Terrorism, Civil War, One-Sided Violence and Global Burden of Disease
Kerridge, Bradley Townsend
Khan, Maria R
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The purpose of this dissertation was to examine relationships between terrorism, civil war and one-sided violence from 1994-2000 and morbidity and mortality in 2002, as measured by disability-adjusted life years (DALYs), attributable to: (1) major communicable and noncommunicable diseases; (2) diarrheal and related diseases; and (3) substance use disorders among World Health Organization Member States. Multivariable linear regression analyses controlled for economic factors shown to affect public health (Papers 1-3) and pre-existing vulnerability factors: percentage of the population using improved water resources/sanitation facilities (Paper 2); and per capita alcohol consumption and prevalence of illicit drug use (Paper 3). Deaths due to terrorism, war and one-sided violence from 1994-2000 were, with few exceptions, significantly related to DALYs lost to major communicable and noncommunicable diseases, diarrheal and related diseases and substance use disorders in 2002 across the majority of sex-age subgroups of the populace. This dissertation research highlighted the need to expand the traditional focus of intervention for communicable diseases among conflict-affected populations to include a variety of noncommunicable diseases (Paper 1). Results underscore the need for international government and nongovernment organizations to prioritize high risk areas for diarrheal and related disease control to include conflict-affected populations with particular attention to young children who are most vulnerable to these diseases (Paper 2). That terrorism and related violence influence diarrheal and related diseases in the longer-term suggests that control strategies should move beyond short-term provisions for safe water and adequate sanitation to seek solutions through health systems infrastructure development. Greater attention should also be given to the prevention and treatment of substance use disorders in conflict-affected populations including brief interventions targeted at high risk substance users, provisions for needles and syringes and management of withdrawal and other acute substance-related conditions (Paper 3). Strengthening substance abuse treatment systems among conflict-affected populations will be critical in identifying and treating of a variety of physical and psychiatric disorders that are often comorbid with substance use disorders. Taken together, this research has served to highlight the full health costs of terrorism, civil war and one-sided violence will ultimately contribute to forging a stronger rationale for promoting peace.