Joshua Bloom Research Fellow London School of Hygiene and Tropical Medicine

1. Strengthening and Distinguishing Conceptual Frameworks: Health as a Bridge for Peace, Peace though Health and the Introduction ofHealth through Peace Joshua Bloom Research Fellow London School of Hygiene and Tropical Medicine jbloom@post.harvard.edu Funded by the UK’s Economic and Social Research Council May 2005 McMaster-Lancet Challenge Conference Peace through Health: Learning from Action Hamilton, ON, Canada

2. For Discussion • Is there confusion about conceptualizations of HBP and PtH? • Are they the same or are they different? • What is Health as a Bridge for Peace? • What is Peace through Health?

3. For Discussion • How are peace objectives handled? • How are health objectives handled? • Should we also use the term “Health through Peace”?

4. For Discussion (Time Permitting) • How and when is the HBP label applied? • Why shouldn’t HBP be perceived or undertaken as a separate, free standing project? • Should the Active Learning Package be the torchbearer of the HBP Programme?

5. Is there confusion about conceptualizations of HBP and PtH? Are HBP and PtH the same or are they different?

6. What is Health as a Bridge for Peace?

7. WHO Definition • “A multidimensional policy and planning framework which supports health workers in delivering health programmes in conflict and post-conflict situations and at the same time contributes to peace-building.” • “The integration of peace-building concerns, concepts, principles, strategies and practices into health relief and health sector development.”

8. Report from 2nd HBP ConsultationJuly 2002 “The assumption that the goals and objectives of HBP were clear for everyone proved to be too optimistic.”

9. Examples of HBP • Humanitarian ceasefires (i.e. Afghanistan, Cambodia, El Salvador, Lebanon, Sudan, Philippines), • Preventative diplomacy (i.e. Bulgaria and Turkey), • Cross-border health surveillance (i.e. Central America), • Demobilizing, quartering, and disarming troops (i.e. Angola),

10. Examples of HBP • Rehabilitation of public health infrastructure (i.e. Mozambique, Croatia, El Salvador), • Central coordination of humanitarian efforts (i.e. Haiti), • Developing systematic links between local communities in donor countries and countries affected by conflict (i.e. former Yugoslavia), • Reintegration of health workers (i.e. Cambodia, Croatia, Angola),

11. Examples of HBP • Promoting community level reconciliation through mental health and ethnic tolerance initiatives (i.e. Liberia), • Assessments of mental health needs (i.e. Sri Lanka), • Trainings of health professionals from different countries who would be willing to work in conflict or conflict-prone areas (i.e. Caucuses and Russia), and • One week multi-party workshops in human rights, humanitarian law and conflict resolution (i.e. Sri Lanka and Indonesia).

12. What is Peace through Health?

13. McMaster’s Definition • “An emerging academic discipline to study how health interventions in actual and potential war zones may contribute to peace.” • Part of McMaster’s Multi-Track Peace Work peace-building model.

14. Inadequate Attention on Peace Objectives in HBP

15. Inadequate Attention on Peace Objectives in HBP • WHO does not stress peace objectives enough. • In its theory, HBP emphasises health outcomes over peace outcomes.

16. Inadequate Attention on Peace Objectives in HBP • 2003 study commissioned by WHO reviewed all activities conducted by its headquarters’ technical departments which related in some way to HBP. • Dozens of examples. • No personnel mentioned peace promotion as the main purposes of their projects.

17. Inadequate Attention on Peace Objectives in PtH

18. Inadequate Attention on Peace Objectives in PtH • Not only the WHO which lacks sufficient focus on peace in its conceptualisation. • As Graeme MacQueen pointed out: “Most institutions involved in PtH initiatives have been strong in health expertise but less strong in peace expertise.”

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

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

21. Misuse of the Term PtH • WHO and McMaster: War is one of the gravest threats to health. • Projections of war-related disability adjusted life years lost. • War seen as a determinant of health.

22. Misuse of the Term PtH • Enveloped into the larger context of the WHO’s general identification of violence as a determinant of health. • War and violence are like diseases, and therefore they can be prevented or eliminated.

23. Redefining Peace through Health

24. New Interpretation of PtH • Peace through Health has an explicit paramount goal of positive peace outcomes. • Health outcomes still are considered objectives, but secondary ones.

25. New Interpretation of PtH • The success of Peace through Health initiatives should be considered conditional upon the attainment of peace outcomes, not necessarily upon the fulfilment of specific health outcomes. • Example: The reform and reconciliation of South Africa’s post-apartheid health sector.

26. Missing Term: Health through Peace

27. Missing Term: Health through Peace • Peace and conflict-mitigation interventions that are designed to achieve an explicit paramount goal of positive health outcomes. • Peace outcomes are still objectives of Health through Peace, but rank as secondary objectives.

28. Missing Term: Health through Peace • The success of these initiatives is not necessarily considered conditional upon the attainment of specific peace outcomes. • Example: Humanitarian ceasefire.

29. Appeal and Advantages?

30. Appeal and Advantages? • Both PtH and HtP should be important to health professionals. • Foreign policy and security interest in Peace through Health.

31. WHO Pigeonholes HBP

32. WHO Pigeonholes HBP • The WHO ostensibly restricts HBP to Health through Peace dogma. • “Health is the objective. At a country level, HBP should not be perceived or undertaken as a separate, free standing project. HBP elements should be identified, highlighted and/or factored into existing or planned public health work.”

33. WHO Pigeonholes HBP • In practice, the WHO conducts both HtP and PtH work under the title of HBP. • The majority of the WHO’s most highly touted HBP initiatives have been PtH projects.

34. WHO Pigeonholes HBP • The WHO has not presented strong arguments that would justify the limitation of its HBP Programme to only HtP approaches. • The WHO did not neglect its standard health priorities in any of the locations where PtH projects took place. No reason to believe they would.

35. Rethinking the Concept of Health as a Bridge to Peace

36. Rethinking the Concept of Health as a Bridge to Peace • Allow HBP to be HtP as well as PtH. • Be explicit about which strategies are employed. • Do not embrace unsystematic non-uniformity.

37. How and When Is the HBP Label Applied?

38. Why Shouldn’t HBP Be Perceived or Undertaken as a Separate, Free Standing Project?

39. Should the Active Learning Package Be the Torchbearer of the HBP Programme?

40. Summary • There’s often inadequate focus on peace objectives within HBP and PtH. • Helped rectify by offering a reinterpretation of the PtH concept and introducing a new concept of HtP. • The WHO is urged to recognise and adopt both PtH and HtP approaches within their HBP Programme.