Friday, November 9, 2012

Second Year Fellow, Tyler Weber writes about public health and determinants of peace


Public Health and Determinants of Peace

Peace is not an imaginary distant utopia; it is a measureable, designable, and achievable human outcome. Thanks to the Institute for Economics and Peace (IEP), we now have an evidence-based platform to critically and meaningfully introduce the determinants of peace into our research and practice in public health.

Discussions of peace and public health, although sparse, have existed for some time. In 2002, Laaser and colleagues suggested that public health professionals could play a role in promoting peace by utilizing multiple approaches to mitigating violence.1 Around the same time, others noted that health and peace can’t exist without each other,2 and that “peace through health” should become a new discipline in health sciences.3 These editorials and commentaries highlighted important issues, however, a critical point was made--the growing interest and movement in peace through health needed evidence.4

Established in 2009, the IEP is a non-profit, independent, non-partisan research organization that creates conceptual frameworks and metrics for defining and measuring peace.5 It was formed after the Global Peace Index (GPI) found strong correlations between peacefulness and national wealth.5 Since then, the GPI has enabled IEP to create an evidence-based framework of the determinants of peace.

Structures of Peace is a notable publication by IEP that lays out a statistically grounded conceptual framework for peace.6 Figure 1 highlights eight key determinants associated with peace,6 some of which are also found in public health models:

Figure 1: Institute for Economics and Peace Conceptual Framework
http://economicsandpeace.org/wp-content/uploads/2011/09/Structures-of-Peace.pdf
Determinants in the IEP conceptual framework, such as high levels of education and good relations with neighbors, have also been found in the public health literature to benefit individual and population health.  In contrast, the role the business environment plays in health doesn’t often enter the public health discourse even though it is a prominent determinant of peace. It has already been suggested that achieving public health objectives may be paramount for successful peace building in a post conflict setting,7 but it would be limiting to think that peace can be defined only as the absence of conflict. Peace isn't merely the absence of violence or conflict, but rather it is a condition that exists in the presence of attitudes, institutions, and systems that foster peaceful communities and environments.6

Similarly, the World Health Organization specifies that health isn't merely the absence of disease, but as a state of complete physical, mental and social wellbeing.8 Consequently, we must continue working towards the elimination of violence, poverty, hunger, and disease, but we may only be successful when we simultaneously build structural peace.

This framework presents an opportunity for those of us in public health to explore the symbiotic relationship between peace building and public health efforts. We are in a position to collaboratively and collectively work across sectors and disciplines to build and sustain healthy and peaceful communities and environments.

In closing, I'll share a quote from IEP found in the Structures of Peace: Identifying What Leads to Peaceful Societies publication.

"Peace is statistically related to better business environments, higher per capita income, higher educational attainment and stronger social cohesion. Therefore, by establishing the appropriate environment to support peace many other benefits will flow. In this light peace can be seen as a proxy for creating the optimal environment for human potential to flourish."6

An important question remains—where do we go from here?

Thoughtful comments and questions are most welcome.

Tyler Weber, MPH
Wisconsin Population Health Service Fellow
Population Health Institute
University of Wisconsin - Madison
tylweber@gmail.com


References

1.      Laaser, U., Donev, D., Bjegoviæ, V., & Sarolli, Y. (2002). Public Health and Peace. Croatian Medical Journal, 43 (2), 107 - 113.
2.      Levy,  B. S. (2002). Health and Peace. Croatian Medical Journal, 43(2), 114 -116.
3.      Macqueen, G., Santa-Barbara, J., Neufeld, V., Yusuf, S., and Horton, R. (2001). Health and Peace: Time for a New Discipline. The Lancet, 357, 1460 - 1461.
4.      Vass, A. (2001). Public Health Through Peace. British Medical Journal, 323 (7320), 1020.
5.      Institute for Economics and Peace. (2012). Institute for Economics and Peace: Quantifying Economics and its Benefits. Retrieved from http://economicsandpeace.org/.
6.      Institute for Economics and Peace. (2011). Structures of Peace: Identifying What Leads to Peaceful Societies. Sydney, New York, & Washington, D.C: N. A.
7.      Tasi, T. (2009). Public Health and Peace Building in Nepal. The Lancet, 374, 515 - 516.
8.      Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
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6 comments:

  1. LizzNovember 15, 2012 at 9:32 AM

    Thanks for sharing this post Tyler - as I read your thoughtful post this framework gave me pause as a reminder of how in our work we can focus on positive outcomes (like peace) rather than filling our models and conceptual frameworks with negtative outcomes. Keep blogging!

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    1. TylerNovember 19, 2012 at 12:16 PM

      Thank you Lizz!

      You highlight a simple yet important concept. It's easy to get locked into the view of eliminating a health problem, all the while forgetting to work towards a positive outcome.

      It would be interesting to see what two conceptual frameworks for the same issue would look if one focused on positive outcomes while the other focused on negative outcomes. Perhaps there's room for both.

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  2. AmberNovember 18, 2012 at 12:48 PM

    Tyler,

    I enjoyed your thought-provoking post, as always. In return I have a question: which came first, health or peace? While they are interrelated and intend to coincide simultaneously, if we can determine which could have possibly "led" to the other, maybe we can find a starting point in which to return?

    Your passion is contagious!
    Amber

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    1. TylerNovember 19, 2012 at 12:01 PM

      Hi Amber,

      Your questions are very much appreciated.

      This is a good point to bring the determinants of health...

      http://www.countyhealthrankings.org/about-project/background

      This is one model of many, but you can see the overlap between determinants of peace and health. It's interesting because one might find high morbidity or mortality rates in less peaceful settings. However, this intersection has yet to be explored in any depth.

      I will postulate that how a neighborhood, city, or country attempts to improve health and build peace will depend on its own context. Each place may have its own starting point, but until peace and health are rigorously investigated and applied in practice, we'll have to leave your questions to thoughtful and insightful conversations.

      More thoughts?

      Thanks!

      Tyler

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  3. TylerNovember 19, 2012 at 12:18 PM

    Thank you for reading Aire! We intend on writing more posts for quite sometime.

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  4. UnknownNovember 20, 2012 at 12:44 PM

    And this is why we are friends. Thank you Tyler for gathering this evidence and for your post. I have been thinking about these issues since I left MPH-land, and am trying to get involved with a working group through APHA's Peace Caucus that is trying to formalize and integrate public health competencies on this very topic.

    I do like quotes. That said, I always wonder, when we list requirements for peace must we always begin with the economic argument (e.g., better business environment)? In a sense, when building a virtual logic model in my head, I would think that higher educational attainment and stronger social cohesion may just lead to better business environments that could then lead to higher per capita income. That said, I am sure this is very bidirectional in practice and may be more of a logic collage than a disentangled, clear model. Maybe, just maybe, there isn't a causal relationship to be isolated; rather, a healthy system to be built. Yet, what metrics constitute healthy systems?

    I am looking forward to reading more on the topic and to dig around to find some systems-based metrics for peace. I am sure your references will be helpful in this quest!

    Best,
    Ashley

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