Our responsibility in a time of war

How can we attend to our responsibility as population health scientists at this challenging moment?

On Thursday February 24, 2022, Russia invaded Ukraine. Although there had been a steady drumbeat of warnings that this invasion was imminent, the war that followed was still a jarring reminder of the evils of war, of an event that felt out of place and time, a twentieth-century war unfold in a twenty-first century context. For a time, it was possible to think such a conflict could not emerge in our highly interconnected and interdependent world. It was particularly striking to see such a war in Europe, where our present interconnectedness emerged, in part, from the ashes of two world wars—conflicts which taught us, we thought, to never again fight in such a way.

Seeing our failure to learn the lessons of history has been, I must admit, a cause for some despair, as I have asked myself: what can we do, as individuals, at moments like this? How much power does the American or Russian citizen have to stop a war when the forces of illiberalism seem bent on waging one? It is incredible to think that all this destruction has been wrought by the choices of such a small number of people—really, by the choices of one man, motivated by abstract notions of imperial glory and resentment for how the world changed over 30 years ago.

Regardless of how they begin, of the complex dynamics they reflect, wars are ultimately about people. Their result is always the same: death, injury, sickness, and the crushing of aspirations for a healthier world. Given these consequences, we have a responsibility to think about what role, if any, our actions play in creating the conditions for wars to emerge, and the role we can play in stopping these conflicts.

I have previously written about the complicity of the population health scientist, noting that it was on us as population health scientists to focus on the consequential causes of poor health, to call out racism, injustice, and other factors that generate poor health. These same factors create the conditions for war. The attempted seizure of Ukraine by Russia is fundamentally an injustice and a symptom of the illiberalism we have seen creep into so much of politics and society in recent years. While we cannot influence the choices of Russian President Vladimir Putin, we can commit to opposing illiberalism wherever we encounter it. We can speak out against injustice and undercut the ability of autocrats to feel like the world is a place where they can get away with murder. In doing so, we will help inform a conversation that shapes the kind of world where injustice and abuse of power no longer take root at any level, either interpersonally or between nations.   

How can we attend to our responsibility as population health scientists at this challenging moment?

First, it seems to me that we have a responsibility to call out the moment, to show how its horrors, its human toll, have a root cause in injustice, in the gross misuse of power, and in the danger of false equivalence. Regardless of what one may think about the historical roots of this conflict, the invasion of Ukraine is a crime, unjustifiable by any argument. It shows us that sometimes there are not two sides to an issue, that our commitment to empathy and compassion should not cause us to equivocate in the face of evil. With this in mind, we should help inform a sense of moral clarity about what we are seeing in Ukraine, and not let our understanding of the many shortcomings of the West prevent us from seeing and naming who is in the right and who is in the wrong here.

Second, we need to be clear-eyed about communicating the long-term consequences of this moment. The economic, social, and health ramifications of this war will not cease with the end of the conflict. The effects of war are intergenerational, rippling across time. The trauma of this moment will linger for years—the legacy of each day of war is a lifetime of sadness and pain for those affected. This is true for those fighting on both sides of the conflict. We should communicate how destructive the war is for ordinary Russians as well as for Ukrainians, in the hope this will inform political pressure within Russia to reverse course on the invasion, and to remind the world that war is bad for everyone everywhere.

Third, it is our responsibility to generate the writing, thinking, and science that creates a scaffolding which supports a healthier world. Such a world does not tolerate the suffering and death caused by war, nor does it let the deeper causes of war go unaddressed. The philosophical basis for this world starts with refusing to give oxygen to ideas that fuel war. We need to push back against the notion that we are more defined by our divisions than by our commonalities. We need to resist archaic interpretations of history that make conquest seem more appealing than common progress. And we need to make space for ideas that encourage using power to make the world better rather than to merely dominate it. Reinhold Niebuhr said, “Ultimately evil is done not so much by evil people, but by good people who do not know themselves and who do not probe deeply.” It is up to us to know ourselves, to probe deeply the fundamental causes of sickness and war, to build a world that is resistant to both, resting on foundations of democracy, small-l liberalism, and the reasoned pursuit of truth.

Finally, and perhaps counter-intuitively given how I started this essay, we need to resist the sense of helplessness that times like these can make us feel. The Ukrainian people and their president showed how a small group of determined people can make a difference against great odds, in the face of  powerful upstream forces. In public health, we rightly focus on these forces as the core determinants of health, and we should engage with them to minimize, to the extent we can, the human cost of war. But we owe it to the example we have seen from Ukraine to also keep in mind that we can, acting with conviction on behalf of liberal principles, push back against illiberalism and the abuse of power and build a better world.