Saturday, November 29, 2014

Uncertain Health in an Insecure World - 12

“Terror’s Toll”

The greatest weapon in a terrorist’s arsenal isn’t a hijacked airplane or a ground-to-air missile or an explosive vest.

It’s fear.

When humans are subjected to the threat of terror, and nothing deadly actually occurs, the terrorists are still winning.

Their victims feel powerless.

It is not surprising that individual survivors of terrorist attacks (9/11, 7/7, The Boston Marathon bombing, Mumbai, etc.) experience early post-traumatic stress disorder (PTSD) at rates twice that among motor vehicle accident survivors (38% versus 19% in a 2005 study). A minority develop chronic PTSD, often in response to continuing stress. Repeated terror acts in countries such as Israel cause psychological distress in the affected communities, with measurably elevated PTSD prevalence.

The World Health Organization’s (WHO) 2005 analysis of 57 million global deaths tallied 35 million deaths from chronic diseases, 17 million deaths from infections (HIV/AIDS, malaria, tuberculosis) and 5 million deaths from terrorism, civil war and one-sided violence (i.e., genocide).

I did not know that!

There is a growing body of evidence that another long-term consequence of being chronically fearful and powerless is higher mortality & morbidity related to substance abuse in conflict-affected populations.

Why is that?

Terrorism & violence damage health and economic infrastructures. Health care services are disrupted (electricity, water, sanitation) and health care workers often flee. During armed clashes in Somalia in 2013, basic health services such as polio vaccinations suffered. Agriculture and food rations (other than home brewed alcohol) dissipate. Forced resettlement marches and refugee camp overcrowding exacerbate these strains.

Not surprisingly, witnesses to extreme personal or family violence are deeply traumatized.

A 2013 report comparing pre-2000 to 2002 substance abuse disorder disability-adjusted life years (DALY’s) in 182 WHO member countries showed that a 1% increase in deaths due to terrorism & violence was associated with a 0.1% increase in alcoholism and a 0.12% increase in drug abuse. If there were 50,000 more terrorism & violence deaths beyond the baseline, there would be 220,000 more DALY’s lost due to alcoholism and 83,000 more DALY’s lost due to drug abuse.
Fifteen to 44 year old males are most negatively impacted by terrorism & violence.

While the alcoholism and drug abuse gender gap continues to close in episodic terror-afflicted affluent nations (Europe, U.S., India, etc.), the gap in terror-afflicted developed nations like Syria, Pakistan and Indonesia remains wide. In these continuously violent countries, the diminished social status of women seems to perversely favor their health.

All this begs the question, “Does the war-on-terror body count consider terror’s indirectly affected victims?”

Of course not!

To walk in The Square, we must confront these terrifying paradoxes.

Without fear...

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