Hello everyone and welcome to the Sydney health ethics research podcast I am your host Diego Silva. Before introducing our guest, I want to acknowledge that we're recording on the unceded country of the Gadigal people of the Eora Nation, and i want to pay my sincere respect to those who have and continue to care for Aboriginal land. This has been always unceded territory.
Today, I have the pleasure of being joined by Professor Oliver Razum, from the University of Bielefeld. And we're going to be discussing the paper that he's written that's published just recently, with Lisa Wandschneider, looking at public health and war hope among the horrors. It's interesting, as I was reflecting on this, and reading your paper, we deal with a lot of sensitive, sad subjects in bioethics and public health. But there's something particularly important about war, obviously, the sort of the ultimate manmade disaster. And obviously, also, we're at the one year mark of the war that Russia has begun in the Ukraine. So it's an appropriate unfortunately, an appropriate time to have you on to have these discussions. So I'm really glad to have you here, Oliver.
Thank you, Diego, and welcome to all listeners. War is a man made public health problem as you just stated, and that should make us reflect a moment because it means that war is ultimately preventable. War is also a topic that should keep public health practitioners and public health researchers thinking in terms of how war can be prevented, and what the role of public health in the prevention of war is. Now, the paper that we are speaking about today, is actually a book review, a review of a book called from Horror to Hope, recognising and preventing the health impacts of war. This book has been written by Barry Levy. Barry is a Professor of Public Health at the Department of Public Health and Community Health at Tufts University in the United States. And he's a former president of the American Public Health Association. I'm much impressed and moved by his book because it brings together his life's work. So he, with other colleagues has been working on this topic of public health and war throughout his life, coming up with documents showing the massive negative effect that a war has on population health. In many respects, there are obvious effects, injuries, death, due to the use of weapons, not only among soldiers, but also among the civilian population.
If you look back at the 20th century, there have been an estimated a 191 million deaths, either directly or indirectly as a result of armed conflicts. And more than half of them were civilian deaths. But these are obviously only part of the problem. For every death, there are numerous people who are suffering because they lost a relative, or people who have been injured, physically or mentally. And sometimes they will continue to suffer from these injuries throughout their lives. It's not only people who are affected, obviously, it's also the environment, which is affected by war and violence. You look at the pictures that we see from Ukraine these days with destroyed buildings with destroyed civilian infrastructure. But of course, it's also nature that is being affected and often affected for very long time periods. So it's very obvious that war is a public health issue. What makes me worrying is how little we in Western Europe and maybe that is the case in Australia and the United States, as well, have been thinking about war as a public health problem, and have been, including war, and its consequences, its causes and its consequences in our public health curriculum We in Germany have been living in peace for many decades now since the end of World War Two and I have to admit that I personally would not have expected that I would see a war of annexation in Europe in my lifetime. And this has dramatically changed on the 24th of February, 2022. So just one year ago, when Russia invaded Ukraine. So we have now a situation with a war of aggression in Europe and all the consequences for the people in Ukraine, the consequences for people in the neighboring country, with an influx of refugees who need support and help, but also all the worries about the war spreading to other neighboring countries and to Europe. We should not restrict our view to Europe alone. It is clear that many countries, say in Northern Africa, but also in Sub Saharan Africa, will be severely affected by this war, because security in terms of nutrition is badly affected. Ukraine is one of the major exporters of wheat, and of seeds to make oils and prices have gone up but also the security of delivering these goods to countries in Africa has been severely affected. So many ways in which this war affects people, not only in Europe, but all over the world.
Yeah, I want to pick up on a couple of things that you mentioned. One is this idea of the collateral damage beyond just the war in the Ukraine itself like you mentioned, issues of food security in places across countries across Africa. We know that this is tied to bigger geopolitical realities in terms of military alliances, economic alliances, sort of globally as well. I want to ask you, I mean, apart from the fact that I would say all of us are would be I assume anti war. What's motivated you in terms of entering into these discussions around the public health and public health ethics of war? What's what's been your motivation? I mean, you mentioned that obviously, this is a book that you're reviewing by Professor Levy. But I know that you're doing other work on this topic. What's what's led you to this?
Much of my work at the past has been on migration and more recently on refugee migration. So there is an obvious connection. Moreover, as I said, I feel personally affected by this war more than by other World Wars, which I think is problematic and a topic in itself. Why is it that a war nearby is more affecting than a war far away? It's people who are mostly affected, no matter where the war takes place. Besides, what I find particularly revolting about Putin's war in Ukraine, is that it has quickly become a war against civilians and civilian infrastructure. So this again, makes it a public health, a burning public health issue. Putin's army not being able to win militarily against the Ukrainian army has quickly started to attack basically, all civilian infrastructure that is essential for human survival, meaning electricity supply, heating, water supply, thereby weaponising what we consider as basic elements of public health and basic necessities for keeping the population healthy. And this is what gives this war, a particularly revolting aspect and one that public health should stand up against.
It's, it's interesting, as I am sort of listening, one of the things that comes to mind are some of the, the criticisms and the writings of scholars from within eastern Europe, within the Baltic states and whatnot, about how sort of Western European and by extension, I would say, North American Australian scholars, whether we're thinking about this properly, or whether we're missing the boat, and I think one thing that's kind of resonated is this idea of colonialism. And the idea that we think colonialism is perhaps something that's occurred in the past, or that it's something that occurs over there. But this idea of colonising is perhaps one way of describing what Vladimir Putin is trying to do in the Ukraine all the way back to 2014. And the annexation of Crimea. I'm wondering what your thoughts are on this, this paradigm, or this way of of, of describing the situation? Does it resonate? And if so, what does that mean for public health to think about this? Yes, as a war, but as also as a sort of a real live attempt at colonialisation in real time.
I'm not an expert in this field, but I share your impression, this smells of an imperialist war. And it's actually the first time in Europe since Germany's war against literally all its neighboring countries, that we see a war of annexation. And what, again, struck me as completely unacceptable, was the discussion I overheard in Germany and in many other countries, shortly after this war started, along the lines of why don't we give Putin what he wants in order to have peace in this region. And I mean, this discussion still reflects this mind frame of cold colonialism. Mind you, we're talking about 42 million Ukrainians and we're not even considering asking them, what they think about it, when we think about the lines of giving Putin what he wants. So this, to me, seems a completely unacceptable way to think about this war, giving Putin what he wants, because this war is clearly violating international law. And it's clearly a war in which war crimes and possibly crimes against humanity have been committed. So when we talk about public health and war, it is also about thinking about ways how to protect people in Ukraine from this war and this brings me very unfortunately, and very, very much against my thinking, years and decades ago, to the point where I have to admit that a well funded army may be something that helps to protect people from aggressive actions and wars like the one that Putin started. And this is something that does not go along with our previous thinking in public health. I mean, many of us, most of us, I, myself included, were saying, beat swords into plowshares, and let's try to invest into people and into social services, not into the military. But what we have seen in the past year, makes me reconsider this.
So yeah, there's a lot to unpack in what you just said. So, one of the things that I wanted to ask you and kind of flows from this quite nicely. And this is a, in a way, it's an impossible question that I'm going to ask you. But, what how do we think in terms, how should we think in terms of the need to fund militaries, given the variety of other ways that we can spend money from a country? You mentioned, the idea of turning swords into spades as it were, paraphrasing, we know that there's a lot of things that we can spend money on. What are your thoughts from the perspective of public health and the perspective of medicine, how should we begin to think about this balance between the need for a standard military and all the other very serious and very real ills that a society might face?
It is a dilemma, and it is one of the many dilemmas that public health faces when it comes to the topic of war. Clearly, we need a perspective in the future towards reducing arms, reestablishing negotiations, on abolishing nuclear weapons. These are priorities. But these are priorities for the future. And unfortunately, at this point in time, we need to find a way to end this war in Ukraine, Russia's war in Ukraine, which seems to me requires investments into weapons, but also thinking about ways out of this situation that we are facing at the moment. So a public health view can never be only on the actual war theater. And along the lines of the immediate needs in Ukraine. It always has to have a longer range perspective, thinking about re-establishing peace and maintaining peace with fewer weapons.
The title of your paper, the title of the book review is about you use the question mark, Hope among the Horrors, and I think that's what you're referring to. Bringing it back to public health, one of the things that stood out in your review was this idea of realism versus idealism and public health practitioners being idealists, and not losing that idealism amongst the horrors with the reality of the situation. What does that mean for a public health practitioner? What does that mean for somebody on the ground to sort of balance the idealism with the realism?
It means accepting a military and funding a military as a necessary instrument of international politics at this point in time. But it also means trying everything to prevent the use of weapons, and looking forward, working towards a future without wars and without weapons. And Barry levy in his book actually comes up with numerous suggestions and ideas regarding the role of public health in preventing future wars. I think it's important to listen to him. And it's important to see that public health can contribute and does contribute. Our disappointment about the war we are seeing right now in Europe, should not stop us from considering that there has been progress towards fewer wars. In the first decades of the 21st century, there have been fewer wars than in the 20th century. There have been international efforts, some of them quite effective, to prevent wars and to stop wars and for Public health practitioners, it is important to document the consequences of wars. It is important to document attacks on health facilities that are occurring in Ukraine. It is important to provide the evidence to take perpetrators to court later on. It is important to make war, a topic in public health curricula, not in the sense of promoting the use of military or the funding of military. But thinking about all the ways that public health can help preventing war. And one of these ways is to point fingers at acts of what I would call othering, of trying attempt to point at differences between people attempts to show that other people have less rights, to construct notions of non belonging. And this has started when when it comes to Ukraine and Russia, this has started long before the military attacks, even before the 2014 annexation of Crimea, and parts of eastern Ukraine. So in this process of trying to set up a larger Russian Empire, a discourse has started or was started by Putin and his government of what is Russian and thereby good, and what is not Russian, and should either become Russian, or is not worthwhile even thinking about. And Ukraine has been a victim of this discourse with all kinds of accusations flying of Ukraine being ruled by Nazis, and whoever doesn't want to be a part of Russia is by definition, then one of these Nazis. This is just an example of how this othering works, this construction of non belonging in a situation where there is an asymmetry of power. And many of these othering processes have been long standing and ongoing for years or decades. But they are amenable, they can be changed. I think a good example of that is Germany and France, there used to be processes of othering between these two countries that have been ongoing for hundreds of years, leading to terrible wars in Europe, in the 19th century, in the early 20th century, and then to the Nazi war against among other countries, also France. And after the Second World War, there was a painful process of reconciliation, painful because of all the suffering that Germany had caused in the neighboring countries. But this was a quite successful process, leading first to economic activities, joint economic activities, the Montan Union, on steel and coal production, and later on to the European Union, so that a war between Germany and France has become unthinkable. And I would say the countries have a strong friendship, and even a war between Germany and Poland is something completely unthinkable after horrendous history in the mid 20th century. So yes, there is something that can be done at many levels, and thinking about othering processes seems to me a core component of this.
So from the perspective of public health, you mentioned othering as something that public health can sort of work at, in terms of finding that balance between this idea of idealism and realism, what does that look like in practice? You mentioned sort of examples where or othering occurs and where it's been sort of superseded or sort of worked at. What's the role of public health in trying to overcome this othering.
I've been talking about othering, at a contextual or political level. othering occurs at all levels at the individual level, at institutional level and I think this is where public health has its most direct role in trying to prevent, reduce, ameliorate, the consequences of othering. When it comes to the way people think about other people, let's say refugees, for example, let's, as public health practitioners, we are in a position to observe this process of othering, for example, by looking at the way how refugees are accommodated. And by making this public talking about it, and explaining why we think this is unacceptable to, for example, keep refugees in camps or completely close borders, towards refugees. So we can start talking about othering processes at different levels. And it doesn't necessarily have to be the global level, although public health through institutions such as the World Health Organization, can play a role there as well.
One of the things that you mentioned sort of the global versus local level. One of the things obviously, about war is the purpose of war, is is violence, so there's an aspect of that is inevitable about war and violence. We see violence in different ways, rear its head and in public health, so through police brutality, police tactics on racial minorities, we see counter movements, like the Black Lives Matter movement in this, you know, again, we see the violence sort of taking on different forms in different places. You also mentioned sort of how the war in Ukraine has sort of changed your perspective about what the ideal should be, or what, you know, what should we be aiming towards? I think that there's a there's a streak of pacifism within public health. Maybe it's not always described that way, but I think that when we're talking about justice, when we're talking about equality within the context of public health, it's always with the view of doing so in a pacifistic way. Given the realities that we're seeing around war, but around violence more generally, what role does the idea of pacifism play in public health in the 21st century? Or what role should it play?
Well, again, it's the dilemma that we already spoke about. Public Health clearly should stand up against any form of violence, be it police violence, or be it war. And I would say there is a continuum. If we accept violence at the small scale, it is more likely that violence becomes acceptable at a larger scale as well. Or if we accept violence at a day to day level, example police violence, it is more likely that we will accept wars as an instrument of politics, as well. So yes, I could not more agree. Public health has a streak towards pacifism. It has to be so, because public health is about protecting the health and the lives of people. Having said that, sometimes we need the help of a well organized police, we need the help of, as we now learned, a well funded military to keep people safe. And this has to be done in a responsible way. And again, public health can play a role in setting up the rules and helping to enforce the rules and police is useful and helpful only if it follows the laws and rules and actually protect people. What we've been seeing recently is rather the opposite of police, murdering people, which should not happen, ought not to happen and again, it is the role of public health to contribute towards a discussion of what police force should do, how it should behave, what its role is, and how to actually follow follow up. Whether the police lives up to these standards.
And I guess, yeah, this idea of who's been the victim of, or who's who's being targeted by police violence, we know it's not the same across the board, and then asking for public trust in policing. There's a there's, at the very least, an inherent tension. I always, I always think about the example of public health surveillance. We'd like to think of ourselves in public health as surveilling for good reasons. But that doesn't mean that populations that have been historically surveilled are going to necessarily interpret it in that way. Yeah, these are, these are very, very thorny issues, to say the least.
I'm going to wrap things up there. I want to thank you again, Oliver, for your paper and your your thoughts on this. I'll be really curious to read and follow your research on this topic as we go forward. I want to thank you the listeners of this episode of The She research podcast. You can find the paper that we discussed link in the episode notes, along with the transcript of the podcast itself. She Pod is produced by Sydney health efforts network and edited by Regina Botros. You can find our other episodes on Spotify, radio public anchor, wherever you get your podcasts of quality. Thank you for listening. Goodbye.