DENVER—Few human undertakings have had such apparent and ceaseless negative impacts on human health and well-being as violent conflict. War might seem such an obvious assault on overall public health that it would hardly bear discussion at a scholarly meeting on that subject. But a slew of researchers are working around the globe to uncover some of the hidden aspects of contemporary warfare's affronts to public health.

In the past 150 years, technology has helped to do away with the mass slaughter of soldiers like those on the battlefields of World War I. At the same time, however, the proportion of civilians killed in conflict has skyrocketed, from some 10 percent during the Civil War to close to 90 percent in some contemporary conflicts, Barry Levy, an adjunct professor of public health at Tufts University School of Medicine, noted here November 8 at the American Public Health Association's 138th annual meeting. In fact, he said, "targeting civilians has become a strategy in many wars" today.

Aside from outright killing, broader civilian public health suffers during conflicts in large part due to the spectacular destruction war and unrest can bring on basic health, sanitation and environmental infrastructure. Hospitals get looted, and people are displaced—often into makeshift encampments that lack basic medical services and reliably clean water, Levy noted.

But modern warfare also works in less visible ways to undermine public health. Here are four offshoots of war that often fly under the radar:

Fueling illness

Jet fuel is an impressive chemical creation, but it is also made up of some nasty stuff. As Levy pointed out, keeping military jets, choppers and other aircraft aloft around the world leaves a cloud of hydrocarbons, sulfur dioxide and nitrogen oxides, which have been linked to respiratory and cardiovascular disease as well as cancer.

But it isn't just the militarized regions that might suffer from the smog of war. Areas where the fuel is manufactured are also suspected to be at higher risk for negative health outcomes. A recent study found that people who live hundreds of miles downstream from a Las Vegas-area factory that makes the jet fuel component perchlorate have higher levels of the chemical in their urine. And that can lead to developmental and thyroid disorders, explained Paul English of the California Department of Public Health's Environmental Health Investigation Branch.

Remote wounds

The arrival of remote-operated aircraft has given rise to new questions about the morality—and legality—of killing suspected insurgents with the press of a button thousands of miles away, noted Victor Sidel, professor of Social Medicine at Albert Einstein College of Medicine. In addition to the hundreds of estimated civilian casualties from the strikes, he explained, the act of such removed killing is likely to have a negative effect on the personnel, military or CIA, who carry it out. "Clearly the people who operate these planes are put in a terrible moral position," he said. In contrast to deployed pilots, many of these individuals are living at home, where faced with the question, what did you do at work today, might have to say: "Well, I pushed these buttons and killed all of these people," Sidel said. Anecdotal reports have suggested that these remote pilots, who actually get a much more detailed view of their targets than most fighter pilots, have higher burnout rates and suffer from the so-called whiplash transition after being seeing such vivid attack images then attempting to rejoin family life after work each day.

Bad relations

Even for fighters who face long stints away from home, being involved in extended conflict promotes violence as a way to settle conflict, Levy explained. Studies have show that in addition to a host of psychological ills, many veterans returning from Iraq and Afghanistan have an increased likelihood of committing violence against a family member—and themselves.

And in areas where violence has so long been a part in daily life, such as the Democratic Republic of the Congo, sexual violence has been incorporated into social norms, noted Jocelyn Kelly, of the Harvard Humanitarian Initiative. In her work in the eastern part of that country, she found that women who had been raped were treated with much the same attitude as women who had willfully committed adultery, and many were cast out from their families due to the perception that they had been tainted.

Limited funds

Some researchers also noted that in addition to the outright harm of war, what it prevents governments from doing also harms global health. In an era with tight budget lines, $4.5 million predator drones—and $17 million reapers—over the skies over Pakistan, might mean millions not being spent on national or global health strategies. The U.S., Levy pointed out, makes up nearly half of all global military spending. That $541 billion was more than 10 times the amount the U.S. spent on health ($52.7 billion) in 2009. And, as UNICEF has surmised, a tiny fraction of the U.S. defense budget could pay for global childhood immunizations against common deadly diseases, such measles and tuberculosis. 

Photo by Sergei Vladimirov, courtesy Flickr