War has been used to resolve political disputes between countries and within a country; to acquire another nation’s territory; and to defend a nation’s borders from foreign invasion. No matter how war begins, it always ends up to be a devastating form of traumatic disease. Because it kills, injures and disables more people in shorter periods of time than any other known disease, war should be recognized as a true disease epidemic. During World War ll alone 50 million lives were lost.

Bullets, shells and bombs are not the only culprits. War-related starvation, exposure and epidemics of infection also take their toll. No one is immune. Of the 23 regional wars during the 1980’s, eighty-five percent of the fatalities occurred in civilians.

Emotional causalities from war occur in the forms of anxiety, depression, post-traumatic stress disorders, drug abuse and alcoholism. These result from the grim, dehumanizing experiences of battle, imprisonment, family separation, death and injuries of fellow comabatants, loss of homes and displacement of refugees. Add to this the anger of the disabled of war and the guilt and fears of survivors whose nightmares refuse to go away.

If war were recognized as a public health form of disease epidemic, considerably greater effort would be directed to try to prevent war before it occurs. Prevention of any disease is, after all, the most cost-effective means of dealing with any disease especially epidemics. In this case, the cost in lives saved is even more valuable than the money saved.

If nothing is done until war actually breaks out, it is too late for prevention. Here the analogy to public health epidemic model is that really effective “treatment” to stop an ongoing war is usually impossible. Diplomatic, political and economic pressures are more likely to be effective to prevent war. All too often the treatment of an ongoing war is for other nations to join that war, hardly an effective solution.

When prevention of war does fail, what options should be considered to reduce suffering and deaths, especially of innocent women, children and civilian men? In a public health model of war, this would be considered the treatment phase for this disease epidemic.

Priority should be given to minimizing civilian casualties. This could be accomplished by avoiding bombing of civilian neighborhoods and pinpointing strategic targets of military importance. This is now possible using so-called smart laser controlled bombs.

Second, those weapons that spread destruction from neighborhood to neighborhood like fire bombs, nuclear, chemical and biologic weapons, should be avoided. Those whose killing and maiming power persist long after the war is over, should be banned. Examples are land mines and defoliants such as agent orange.

The priority of killing as many of the enemy personnel in as short a period of time as possible, has rendered the military leaders to consider the safety of combatants on both sides, as well as civilians, to be of secondary importance. Examples are contaminating our own troops in Vietnam with agent orange; exposing our own troops and nearby communities to the effects of aboveground nuclear detonations; bombing two mostly civilian Japanese cities with atomic bombs in World War Two, when bombing major military targets would likely have been as effective; fifty years of lying that nuclear weapons plants were not polluting nearby American communities; and misleading Persian Gulf War veterans that they were not exposed to Iraqi chemical weapons.

For these reasons the Defense Department and its military leaders should have independent medical advisors from the Communicable Disease Center to advise them regarding unnecessary risks during peacetime training and war. Military physicians in leadership positions depend upon military superiors, often non-physicians, for their promotions.

Political and economic isolation of a potential or actual warring aggressor nation would reduce its capacity to obtain weapons and financially reduce its ability to maintain an ongoing war. Diplomatic threats by the United Nations or other organized nations would require detecting the earliest possible indications of an impending war followed by the strongest warning that the economic and political sanctions will certainly be enforced.

The latter requires the best and most effective early diagnosis that a war may be eminent and the conventional word for this is military intelligence. Recent technical advances using spy satellites allows early detection of war preparations in terms of weapons and supplies.

An example of the failing to take the opportunity to use diplomatic means to prevent a war occurred when the United States Ambassador to Iraq was asked by the Iraqi government how the United States would react if Iraq invaded Kuwait. The answer given by the U.S. Ambassador was that this would be considered an internal domestic affair. Within days Iraq invaded Kuwait in the Persian Gulf War. If Iraq did not care what the U.S. reaction would be, the U.S. Ambassador would likely not have been asked that question. Why the ambassador was instructed to say what she admitted six months later to a congressional committee is a matter of conjecture.

The Persian Gulf War was followed by a disabling chronic new epidemic among many thousands of the American military veterans This illness was called The Persian Gulf Syndrome and our military leadership denied that such an illness existed. They claimed that it was just a stress reaction. When Czech military specialists discovered five years later that their instruments detected that American troops were exposed to Iraqi poison gas, it was not initially admitted by American authorities and was downplayed later on. It was an embarrassment to our government because they had checked for poison gas exposure immediately after the Persian Gulf War and had not indicated that any of our troops were exposed to it.

This illustrates the common phenomenon that during and after war it is quite common for military authorities to evade, lie or exaggerate what has really happened. This distortion of truth also occurs in the censorship of the public media that occurs during war. While the public has come to accept this avoidance of honesty during war as being necessary, it is becoming more evident that in the long run honesty is a better policy. Deceit and lying only breeds suspicion and disbelief of government authorities not only during war but also during peace.

The emphasis of the prevention of war and the use of effective diplomatic, political and economic alternatives would not necessarily guarantee the elimination of war. However, it would likely decrease its frequency, especially by the countries who are most likely to prefer peaceful methods.

On the other hand, what about the political despots and dictators who crave the power of war and the acquisition of new territories? This is the reason why even the most peaceful nations need a strong military defense. It is also evident why this prevention-oriented disease model for war is not a form of idealistic passivism. Just the opposite. This approach would require continued vigilance and effort during peacetime to spot the earliest sparks of a possible impending war anywhere in the world and bring it to national and international attention such as the United Nations or NATO. Then international organized political and economic pressures would have a better chance to be effective than waiting until war breaks out.

Civil wars within a nation’s boundaries are obviously more difficult to deal with. But even here international organized United Nation like pressures could be brought to bear simultaneously upon both opposing political leaders of the warring parties.

The Vietnamese War is one of the darkest chapters in American History. Even the then Secretary of Defense admitted several decades later that the United States’ Vietnam involvement was a tragic mistake. How does that make the over 50,000 American Families who lost a son, husband or daughter feel? How does that make an American veteran of that war feel? This may be why there are so many drug addicted, alcoholic, homeless and post-traumatic stress syndrome affected Vietnam veterans.

American involvement in World War ll was obviously unavoidable by the time the U.S. was attacked at Pearl Harbor and had war declared on it by Nazi Germany the following day. In fact it could be argued that this war involving the United States was inevitable by the time Germany and Japan were invading one nation after another. If so, the United States might have considered joining their allies even sooner than they did. Whether United States involvement in World War l, the Korean War, the Spanish American War and the Mexican-American Wars were really necessary is a matter of conjecture.

Besides the necessary use of war to defend a nation’s borders and possibly to deal with an expanding invader nation, the recent use of military personnel by the United Nations with the help of the United States for humanitarian purposes such as preventing starvation in Somalia and reducing genocide in Bosnia, would appear to be the most ethical use of military personnel. However, it is always important not to expose the United Nations’ and the United States’ troops to greater risks than necessary.

A practical way to look at war and peace is to consider that for most nations there is not sustained peace. There may be periods of no overt military action but the preparations for the next war goes on as if it were inevitable. The two world wars were only separated by 20 years, Korea occurred only a handful of years later and Vietnam only about ten years after Korea. A number of more limited involvements in the 1980’s and 50 years of high military readiness and preparation occurred between the United States and Russia in the so-called Cold War.

Therefore, periods of overt war alternate with periods of active preparations for the next one. Preparations include not just maintaining a well-trained military who know how to use the latest weapons but constant upgrading and technological improvements in weapons, air power, rockets, nuclear weapons, submarines and ships, and even development of new means of biologic and chemical warfare.

The deadly cycle of war and its preparations are not confined to this century but goes all the way back to the very beginnings of human history as documented in ancient Greek and Roman records and even in the Old testament.

Little wonder that most people believe that war is an inevitable part of human existence and almost nothing can be done to reduce its recurrence. This defeatist attitude regarding war is similar to saying that nothing can be done to eliminate any disease epidemic.

Yet look at the progress that has been made against the epidemics of heart disease and strokes and the reduction in childhood death rates through immunizations and safe water supplies. An example is how international efforts have actually eliminated smallpox from the face of the earth. Those that are old enough to remember the extent of polio epidemics in the United States before polio immunizations have been greatly impressed by the fact that this disease has all but been totally eliminated from our country and other industrialized nations.

The futility of war is best illustrated by the horrendous suffering of both military combatants and civilians on both sides of any war. The increasing uncivilizing effects of war is best illustrated by the newer technical weapons that destroy huge numbers of mostly civilians during war. In prior centuries reasonable attempts were made to confine war to military combatants and not target civilians as has been done during this century. Nobody really wins in terms of the ordinary citizens involved in war. The winning political leaders and generals, however, become heroes who often become the future presidents and dictators with even more powerful support.

The irony of war is illustrated by the fact that our two demonized enemies in World War ll, Japan and Germany, have become our new international friends within just a few short years. Similarly, two of our closest allies during the war, Russia and China, would become our new future enemies during that same short period.

One of the greatest human rights violations occurs when healthy young men are forced to “lill or be killed” by means of a military draft or conscription. Even during our Revolutionary and Civil Wars the military was primarily composed of volunteers as it has been in the last few decades. Military training during war and peace is a dehumanizing experience. Individual freedom and choice is replaced by being told when and what to eat; when to sleep and when to wake up; what clothes must be worn; where one must live and travel often causing long separations from spouse, family and children. Absolute unquestioning obedience to one’s superior officer results in the ultimate loss of individuality. It the military method would occur in civilian life, it would be immediately labeled as a human rights violation.

Perhaps all these extreme measures are necessary to be adequately prepared for war. Perhaps they could be made less dehumanizing. What is needed is true scientific studies involving multidisciplinary professionals, officers and enlisted men and women, psychologists, sociologists, and public health experts and both civilian and legal experts.

Another undemocratic activity is that the decision to go to war has traditionally been the exclusive domain of the top national political leader, king, president or dictator. Even in democracies citizens usually have no voice in this life and death decision. Yet they are the ones who pay the price in terms of lives, disabilities and suffering.

Our forefathers recognized the unfairness of this power of leaving this life and death decision to just one individual. That is why our constitution provides that only the congressional representatives of our citizens have the right to vote for or against a declaration of war. However, since World War ll our presidents have gotten around this limitation by deploying military combatants around the world, as in Vietnam, and calling it a police action rather than a war. Once our troops are already in harm’s way, then the president will ask Congress to vote for war. By that time we are already involved.

Look at the remarkable growth of private militias recently all over the United States. They train with modern weapons in their own fenced off and guarded territories. They create their own laws and constitutions and are usually prepared to do battle with federal or local law enforcement authorities if they “invade” their private territories. Usually these organizations promote their own brands of racial and ethnic prejudice and often declare that they are not accountable to the laws of the nation.

Another concern that has never been properly investigated is the possibility that an individually with an actual or potential personality disorder who undergoes military battle experience, may be unable to turn off the “kill or be killed” war commitment and be unable to resume the “thou shalt not kill” peacetime value. This possibility needs to be studied by behavioral scientists and their military counterparts. Recommendations should be made for military combatants to undergo adequate postwar psychological evaluation and retraining for civilian life before discharge. Whether or not this activity might have prevented the Oklahoma City Federal Building bombing by a recent Persian Gulf War veteran is a matter for conjecture but needs evaluation.

Consider also the effect of war glamorization used by urban gangs. They also use sophisticated weapon to protect what they consider their neighborhood territories. They dress alike in colors and clothing styles similar to uniforms and often display gang tattoos and use gang signs to communicate. Usually they pledge blind obedience to their gang leaders and take on rival gangs in deadly battle.

Consider how war has been glorified in our history books, our movies, TV and print media and in our childhood toys and now video games. In fact, if wars were eliminated from our history books and recreational activities, and they will not be, it would cause major economic and educational difficulties. In reality, war is too an important part of civilization to ever eliminate its popularity as games and media. But again, scientific behavioral studies could be done to reduce the excessive sensationalization and commercialization of war. Also appropriate age of exposure to war games, videos and toys needs to be studied by the proper authorities.

The excitement and glamorization of war has lead countless millions of young men through the ages to join in the military and then to their horror experience the most unimaginable dehumanization witnessing or experiencing the realities of instant death, mutilation and disability. The television series “The Civil War” based on letters from Civil War soldiers said it all very well.

Part of the glamorization of war is to focus on our historical war heroes. I recall the profound emotional impact when after viewing the names without rand of dead American military on the Vietnam War Memorial in Washington, I immediately walked across the bridge to see the Arlington National Cemetery. Here the military dead had their military ranks on their monuments, especially those of higher rank. My emotional reaction to the rankles lists on the Vietnam Memorial was that these dead men and women were all equally important in life as well as in death. It brought home the full overwhelming tragedy of war that in no way reduces the tragedy of those who were buried at Arlington National Cemetery across the bridge. In fact, all of our military combatants, dead, disabled or intact, deserves the greatest appreciation possible from our country and its citizens. They made truly supreme sacrifices. The greatest honor that could be bestowed on those who have sacrificed their lives in combat would be to reduce the incidence of and severity of wars so that their children ad grandchildren would not have to suffer the same tragic losses.

With all the cataclysmic technical weapons already available, nuclear, biologic and chemical and those that will be even worse yet to be developed in the future, there is likely to be little or no future human survival unless we become more proficient at preventing and controlling wars.

It is ironic that the United States is the largest supplier of weapons of war to nations all over the world. These weapons often end up being used against our own troops when they are sold or shared with enemy nations that were not intended to receive these weapons. Also friendly nations do not always remain friendly.

The Soviet Union left tens of thousands of nuclear armed rockets in many former Soviet nations no longer controlled by a former central authority. Russian authorities announce that some of these weapons, as well as the high-grade plutonium to make them, have disappeared presumably by stealing them and selling them to other countries. The reality is that even smaller nations often lead by dictators have or will soon have nuclear bombs or rockets. Others will manufacture them in the future. There is no realistic way to cap their proliferation and there is little likelihood that the many thousands of those weapons stockpiled by the United States and the former Soviet Union nations can be completely dismantled and eliminated.

For this reason alone the world has little choice but to reduce and to exert as much control as possible over the possible use of nuclear as well as biologic and chemical weapons. But it also has to be realized that even without using these weapons, increasingly devastating other types of weapons are being developed or will be developed so that it is necessary to emphasize that war itself needs to be more efficiently controlled in frequency and severity and not to focus on nuclear weapons alone.

Using healthy values to deal with war may seem a contradiction in terms. After all, “First do no harm” can not be applied to war although the healthy value of prevention can. But a public health model for war will help put war and its prevention in a more realistic perspective. It also will make the study of war and its prevention less emotional and nationalistic and more humanistic and scientific. In fact, the prevention of war should be a major focus of universities and medical centers.

A new world order based on international cooperation rather than military might have already begun. Witness the economic boycott of Iraq by the United Nations; the peaceful resolution of 45 years of the East-West Cold War; international agreements on resolving global pollution; greater international economic cooperation and such entities as the European Common Market. We need every ounce of resources and human creativeness to build rather than to destroy. The real challenges to survival of civilization are international in scope, and include in addition to war, global pollution, overpopulation, international epidemics such as AIDS and urban decay.

War and violence as public health epidemics are concepts whose time has come and not a moment too soon.