National Nurses United

Mini Features 1/9/07 1:22 PM Page 13 What Price, War? War and Public Health, edited by Barry S. Levy and Victor W. Sidel, American Public Health Association, $23.50 Terrorism and Public Health: A Balanced Approach to Strengthening Systems and Protecting People, edited by Barry S. Levy and Victor W. Sidel, Oxford University Press, $39.95 "It is only those who have neither fired a shot nor heard the shrieks and groans of the wounded who cry aloud for blood, more vengeance, more desolation. War is hell." —Gen. William Tecumseh Sherman I ndeed it is, and it does not end when the guns fall silent and the last flag-draped caskets come home. War, and its modern companion, terrorism, increasingly dominate our daily lives and touches on everything, from how we structure our political systems to the way we conceive of the world around us. In two books, War and Public Health and Terrorism and Public Health, doctors Barry S. Levy and Victor W. Sidel, both past presidents of the American Public Health Association, assemble a pantheon of distinguished experts to examine the health consequences of military conflicts and terrorism. The subject matter is daunting, but Levy and Sidel have developed an accessible formula for tacking complex issues without losing the depth and details such serious topics require. For starters, they cast their nets widely. War and Public Health covers everything from the impact of war on the psychology of women and children, to some sobering details on things that go bump in the night, like biological and chemical weapons. The book, which was originally published in 1997 by Oxford University Press and then reissued in paperback with an updated epilogue by the American Public Health Association in 2000, set a template for the authors' volume on terrorism and their recent book, Social Injustice and Public Health. The books break the subjects into general categories, and then further into detailed chapters on subjects like "Environmental and Health Effects of Weapons Production" and "Protecting the Health and Safety of Rescue and Recovery Workers." Even though the book on war is six years old, it is, unfortunately, very current. A recent U.S. Department of Defense study found that one in six Iraq War vets suffer from Post-Traumatic Stress Disorder (PTSD), and that 35 percent have sought counseling for emotional difficulties. The Veterans Administration treated 20,638 Iraq war vets for PTSD in the first quarter of 2006, and has a backlog of 400,000 disability claims pending. DECEMBER 2006 While the book is ripe with charts and details, the language is lively, and the experts never stray from the central theme: war is ultimately a public health problem. Levy and Sidel constantly revisit the outcomes of the choices we make. While public health programs go begging, the war in Iraq is chewing up $10 billion a month. According to a recent projection by the Nobel Laureate economist, Joseph Stiglitz, the lifetime cost of treating the Iraq War's 20,000 wounded will be more than $2 trillion. In Terrorism and Public Health, the authors argue that it is not enough to stop terrorism, but it is also necessary to prevent "inappropriate or hazardous responses to threats of future terrorism, such as diversion of resources and attention from other urgent public health needs, adverse health effects from misuse of antibiotics and ill-conceived immunization programs, and abrogation of human rights and civil rights." In short, it's a bad idea to destroy the village in order to save it. A consistent theme in both books is the responsibility of public health professionals in conditions of armed conflict or the ongoing "war on terrorism." If smallpox can be eliminated, the authors ask, why can't public health and medical personnel work to eliminate the scourges of war and terrorism? Like good epidemiologists, they look for causes and sources. What are the roots of terrorism, and how might we address some of the conditions that allow it to flourish? Why aren't war and its health consequences treated as a preventable public health problem? The books have lots of tools on how to tackle those questions. War and Public Health has a section titled "Can war and its public health consequences be prevented?" The terrorism volume ends with "Challenges and Opportunities." Levy and Sidel are strong believers that knowledge can set one free, but only if health professionals act on it. The book on war, for instance, includes an extensive appendix of organizations (including telephones and e-mail addresses) that work on these issues, from the American Refugee Committee to the World Health Organization. In the authors' opinion, war and terrorism pose both immediate and long-term dangers to our society. If we go to war without considering the consequences, we may end up saddling ourselves and future generations with staggering fiscal and psychological costs. If we overreact to terrorism, our civil liberties and the ability to question policies that make the problem worse may end up as collateral damage. Getting war and terrorism right is important because the social price we all pay for getting it wrong is unacceptable. These engaging, thoughtful, and useful books are about getting it right. —conn hallinan W W W. C A L N U R S E S . O R G REGISTERED NURSE 13

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