War and Public Health

Often a second edition of a book is not worthy of special note or review. However, War and Public Health is an exception. The ideas and cases presented a decade ago were equally relevant, but inclusion of recent world events makes this second edition all the more useful, timely, and important.

I was drawn to this book because of the editors' reputations as leaders for generations of individuals wanting to be involved in improving the health of others in the world. Levy and Sidel could have written this book themselves, but they chose to edit a volume including the writings of many other major leaders in a variety of fields and disciplines, creating a chorus rather than a duo of strong voices. They have orchestrated a coherent volume with a disciplined approach to uniformity in certain aspects of the presentations (short, boxed, punchy points or stories; chapters with clear overviews, descriptions, and conclusions), yet varied the voices, perspectives, and contributors to produce a nuanced, fascinating, and compelling whole. As with any great piece of music, it is best appreciated by experiencing it in its entirety but with the opportunity to go back to relish specific sections for deeper understanding and insight.

The underlying message of War and Public Health is the critical link between the manifestations, impact, and ways to mitigate the harmful effects of conflict on the health of the public. The obvious dissonance of the words “war” and “public health” is addressed in an overview in the introduction by the book's editors. The remaining 6 parts are a logical progression building the case for a different approach to dealing with war—namely, new ways to conceptualize and prevent war and its health consequences.

One of the many features that make this volume so readable and galvanizing is the mixture of descriptive prose, graphics, tables, and boxes with perspectives that truly add to the understanding and meaning of the words. A collection of superb references further supports the conclusions and recommendations in each chapter. My favorite of the personalized accounts is the contribution by Khassan Baiev on the War in Chechnya (part 5, “Specific Wars”). His description of what it felt like to have his hospital and then his home (where he was caring for wounded civilians after the hospital was destroyed) bombed repeatedly, while he continued to provide whatever services he could, is seared in my memory as the ultimate sacrifice clinicians can make as health practitioners or citizens without compromising their ideals.

Part 2, “The Consequences of War,” describes epidemiology (Garfield) and human rights (Annas and Geiger), while part 3 describes types of weapons including conventional weapons, land mines, and chemical, biological, and nuclear weapons. The following parts expand the reader's insight and comprehension of the impact of war on specific vulnerable populations (part 4) and provide a series of case studies of specific wars in Iraq, Chechnya, Democratic Republic of the Congo, Latin America, and Vietnam (part 5). These case studies provide context for the rest of the book and elucidate what is common and different among recent major wars.

Part 6, “Prevention of War and Its Health Consequences,” broadens the reader's view from the particulars of war to ways in which public health can first ameliorate and then contribute to the prevention of war. In chapter 20, Rez, Anderson, and Mercy offer a useful framework for considering the role of public health. Relevant aspects of international law are well reviewed in chapter 21 by Weiss, who describes the rationale for various pivotal United Nations conventions underpinning current approaches to control and ameliorate the impact of conflict on civilians. In “The Role of Nongovernmental Organizations,” Loretz samples a few specific international nongovernmental organizations (NGOs) to illustrate their historic and current role. Given the rapid expansion in the number, size, and growing pivotal role of international NGOs, I would have appreciated an expanded chapter addressing some of the current issues and controversies in the sector, including topics such as the pluses and minuses of international NGOs being put in the position of comprising the health infrastructure in areas with prolonged postconflict situations (eg, Democratic Republic of the Congo). Since so much of the resources of governments, the United Nations, and foundations are now focusing on this sector, the book could have more fully addressed issues of “neutrality” as well as questions such as the role of humanitarian assistance vs peacekeeping or military personnel doing community development.

My major sadness in reading this book was that I did not have it for guidance when I began my career in medicine, public health, and humanitarian assistance. The authors have built on evidence-based research to achieve a perspective gained over decades, culminating in a rich volume that students and their teachers can use as a foundation for understanding the world as it is and making it better.

Who should read this book? Certainly students in health, law, and social policy—and those who teach them—will find it a “go-to” readable resource. However, I would enlarge the lens of readership to include those who want to better understand the world as well as identify ways to make it a healthier one in which individuals might not merely survive the horrors of war but take necessary steps to change those conditions that lead to war so that people might thrive, not merely survive.