public health (Wiist et al. 2014).

Peace and health – a north south divide in academia?

Articles in this issue include two from the APHA by Hagopian and White, examining collaborations for peace, and barriers to the inclusion of peace in public health academia, and two from Medical Peace Work, by Boegli and Arcadu and Chemali et al., both of which explore medical peace work in the field. There is also a contribution by Izzeldin Abuelaish (co-authored by me), a Gazan-Canadian gynaecologist and infertility specialist who, after years of bringing life across the Israeli-Palestinian divide, saw his whole world shattered and worldview on promoting peaceful coexistence challenged when, in 2009, Israel shelled his home killing three daughters and a niece. Izzeldin, who has written a book ‘I shall not hate’, focuses his piece on hatred as a disease. I focus a final piece on the instruments of global genocide, calling for renewed public health advocacy against nuclear weapons. So this seems like a broad agenda from different parts of the world, but is this enough?

In the Global Health world there is often a feeling among colleagues from the Global South that their priorities may be secondary or peripheral, that agendas (for example, in disease control) seem to be driven from the North and a blind eye turned to root causes. Is the same true of work on peace and health? Those in the Global South represent the vast majority of victims of war, while countries in the North often precipitate or help fuel violent conflicts. Despite the predominance of lived experience from the South, the discourse, discipline and conceptual elements of Peace and Health have largely been developed in the North.

IPPNW: a north south divide in practice?

IPPNW retains its focus on nuclear weapons. Even though many of us continue to work on the development and environmental parts of the IPPNW triangle (Ashford 2000), some believe that coalitions with other development and environment organizations may dilute IPPNW’s attempts to oppose the instruments of instantaneous planetary extermination.

But this does not need to be the case. To its credit, IPPNW rightfully opposed the folly of sanctions on Iraq (ICRC 1999) and the subsequent war (Salvage 2002) and has highlighted the damage caused by small arms since the Helsinki Conference of 2001 (Arya 2002). National affiliates have worked with Indigenous communities on uranium mining, and with Pacific Islanders and those in the Indian Ocean who were victims of nuclear tests. But those in IPPNW from the Global South sometimes feel dismissed when they want to challenge the world economic system.

The links between poverty, injustice and war have been well-known for at least the last half century. In his farewell address, former Second World War General President Eisenhower challenged the nation to confront the military-industrial complex: ‘Every gun that is made, every warship launched, every rocket fired signifies, in the final sense, a theft from those who hunger and are not fed, those who are cold and not clothed’ (Eisenhower 1953). Concentrating on a major symptom, nuclear weapons, and failing to address the complex and its relationship to the global economic system, is perfecting lung cancer surgery, but failing to address smoking. The challenges cited by the President have only multiplied, as the US military budget has ballooned to $600–800 billion, depending on the source, and now approaches 40% of the world’s military spending – more than the next seven countries combined (National Priorities Project 2017).

A way forward

There is hope for a new way, a fruitful marriage between North and South. In Global Health, we must seek justice, reach across divides, and respectfully share knowledge and experience, recognizing inequality of circumstance. Sometimes however painful, we must acknowledge our roles as perpetrators of violence and injustice or as beneficiaries of colonialism.

Northern peace academics can benefit tremendously from collaboration with Southern colleagues and practitioners. Gene Sharp may have provided tools for non-violence but, despite subsequent retrenchment, the Arab spring gave it life (Engler 2013; Batstone 2014). Many examples of resilience and reconciliation are found in the Global South or in marginalized populations of the North: the ‘gacaca’ courts for restorative justice, Indigenous healing circles, and even the use of social media for the common good, provide lessons for all. Countries such as Lebanon, challenged with hosting refugees representing a quarter of the population, thus far have dealt with xenophobia far better than the US or Europe.

Peace practice must reach across professional and disciplinary boundaries and work from the macro to micro levels on the linked issues of climate change, resource shortages, the global military-industrial complex, refugees, disease transmission and nuclear weapons.

PEGASUS

How do we promote collaboration and disseminate stories of success? This brings us to the Medact/ IPPNW Health through Peace Conference in September 2017 (https://www.medact.org/project/forum-2017/), which explicitly explores these issues, and the Third biennial PEGASUS Conference on PEace, Global health And SUStainability, to be held at the end of April 2018, in Toronto, Canada. PEGASUS was the primary inspiration for this issue, and supplies the content for a couple of issues to follow. We seek your input and participation in the next PEGASUS conference (www.pegasusconference.ca). With a theme of ‘From Thought to Action’, we will be examining links among our four streams of Global Health International, Global Health Local, Peace, and Sustainability. Whether you are a student, policy-maker, advocate, educator, practitioner or researcher, or wish to link with others, within and beyond sectors, come and join us!

Neil Arya
Waterloo, Ontario, Canada
[email protected], [email protected]