The commitment to preventing disease, promoting health, and prolonging life at the population level has shifted efforts away from individualizing health disparities to understanding how social and structural determinants shape individual health outcomes. However, there is less-explicit focus on what conditions shape socio-political structures. A baseline level of peace, defined as the absence of both direct and structural violence (https://tinyurl.com/2s3jhh5h), is often an unstated assumption that underscores our ability to mount effective and sustainable public health responses.
The tenure of the 2022 AJPH Student Think Tank occurred during several paradigm-shifting socio-political events (the COVID-19 pandemic, highly visible and racialized violence in the United States, the civil war in Ethiopia, the femicide of Mahsa Jina Amini in Iran, and the war in Ukraine just to name a few), which challenged us to critically reflect on whether the socio-political environments where public health is practiced have truly ever been peaceful.
The nexus between health and peace is not new; in 1981, the World Health Assembly’s Resolution stated, “the preservation and promotion of peace is the most significant factor for the attainment of health for all” (https://bit.ly/3HD3yVw). While there is an urgent need to conceptualize peace as a fundamental determinant of health, certain forms of direct and structural violence have become part of the zeitgeist.
When violence becomes normalized, it hampers the ability to recognize that the absence of peace anywhere poses global threats to public health everywhere. For example, the legacy of armed conflict in the Democratic Republic of the Congo has eroded medical and public health infrastructure, rendering Congolese populations vulnerable to emerging infectious diseases that can now spread internationally faster than ever before (https://tinyurl.com/52t7ja6w). Furthermore, despite the United States maintaining the world’s highest gross domestic product (https://tinyurl.com/mr2d7fkj), US maternal mortality rates rank among the highest globally, with Black women experiencing three times the risk of death compared with their White counterparts (https://tinyurl.com/2bwryeca), thereby yielding intergenerational adversities. The direct violence from armed conflict and the structural disparities that cause the premature mortality of Black women illustrate that when peace is threatened, so is public health.
We conceptualize threats to peace across three dimensions. First, the presence of direct violence in the form of war and conflict between and within nations has a profound effect on whether environments sustain life or exacerbate premature morbidity and mortality. Second, high-income countries can have “pockets of fragility,” wherein subpopulations experience a disproportionate disease burden. Third, forced displacement and migration, either within a country or across international borders, can yield intergenerational health adversities at the intersection of gender, class, and race.
To highlight our conceptualization of the peace‒health nexus, we present diverse student perspectives and experiences on the theme of peace as a fundamental determinant of health (see pp. 146–159). The selected submissions engage critically with the most pressing public health issues at the crossroads of peace and health. The submissions collectively emphasize that the absence of peace anywhere and among any group threatens us all. Without peace, public health cannot reach its goals of preventing disease, promoting health, and prolonging life. It is time for the public health community to declare explicitly that peace is fundamental for health and to advocate accordingly.
12. Years Ago
The New Left and Public Health
We continue wrestling with the politics of “community”—a term invoked frequently (and often mystically) yet imprecisely in public health—and the associated search for sources of transformation in health provision. Historical and present efforts related to government health insurance have been propelled mainly by middle-class reformers, not more popular constituencies. With some exceptions, mass organizing around health equality remains difficult.
From AJPH, February 2011, pp. 247–248
45. Years Ago
Consumer-Based Boards of Health Centers
Consumers need to be involved in the larger health care system, not just in the governance of local facilities such as health centers. This would provide new power bases and open up communication channels between higher levels in the health care system and consumers on local levels. The effect would be that local consumer board members would have access to information other than that channeled through the traditional professional channels. …It may be that consumer board members should have some identifiable constituency. This could take the form of official representation of other relevant community organizations, thereby providing a power base as well as relevant organizational experience for potential board members. If this occurs, providers and other professionals should be prepared for an increase in conflict, as consumers would now come to the board with vested interests and increased self-confidence.
From AJPH, June 1978, p. 581
Biography
