We need to define terrorism first

I have discussed armed conflicts in my recent book (attached below). According to the available data, terrorism does not impact public health. It is only a minor phenomenon compared to the toll of wars, homicides, and road traffic deaths that are the major causes for violent deaths in our world (see pages 173-184). In many cases, the media as well as some governments speak about terrorism instead of civil wars that would be more appropriate name for many current armed conflicts.

Book Missing a Decent Living for Everyone: Success and Failure in...

Dear Hallom, as you know, the most critical public health problem in many countries is nowadays mental health. Greece, Sweden, U.S.A., Japan...

The financial crises, terrorism, and many other factors do affect people's mental health. This is the most hidden open secret - if you know what I mean...

Dear Hailom Banteyerga. In response to your question, I can suggest you:

Lewis M.W., Lanzara B.L., Stein J.L. et al. Maternal drinking patterns and drug use increase impact of terrorism among pregnant women attending prenatal care. Journal of Prenatal and Perinatal Psychology and Health 2005; 19(4): 275-288.

It is difficult to define terrorism, but I will put my operational definition, though should not be limiting. If I am not wrong, terrorism is an event that happens in an unpredictable moment and place with no reference to boundary. It uses force resulting in the destruction of property and loss of human life. Its purpose could be political or otherwise. It does not follow the rules of war. In such a situation, people do not feel safe one way or the other as we see it happening in Syria, for example. In the so called ‘civil war’ competing political groups use terrorism as a strategy to be feared by people and keep them silent. It happens that some legitimate governments use terrorism as a blame tactic against their opponents to achieve their political goals as well; too bad. Terrorism and terrorist acts have been part of human history, but have never been accepted as social norms. No religious or secular institution has ever officially subscribed to terrorism and terrorist acts. However, in the name of defending religion or law and order of the state, terrorist acts are being practiced at scale this time. I am afraid that if this trend continues terrorism and terrorist acts may assume legitimacy as a tool for hegemony. I think in such a trend, the health system is the first victim. The East Mediterranean WHO region member states have poor health systems because of the repeated terrorist attacks and even call it civil war, for example. Health is  very appealing  to people.It is number one concern of people. If we could generate data how terrorism and terrorist acts are impacting public health, I feel that such works could be used to educate people and assume ownership in the fight against terrorism and terrorist acts.

If practiced in a wide scale like in Nigeria, Syria, South Eastern part of Turkey or a civil war in any country, terrorism surely disrupts health care. Epidemics break out because of lack of immunisations, as ıhe polio epidemic in Syria. As allways mothers and children suffer the most followed by the elderly, disabled and, the poor of all ages. Extended and individual acts of terrorist actions affect the wellbeing and thereby the health of citizens. Comparing health indicators in a region or in a country before and after terrorism should provide sufficient information of such an effect.

Correct. If we could work on such data plus case studies of population in terrorist spots, it could be illuminating. Such works could be used for advocacy The discourse coming from the mass media is more polarizing rather than informing. Excellent suggestion.

Dear Hailom - There is a Campbell Systematic Review on counter-terrorism interventions.  I have attached it here. You might find some relevant research on public health impact in it.

My forthcoming book on the history of epidemics and quarantines ends with a few reflections about the employment of militarized models of public health in the USA by conflating bioterror and pandemics such as Ebola fever. The title of the book is Driven By Fear: Epidemics and Isolation in San Francisco's House of Pestilence (University of Illinois Press, Fall 2015) 

I heard on the radio that, after the last events, the sleeping pills consumption has increased in France.

Hi,

I found around 500 papers published on this subject. I am attaching here a sample articles. Good luck in your research.

Regards

Dr. Avishag Gordon

Our town in SC was subjected to an high-concentrated chlorine and other chemicals train accident in 2005.  The initial response by local, state and federal emergency crews was to not rule out terrorism.  This created the use of roadblocks at all corners of the town, in which residents needing immediate medical assistance had to break through these roadblocks to gain access to a hospital.  This was a unique situation, as the railroad company did not inform our town of over 5,000 residents what the emergency was for hours, so most residents were dependent solely on the news media advising us what was next.  I am a community investigator on our grant, who was a victim of the accident who became involved to help those who were injured as a result of the chemical spill.  My formal training was on the job as a volunteer.

Thank you Avishag. I will read through them and the other articles on the subject.

Tina glad that you escaped the accident. Your experience is extremely useful and needs to be documented.

The media for reasons that I do not understand tends  to create more fear than the act ,itself. Fear underpins most chronic diseases if my reading on mental health is correct. If people live under fear they cannot be productive in anyway. This makes me think that terrorism is a public health issue. I feel that the study products in this phenomena could help communities to take care of their members form being participants in terrorism. I do not think any political objective could be achieved through such acts that degrade humanity.

Thank you all.

Dear Hailom

War and violence (whether perpetrated by states or disgruntled individuals/groups) have always been part of demographic and epidemiological studies, and there are specific codes for recording deaths and injuries arising from these in the ICD-10 or the GBD of system of classification of diseases and causes of death. For example, according to the 2013 GBD study, global deaths due to collective violence and government interventions were estimates at 31.2 thousand deaths and was more than twice higher (about 72.4 thousand) in 1990. You can find more information on estimates for individual countries from the original paper (Global, regional, and national age-sex specific all cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for global burden of disease study 2013), which you can download from research gate.

Thank you Yohannes I will do that. The trend you quoted show that it is getting worse and needs attention.

Dear Hailom, bonjour, I suggest that you check the landmark book of Barry S Levy and Victor W. Sidel, "Terrorism and public health", Oxford uni press and Am Public Health Assoc, 2007. This is a very good general textbook, of course most chapters would need updating.

In Nepal, there is still hot debate whether armed conflict had positive impact on utilization of primary health care services in the rural and remote parts of the country or not. On the one hand, some studies reveal a paradoxical effect of armed conflict in the health care system of Nepal. Some studies show that the armed conflict destroyed many physical infrastructure, displaced and killed many health workers, contributed to the suffering of the poor and marginalized people and health services obstructed largely at primary health care level and on the other hand, some  studies state that the Maoist activists and the People’s Government monitored the primary health care services closely in the Maoist affected areas, which favoured better health performance at the primary health care level.

As of recent I believe that there has been an increase in the sales of various over-the-counter drugs that assist in feeling relaxed particularly in France (Russia Today news report). Assuming this to be true, the spike is understandable, and would probably link quite well with anxiety levels.

Dear Tulsi,You gave us a good description about Nepal which is in most cases cited as a good example in primary heath care. How sustainable is that Nepal continues protecting primary heath care facilities in  war conflict. This would require allocating budget that could have otherwise being used for improved health care or any other sector of significance to public safety.

Dear Jonathan, you raised the availability of drugs and addiction to drugs as related to anxiety. Well said. The question I would like to ask you is that  would such a scenario contribute to potential recruits for committing terrorist acts? Why I am asking you this  is that I think what you said has programmatic implication.

There are two very separate answers. The first is that where an attack occurs affecting significant members of the public a public health disaster occurs. This can have ripple effects active over months or years. The 2001 attack on the World Trade Centre is the best example. The public health issues went far beyond the deaths occurred that day. They included caring for survivors with injuries and the health effects on first responders. That's one level.

  Another and more complex answer lies in the degree to which governments have focused on "terrorism" instead of public health. So after 9/11 the money flowed for anti-terrorism and some of that went into public health infrastructures. Monies for computerized mapping, for example, fell into this category. So, too, did money for trauma programs. The more traditional avenues of public health conceern were not ignored so much as back-burnered (nutrition, vaccination, etc.).

Note: I put terroris in quotations because its use as a noun has become so broad it covers almost everything that is anti-government or anti-social, including in some areas legitimate protests that are non-violent threats.

Dear Hailom,

1. An important aspect of terrorism and health is that how the health professionals and health care workers perceive it. Not much has been thought about this aspect of terrorism. 

First, I would begin by saying that terrorism almost always makes a division among the general population in the affected area: those who are pro- terrorist ideology, those who are neutral and those who are anti terrorist in their ideology. In any case some supporters in local population are always there as without them the terror infrastructure cannot work. Second, that terror affected area is largely a lawless land. 

Now, it is also natural that some health professionals and health care workers may have sympathy with the terrorist ideology as against the law of the land. A lawless condition may give them a chance of expressing this ideology in their profession as against professional ethics (Ref Nazi war crimes and trials).

As a child I grew up under terrorism and it was common to hear that going to a particular doctor will not be good as he is known to be negligent towards a particular community and will not institute a good treatment . I do not know, how sound basis it had, but it did effect use of health care facilities.

2. A recent paper debates about introducing terror medicine in medical schools. I am attaching the paper below as a link. It is interesting as it may make health professionals aware of terrorism and how to cope and work in such conditions.

http://journal.frontiersin.org/journal/10.3389/fpubh.2014.00138/full

Hailom

Drug addiction in itself makes individuals vulnerable to manipulation in the help seeking phase. To contribute to potential recruits as you said, the individuals in question would have to receive their help from radical clerics etc and these individuals would then have a much deeper commitment should they overcome their addictions. ('Slave to the power of drugs, servant to the power that assists me in overcoming them', see what I am getting at? Former drug users typically need a daily belief/routine/meaning in life, to keep themselves from slipping back. I speak as someone who has had exposure to people in the process of coming clean). I believe that many recruits already come from poverty backgrounds since they don't have much else going for them to give them meaning in life.

I don't believe that this answers your scenario question directly as per the anxiety, but through applying some thought process to it, I think that this outcome has relevance to addictions contributing to extremism. As far as public anxiety goes, it is no secret that worrying/anxiety has a negative impact on a persons health in comparison to the carefree.

Yes,Jonathan what you said leads us to think of our social order and social  practice.  The drug addicts in most cases are those that think are marginalized and ignored by society and the prevailing social statuesque in a given community. A PhD study on street children that  is being undertaken by my former students shows that  substance abuse,addiction and hopelessness  underpin the illegal acts and misbehavior of street children. In the rehabilitation process such children are likely to  assume the identity of the person or organization that helped them come to a better life. There are evidences from religion and the secular world that support the implicatures you made in your answer.  It is something that policy makers this time need to consider. There are organizations that work in the name of humanitarian activities, but are exploiting  such gaps to recruit potential terrorists.This is the reason why I think empowering people in the terrorist breeding sites to fight terrorism would be more effective than relying on security forces. The communities in the terrorist breeding sites are those that suffer most. This requires I think  a change of social order and practice.

Dear Hailom,

I haven't read through all the responses, so someone may have already sent you this book--if so, please accept my apologies:

Barry S. Levy, and Victor W. Sidel (eds). Terrorism and public health—a balanced approach to strengthening systems and protecting people. Oxford. ISBN 978-0-19-976554-6

The first edition was 2003. In 2012 or 2013, they printed an updated edition. It contains an analysis of different definitions of terrorism, health outcomes and the response and challenges for the public health community.

Best,

Dacia

Thank you Dacia; I will try to get hold of the book. It very much relates to my question.

Regards,

Hailom

Dear Hailom,

 As a practicing addict for almost 25 years and have been in recovery for the last 19 years (sobriety date 1996) the vast majority of addicts are not as you describe. I must take issue with

@ Jonathan, I beg to not claim as factual X simply because you "have been exposed to" Y

@ Hailmon, I also beg you not to speak on issues you no not "The drug addicts in most cases are those that think are marginalized and ignored by society and the prevailing social statuesque in a given community". This claim is simply false and the ones on the streets as you say "think they are marginalized" are in-fact marginalized and are thrown away by society.

Most addicts are working people and mask their addiction so completely that even their own family members do not know. For example the overwhelming majority of heroin addicts are professionals who are described as functioning addicts. The overwhelming majority of cocaine addicts are from middle/upper middle class and the wealthy and are also functioning. Addicts hooked on pharmaceuticals same, alcohol same, what is seen and reported on however is what you have described.

In the recruitment of "help"  whether it be terrorism or the  "mule" who hauls the drugs all have a commonality. That being a person who has been living under oppression and marginalized leaving him/her currently in despair and hopeless, tired, frustrated, angry, ideologically driven, and isolated and voiceless from/in society. Poverty has this effect, religious persecution, culturally, and sexually all have great effects on ones psychological and physical well being.  Being without hope also describes those who commit suicide and youth who murder their own family. This is made obvious by "suicide bombers" and after finishing the deed others turn the bullet onto themselves.  

The real issue is the social conditions which allows for any oppressive living conditions which millions of people/families must endure. To be honest I am surprised many more "terrorists attacks" have taken place.

Douglas 

Dear Douglas,

Thank you for giving a broader analysis on drug addition and those who engage in terrorist acts. I agree with you. I would think that drug addition and terrorist attacks are symptoms of a failing social order  be it national or global irrespective of class. I personally believe that we have to work for a new social order and social practice that inclusively deals with social issues. This may help young people to see hope and aspire for better change through healthy and peaceful means.

Hi!

you may look at papers on risk perception by Slovic.

Dear Hailom,

I agree with your position that "I personally believe that we have to work for a new social order and social practice that inclusively deals with social issues".

For that to happen we may need to bring back Timothy Leary.

In solidarity

Douglas

Dear Douglas,

Thank you from introducing me to Timothy Leary.

When I say new social order and social practice, I am not speaking of an imagined social order and social practice. I am thinking in terms of the need to  reposition the prevailing social order in order to have a more inclusive social practice. For example, 'Equity' is a nodal discourse in public health. However, this cannot be achieved with the existing social order . It may be a wishful thinking, but cannot be    a social practice in public health. For example, if the national wealth of a nation is  controlled by less than 10% of the population of that nation, then  equity in public health cannot be realized as a social  practice. The worst thing is that In the form of 'aid'/assistance' poor countries become a dumping place of expired or nearby expiry pharmaceuticals as we observe in research works we do. The dumping of such pharmaceuticals helps pharmaceutical industries in developed countries make business. The tax payers of developed or aid giving countries pay the price. The tax payers are cheated, for they think they are doing it to help their poor compatriots in poor countries. Expired drugs are sold to the public by local businesses in poor countries and cause huge health problems.  Such social practices cannot help aid recipient countries strengthen their health systems ; in fact it is deceptive and weakens their health systems. We can advocate for a responsible global order that takes us in  a healthy path for all of us. There are moments, events appearing here and there that make us optimistic and hopeful for a better social order and social practice.

Dear Hailom,

I agree with you in the need to change the existing social order  in order to begin a social order based in equity. In fact I am very pleased with your introducing equity into our discussion.

The reference to Timothy Leary was metaphoric in nature. I was in-fact referencing what I believe is the necessary first step in contemplating what an equitable social order would be and that is imagining what one would look like! My agreement with your position is a complete agreement. I am well aware of the pharmaceutical "dumping" of both out of date and diluted, tampered, and out of date medicines on emerging nations.

I am sorry for the misunderstanding and will attempt to make my meaning clearer in the future.

Douglas  

Douglas, you made a very good point by referring to Timothy Leary.  He looks to be a person of extraordinary talents, but disillusioned by what he experienced and observed. He tried to make his cases clear  by committing himself to the cause of the marginalized and/or excluded members of society. The saying that 'All people are born equal' which I think very much refers to rights and access to resources needs to be our yardstick  in measuring and deciding whether a social order is healthy or not.  I think  it can help us determine for having a forward moving healthy society.  This means putting global and national policies in order. Everyday I hear  of victims of terrorism, I get the impression that our prevailing social order is failing to regulate itself and enure a peaceful life for its members.

Please forward your views, for this is a topic of concern for all of us.

Terrorism has affected health of Pakistani people al lot. Apart from stress or depression or fear, one very clear evidence is that people sleep inside closed doors during summer days which affects their health.

Hi'

There are many papers addressing the issue of Post Traumatic Stress Disorder (PTSD). Many of these researches are concerned with post terrorism trauma and public health. A search by these keywords will yield many papers on the subject.