Strengthening and Distinguishing Strengthening and Distinguishing Conceptual Frameworks: Conceptual Frameworks:

Health as a Bridge for Peace, Health as a Bridge for Peace, Peace though Health Peace though Health and the Introduction ofand the Introduction ofHealth through PeaceHealth through Peace

Joshua BloomJoshua BloomResearch FellowResearch Fellow

London School of Hygiene and Tropical MedicineLondon School of Hygiene and Tropical Medicinejbloom@post.harvard.edujbloom@post.harvard.edu

Funded by the UK’s Economic and Social Research CouncilFunded by the UK’s Economic and Social Research Council

May 2005May 2005McMaster-Lancet Challenge ConferenceMcMaster-Lancet Challenge Conference

Peace through Health: Learning from ActionPeace through Health: Learning from ActionHamilton, ON, CanadaHamilton, ON, Canada

For DiscussionFor Discussion

Is there confusion about Is there confusion about conceptualizations of HBP and PtH?conceptualizations of HBP and PtH?

Are they the same or are they Are they the same or are they different? different?

What is Health as a Bridge for What is Health as a Bridge for Peace?Peace?

What is Peace through Health?What is Peace through Health?

For DiscussionFor Discussion

How are peace objectives handled? How are peace objectives handled?

How are health objectives handled?How are health objectives handled?

Should we also use the term Should we also use the term “Health through Peace”?“Health through Peace”?

For Discussion (Time Permitting)For Discussion (Time Permitting)

How and when is the HBP label How and when is the HBP label applied?applied?

Why shouldn’t HBP be perceived Why shouldn’t HBP be perceived or undertaken as a separate, free or undertaken as a separate, free standing project?standing project?

Should the Active Learning Should the Active Learning Package be the torchbearer of Package be the torchbearer of the HBP Programme?the HBP Programme?

Is there confusion about Is there confusion about conceptualizations conceptualizations of HBP and PtH?of HBP and PtH?

Are HBP and PtH the Are HBP and PtH the same or are they same or are they

different?different?

What is What is Health as a Bridge Health as a Bridge

for Peace?for Peace?

WHO DefinitionWHO Definition

““A multidimensional policy and A multidimensional policy and planning framework which supports planning framework which supports health workers in delivering health health workers in delivering health programmes in conflict and post-programmes in conflict and post-conflict situations and at the same conflict situations and at the same time contributes to peace-building.”time contributes to peace-building.”

““The integration of peace-building The integration of peace-building concerns, concepts, principles, concerns, concepts, principles, strategies and practices into health strategies and practices into health relief and health sector development.” relief and health sector development.”

Report from 2Report from 2ndnd HBP Consultation HBP ConsultationJuly 2002July 2002

““The assumption that the The assumption that the goals and objectives of goals and objectives of HBP were clear for HBP were clear for everyone proved to be too everyone proved to be too optimistic.”optimistic.”

Examples of HBPExamples of HBP Humanitarian ceasefires (i.e. Afghanistan, Humanitarian ceasefires (i.e. Afghanistan,

Cambodia, El Salvador, Lebanon, Sudan, Cambodia, El Salvador, Lebanon, Sudan, Philippines),Philippines),

Preventative diplomacy (i.e. Bulgaria and Preventative diplomacy (i.e. Bulgaria and Turkey),Turkey),

Cross-border health surveillance (i.e. Cross-border health surveillance (i.e. Central America),Central America),

Demobilizing, quartering, and disarming Demobilizing, quartering, and disarming troops (i.e. Angola),troops (i.e. Angola),

Examples of HBPExamples of HBP

Rehabilitation of public health infrastructure Rehabilitation of public health infrastructure (i.e. Mozambique, Croatia, El Salvador), (i.e. Mozambique, Croatia, El Salvador),

Central coordination of humanitarian efforts Central coordination of humanitarian efforts (i.e. Haiti),(i.e. Haiti),

Developing systematic links between local Developing systematic links between local communities in donor countries and communities in donor countries and countries affected by conflict (i.e. former countries affected by conflict (i.e. former Yugoslavia),Yugoslavia),

Reintegration of health workers (i.e. Reintegration of health workers (i.e. Cambodia, Croatia, Angola),Cambodia, Croatia, Angola),

Examples of HBPExamples of HBP Promoting community level reconciliation Promoting community level reconciliation

through mental health and ethnic tolerance through mental health and ethnic tolerance initiatives (i.e. Liberia),initiatives (i.e. Liberia),

Assessments of mental health needs (i.e. Sri Assessments of mental health needs (i.e. Sri Lanka),Lanka),

Trainings of health professionals from Trainings of health professionals from different countries who would be willing to different countries who would be willing to work in conflict or conflict-prone areas (i.e. work in conflict or conflict-prone areas (i.e. Caucuses and Russia), andCaucuses and Russia), and

One week multi-party workshops in human One week multi-party workshops in human rights, humanitarian law and conflict rights, humanitarian law and conflict resolution (i.e. Sri Lanka and Indonesia). resolution (i.e. Sri Lanka and Indonesia).

What is Peace What is Peace through Health?through Health?

McMaster’s DefinitionMcMaster’s Definition

““An emerging academic discipline An emerging academic discipline to study how health interventions to study how health interventions in actual and potential war zones in actual and potential war zones may contribute to peace.”may contribute to peace.”

Part of McMaster’s Multi-Track Part of McMaster’s Multi-Track Peace Work peace-building model.Peace Work peace-building model.

Inadequate Inadequate Attention on Peace Attention on Peace Objectives in HBPObjectives in HBP

Inadequate Attention on Peace Inadequate Attention on Peace Objectives in HBPObjectives in HBP

WHO does not stress peace WHO does not stress peace objectives enough.objectives enough.

In its theory, HBP emphasises health In its theory, HBP emphasises health outcomes over peace outcomes. outcomes over peace outcomes.

Inadequate Attention on Peace Inadequate Attention on Peace Objectives in HBPObjectives in HBP

2003 study commissioned by WHO 2003 study commissioned by WHO reviewed all activities conducted by reviewed all activities conducted by its headquarters’ technical its headquarters’ technical departments which related in some departments which related in some way to HBP. way to HBP. Dozens of examples.Dozens of examples. No personnel mentioned peace No personnel mentioned peace

promotion as the main purposes of their promotion as the main purposes of their projects.projects.

Inadequate Inadequate Attention on Peace Attention on Peace Objectives in PtHObjectives in PtH

Inadequate Attention on Peace Inadequate Attention on Peace Objectives in PtHObjectives in PtH

Not only the WHO which lacks Not only the WHO which lacks sufficient focus on peace in its sufficient focus on peace in its conceptualisation.conceptualisation.

As Graeme MacQueen pointed out: As Graeme MacQueen pointed out: “Most institutions involved in PtH “Most institutions involved in PtH initiatives have been strong in health initiatives have been strong in health expertise but less strong in peace expertise but less strong in peace expertise.”expertise.”

Misuse of the Term PtHMisuse of the Term PtH

Even McMaster can be critiqued for Even McMaster can be critiqued for confusing some of the peace aspects confusing some of the peace aspects of their PtH work at times. of their PtH work at times.

Misuse of the Term PtHMisuse of the Term PtH

Articles about Peace through Health Articles about Peace through Health in the medical literature frequently in the medical literature frequently portray peace components as portray peace components as tangential issues or as obstacles to tangential issues or as obstacles to the implied foremost goal -- health.the implied foremost goal -- health.

Misuse of the Term PtHMisuse of the Term PtH

WHO and McMaster: War is one of WHO and McMaster: War is one of the gravest threats to health.the gravest threats to health. Projections of war-related disability Projections of war-related disability

adjusted life years lost. adjusted life years lost.

War seen as a determinant of health.War seen as a determinant of health.

Misuse of the Term PtHMisuse of the Term PtH

Enveloped into the larger context of Enveloped into the larger context of the WHO’s general identification of the WHO’s general identification of violence as a determinant of health.violence as a determinant of health.

War and violence are like diseases, War and violence are like diseases, and therefore they can be prevented and therefore they can be prevented or eliminated.or eliminated.

Redefining Peace Redefining Peace through Healththrough Health

New Interpretation of PtHNew Interpretation of PtH

Peace through Health has an explicit Peace through Health has an explicit paramount goal of positive peace paramount goal of positive peace outcomes. outcomes.

Health outcomes still are considered Health outcomes still are considered objectives, but secondary ones. objectives, but secondary ones.

New Interpretation of PtHNew Interpretation of PtH

The success of Peace through Health The success of Peace through Health initiatives should be considered initiatives should be considered conditional upon the attainment of conditional upon the attainment of peace outcomes, not necessarily peace outcomes, not necessarily upon the fulfilment of specific health upon the fulfilment of specific health outcomes.outcomes.

Example: The reform and Example: The reform and reconciliation of South Africa’s post-reconciliation of South Africa’s post-apartheid health sector. apartheid health sector.

Missing Term: Missing Term: Health through Health through

PeacePeace

Missing Term: Health through PeaceMissing Term: Health through Peace

Peace and conflict-mitigation Peace and conflict-mitigation interventions that are designed to interventions that are designed to achieve an explicit paramount goal achieve an explicit paramount goal of positive health outcomes.of positive health outcomes.

Peace outcomes are still objectives of Peace outcomes are still objectives of Health through Peace, but rank as Health through Peace, but rank as secondary objectives. secondary objectives.

Missing Term: Health through PeaceMissing Term: Health through Peace

The success of these initiatives is not The success of these initiatives is not necessarily considered conditional necessarily considered conditional upon the attainment of specific upon the attainment of specific peace outcomes.peace outcomes.

Example: Humanitarian ceasefireExample: Humanitarian ceasefire. .

Appeal and Appeal and Advantages?Advantages?

Appeal and Advantages?Appeal and Advantages?

Both PtH and HtP should be Both PtH and HtP should be important to health important to health professionals.professionals.

Foreign policy and security Foreign policy and security interest in Peace through interest in Peace through Health.Health.

WHO Pigeonholes WHO Pigeonholes HBPHBP

WHO Pigeonholes HBPWHO Pigeonholes HBP

The WHO ostensibly restricts HBP to The WHO ostensibly restricts HBP to Health through Peace dogma.Health through Peace dogma.

““Health is the objective. At a country Health is the objective. At a country level, HBP should not be perceived or level, HBP should not be perceived or undertaken as a separate, free standing undertaken as a separate, free standing project. HBP elements should be project. HBP elements should be identified, highlighted and/or factored identified, highlighted and/or factored into existing or planned public health into existing or planned public health work.” work.”

WHO Pigeonholes HBPWHO Pigeonholes HBP

In practice, the WHO conducts both HtP In practice, the WHO conducts both HtP and PtH work under the title of HBP. and PtH work under the title of HBP.

The majority of the WHO’s most highly The majority of the WHO’s most highly touted HBP initiatives have been PtH touted HBP initiatives have been PtH projects. projects.

WHO Pigeonholes HBPWHO Pigeonholes HBP

The WHO has not presented strong The WHO has not presented strong arguments that would justify the arguments that would justify the limitation of its HBP Programme to only limitation of its HBP Programme to only HtP approaches. HtP approaches.

The WHO did not neglect its standard The WHO did not neglect its standard health priorities in any of the locations health priorities in any of the locations where PtH projects took place. No where PtH projects took place. No reason to believe they would.reason to believe they would.

Rethinking the Rethinking the Concept of Concept of

Health as a Bridge Health as a Bridge to Peaceto Peace

Rethinking the Concept of Rethinking the Concept of Health as a Bridge to PeaceHealth as a Bridge to Peace

Allow HBP to be HtP as well as PtH.Allow HBP to be HtP as well as PtH.

Be explicit about which strategies are Be explicit about which strategies are employed.employed.

Do not embrace unsystematic non-Do not embrace unsystematic non-uniformity. uniformity.

How and When Is How and When Is the HBP Label the HBP Label

Applied?Applied?

Why Shouldn’t Why Shouldn’t HBP Be Perceived HBP Be Perceived or Undertaken as a or Undertaken as a

Separate, Free Separate, Free Standing Project?Standing Project?

Should the Active Should the Active Learning Package Learning Package

Be the Torchbearer Be the Torchbearer of the HBP of the HBP

Programme?Programme?

SummarySummary

There’s often inadequate focus on There’s often inadequate focus on peace objectives within HBP and PtH.peace objectives within HBP and PtH.

Helped rectify by offering a Helped rectify by offering a reinterpretation of the PtH concept and reinterpretation of the PtH concept and introducing a new concept of HtP.introducing a new concept of HtP.

The WHO is urged to recognise and The WHO is urged to recognise and adopt both PtH and HtP approaches adopt both PtH and HtP approaches within their HBP Programme.within their HBP Programme.