Violence - THE Public Health Threat of the Millennium – An Ounce of Prevention

David Swann MD, FRCP(C)

Oct. 12/03

Presented at the First Peace Educator’s Conference in Calgary ; Oct 9-12/03

These are terrifying times- in the past decade of wars: 40 million deaths ( now approaching 75% civilians) and  45 million refugees with countless injured and disabled. (2003 State of the Future; United Nations University ). Where are the resources to deal with this profound public health catastrophe? Where is the acknowledgement of this as a preventable international catastrophe beyond any other public health losses such as SARS and West Nile virus. It’s right up there with AIDS and climate change in its implications for people and the planet.
 We are a culture of violence and it is time we acknowledged the truth about ourselves, smug as we may be as Canadians in our “middle power” status. The State of the Future documents a 400% increase in media violence in the past decade as we puzzle over the lack of peace in our own country in relation to aboriginal people and others. Internationally, we continue to sit on the fence in military investment rather than make a strong, clear commitment to forces for creating security for all people on the planet.
Military investments on the planet continue at over $2 billion per day, supported by fear and employing vast numbers of young people. But this is a fraction of the real cost. How, you say?
  1. salaries, research, production, testing, training, deployment, and use of weapons and defence against them – this is what we measure
  2. destruction of people, property and environment
  3.  cost of rebuilding – all adds to our measure of GDP – proving that war is good for the economy!
  4. opportunity lost for developing people, constructive relations, food production and human services

Bad News


Our challenge is to bring the bad news in a way that people can hear it, feel the anxiety this must generate, yet feel supported by others who see the possibility of action to change. Far from contributing to more “fear-mongering” and media obsession with violence we need to convey a sense of hopeful urgency. Yes, the diagnosis is troubling and it takes courage to face the truth, but we must stay with each other as we deal with the stages of grief:  shock-denial- anger-depression-acceptance.

“We have seen the enemy and it is us” – Pogo. We are the greatest public health threat on the planet.

On the other side of the coin we are also the second “super-power” as demonstrated in the streets of most major cities in the world early this year against the war in Iraq . Our actions and inaction make a difference in relation to creating the conditions that contribute to basic needs, to health and to justice- the conditions that would prevent war and lead to real human security.


Good News


The good news of course is that, as part of the problem we are also part of the solution. We may not know completely what needs to be done, but we know some basic truths which we can build on:

ü      Peace is more than the absence of conflict – just as health is more than the absence of disease.

ü      The conditions for health are the same as for peace- basic needs, justice, freedom, income, human services, etc.

ü      The health of the planet is too important to leave to politicians. (just as our personal health is too important to leave to our practitioner.)

ü      Health is about power; power is about politics - life is political .

ü      We must shift from symptoms (violence and terrorism) to cause: poverty, unfair trade, militarization for profit. This is true at home, work and in the community.

ü      We must recover a vision of peace and justice for all beginning with our own health  “fully human, fully alive”.

ü      We must get involved locally to contribute to a living democracy



Symptoms, Cause and Vision – The Chronic Headache


As physicians, we should not be satisfied to remove the symptoms of pain without knowing the cause. It is true that many headaches have no pathological basis but this does not mean the cause is trivial, or the consequences of ignoring them irrelevant. In our fast-paced society there is little time to analyze situations and a habitual lurch for the quick fix.


Our challenge is to assist with symptoms at the same time as searching for the underlying cause. Violence is a symptom.


I spent many years in early marriage trying to avoid conflict. What I needed to know is that conflict is an opportunity to avoid war. Conflict exposes differences and, assuming that dialogue is possible, can aid understanding and constructive development.


Underlying causes must be addressed at both the individual and the international levels. At the systemic level underlying cause would mean addressing the growing chasm between rich and poor, north and south and widespread poverty, related to systemic violence of economic globalization, decline in environment, resource depletion and  climate change.


Each one of us contributes to social environments that either confront injustice and dis-ease, or ignores them; treats symptoms alone or explores underlying cause; envisions a world where everyone is equally valued or one in which there are the ‘haves and have-nots’.


Another dimension to this is the extent to which we, as individuals, families and communities have a vision of what health can be – what a healthy person in a healthy community looks like. Many have settled for a poor replica of health – “fully human, fully alive” (St Iraneus).



Do You Still Hope?


Many people in our world have lost hope and do not realize it. It is evident in their priorities however, where they spend their time and money and where they point the finger of blame for the conditions we have all created. Cynicism is pervasive and is as damaging as overt violence in its effect on others. If peace is a priority and if we still hope, then politics must become a way of life. Peace education or, rather, lived peace must also become part of our daily experience at home, school and in the workplace. It’s not enough to talk about conflict resolution skills. Real change comes when individuals confront unhealthy issues in their daily relationships, communities and in the national political scene and decide to share responsibility for correcting it. “Be the change.” Gandhi



One Prescription for Peace: TLC


Change begins at the individual level and extends to the home, work, community and planet. What is needed simply and fundamentally :


Truth – being honest with ourselves and our world about what we see, what we know and what we want for ourselves and the planet.


Love – learn to love ourselves in all our failings and brokenness; to love others and to allow them to extend their love to heal us.


Courage – to think our thoughts, speak our truth and take actions needed to address the important values of our lives – especially peace, justice and human rights for all.


These are terrifying times in our Brave New World and we  need people of faith and courage, willing to look the “beast” in the face - see ourselves as neither angels nor demons but persons with capacity, caring and courage, especially when we act with others.


My marriage taught me the importance of facing my wounds and confronting my differences rather than avoiding them and avoiding becoming more fully human. We are given a sacred trust to future generations and we will not squander life and we will not give up hope. We choose to take responsibility for our lives, our thoughts, our words and our actions and recognize the trivial- to advance genuine peace, starting with myself.


I cannot do everything, but I can do something.  I must not fail to do the something that I can do.- Helen Keller