I. Statement of the Problem
The central concern of the American Public Health Association is the protection of the health of the public, which includes the prevention of any significant threat to the health of the populations of the United States and the world. In previous resolutions, the APHA has defined the danger of nuclear war (Resolution No. 8117, 1981),1 and the escalating military budget (Resolution No. 7913, 1979),2 as falling within the area of preventive health.
A nuclear war, in a "reasonable" Pentagon scenario of a 6,559 megaton attack on the US, would cause over 130 million US deaths.3 Severe cuts in US domestic social programs have occurred at a time when infant mortality rates have been increasing in many states and individual urban areas.4 In addition, by comparison, the entire cost of the malaria control program of the World Health Organization is less than the cost of one day of world military expenditures.5
These three examples alone document why the APHA should take a position on the entire growing phenomenon called "militarism," the persistent reliance on the use of military force rather than negotiation and diplomacy, in conducting international relations. This position paper will demonstrate the domestic and global health effects of militarism. In a nuclear age, the dangers of militarism are so great that opposition to US militarism should become a major priority for health professionals.
A. Domestic Health and Social Costs of Militarism
The rise of militarism causes serious actual and potential negative effects on the health of people of the United States:
- Reduction in Health Resources
Along with the growth of worldwide militarism, the transfer of resources from health and social services to the military has accelerated in the last six years. The proportion of the federal budget allocated to military and related expenditures rose from 38 percent in 1979 to 46 percent in 1984. During this same period, domestic programs have been cut, in real dollars, by 20 percent in such areas as health, nutrition, and housing.6,7 These social service reductions, required by growing military budgets, have had an especially negative impact on minority groups. These same minority populations have disproportionately fought and died in US wars, illustrated by the number of Blacks and Hispanics who suffered such disproportionate fatalities during the Vietnam War (e.g., Blacks constituted 11 percent of the US population; they suffered 23 percent of the fatalities.8
At President Reagan's request, Medicare expenditures between fiscal year (FY) 1982 and FY 1985 were reduced by $14 billion from what they would have been without cuts, and the FY 1986 budget calls for another approximately $18 billion cut between FY 1986 and FY 1988.9-11 Despite the sharp increase in the number of "officially" poor—from 26.1 million in 1979 to 35.3 million in 198312—Medicaid, which finances health services for the poorest children and families, was cut $4 billion between FY 1982 and FY 1985.9-11 Further cuts of approximately $6 billion are proposed over the next three years.11 Because Medicaid coverage was automatically cut off for the 500,000 low-income working families (nearly all female-headed) that had their Aid to Families with Dependent Children (AFDC) benefits terminated from the budget cuts, an estimated 700,000 children lost Medicaid coverage as well.13
Although the second National Health and Nutrition Examination Survey (NHANES II) determined that 4 percent of the nation's children between the ages of 6 months and 5 years have high blood levels of lead, and that large numbers of children (especially preschool Black children from low-income households) with elevated levels remain undetected,14 as of October 1, 1981, the funding for the Centers for Disease Control (CDC) Childhood Lead-Base Paint Poisoning Prevention Program was discontinued. Since that time, states and local programs that elect to continue screening activities through funding by Maternal and Child Health (MCH) block grants (limited funds that are needed for many other vital social programs returned to state or local control) only had to report lead-screening information on a voluntary basis. As a result, the number of reporting programs declined sharply from 60 in September 1981 to 21 in September 1982, with the reported number of children screened dropping almost 50 percent from 1981 to the end of 1982, 15 making it impossible to determine the true incidence of lead poisoning among children.
Severe budget cuts have also hit those regulatory agencies created to protect Americans from hazards in the workplace and environment. For example, the Occupational Safety and Health Administration (OSHA) covered 1.5 million fewer workers at the end of 1982 than in 1980. Between these same years, 17 percent fewer workplace inspections were performed, and total penalties imposed on violations decreased 67 percent.16,17 Another cut related to the growing military budget is the 30 percent reduction in the US Environmental Protection Agency's four major programs (water, air hazardous wastes, pesticides).18 Approximately $40 billion over the next 10 years is needed to control the problem of industrial emissions that cause acid rain.19 In addition, the 8,000 tons of radioactive wastes from military installations and nuclear power plants require permanent storage depots costing $10 billion per site.20
- A Growing Military Budget
While health and social resources have been severely cut, by 1986 the military budget will have nearly doubled over the previous five years.21 The military budget, in addition to representing a wasteful allocation of resources, contains expenditures that illustrate a shift to a more aggressive nuclear posture that threatens the health and welfare of all Americans:
- Approximately 20 percent of the military budget is now allocated for nuclear weapons listed by the Secretary of Defense as offensive, not defensive, strategic forces.22
- In March 1982, President Reagan signed into action a program for the Department of Defense to produce another 16,000 nuclear warheads through 1990, adding to the 26,000 operational warheads already in existence. Although some of these will be retired, the net increase is projected to be 13,000. If the objective of nuclear policy were deterrence, only 400 of these warheads would be needed to destroy the 100 largest cities in the USSR.23,24
- The 1986 Federal Budget11 indicates that total revenues will be $793.73 billion, of which $300.26 billion is derived from Social Security revenue, leaving a discretionary revenue balance of $493.47 billion. Of this discretionary revenue, the defense budget ($285.67 billion) and debt service ($142.4 billion) will use 86.75 percent.
- In his March 1983 "Star Wars" speech, President Reagan announced plans to build anti-satellite and advanced missile defense systems at estimated costs ranging from $60 billion to $1 trillion.25-28
In order to provide adequate security for the American people, without substituting the insecurity of devastated social services, alternative defense budgets have been suggested. For example, HR 6696 (1982) would have reduced the Pentagon's outlays by over $50 billion in FY 1983, without compromising the defense of the United States.22
B. Militarism and the Health of Less Developed Countries
Since 1945, US military interventions in the world—overt as well as covert operations—have cost literally millions of lives.29-31
Worldwide military expenditures in 1983 totaled over $660 billion; approximately 20 percent of this was spent by impoverished, less developed countries,32 with major suppliers including the US, USSR and France. The current Administration, under guidelines corresponding to a directive signed by President Reagan on July 8, 1981, has increasingly used arms sales as a direct means of foreign policy implementation, no longer withholding arms sales to friendly nations solely because of a poor record on human rights.33 In 1983, total US arms sales to the Third World reached $9.7 billion, compared to sales of $6.4 billion in 1980.34 If worldwide military expenditures were transferred to world health programs, the impact would be enormous. For example, the equivalent of three weeks military expenditures would provide the fresh water and sanitation needed to overcome the cause of 80 percent of the sickness in the world.29,32,35
C. The Threat of Rising Militarism to Global Health
In the past four years, the current Administration has made a qualitative change in policy; militarism has now become a major aspect of international relations. This increased reliance on militarism has been manifested by an enunciation of aggressive nuclear strategies that, when coupled with policies of military interventionism, pose a major threat to health, and more, survival on the planet, through greatly increasing the chances for the outbreak of the "final epidemic," nuclear war:
- "Winnable Nuclear War," Space Weapons, and Civil Defense
The danger of nuclear war has become far greater than under previous administrations, through the elaboration of the concept of "winnable nuclear war." This doctrine, articulated in National Security Decision Document 13 which was approved by President Reagan in 1982, and incorporated into a secret directive (Fiscal Year 1984-88 Defense Guidance) prepared under the supervision of Defense Secretary Caspar Weinberger, represented the first detailed plan formulated by a US Administration for waging a protracted nuclear war.28,36,37 A great amount of public furor resulted from the leaking of the directive to the media, and Weinberger subsequently was quoted in the press as saying "we do not believe there could be any winners in a nuclear war," a position since echoed by President Reagan.38 In 1983 Weinberger deleted the phase "protracted war" from the revised Fiscal Year 1985-89 Defense Guidance, although this later strategy document contained no new initiatives to otherwise indicate a fundamental change in long-range thinking.39
According to a recent Newsweek poll, 28 percent of senior US military officers believe there are conditions that would justify a nuclear first strike on the USSR—a view shared by many of President Reagan's top military advisors. "First-strike" and "winnable nuclear war" doctrines have destabilized the equilibrium of mutual deterrence, increasing the chances of nuclear war occurring through miscalculation or accident.40
The FY 1984-88 Defense Guidance, a classified document representing the official policy of the Department of Defense, states that the United States must have "plans that assure US strategic forces can render ineffective the total Soviet military and political power structure" ...41 These plans echo the call by Colin Gray, a Reagan Administration appointee to the General Advisory Committee on Arms Control and Disarmament, who wrote: "The United States should plan to defeat the Soviet Union and do so at a cost that would not prohibit US recovery," ... a cost which Gray approximates as being 20 million US casualties.28,42
The Reagan Administration's strategy for achieving nuclear superiority over the USSR has extended the nuclear arms race to the realm of outer space. According to the New York Times, the Reagan Administration has declined to open the question of preventing the militarization of space to serious negotiations with the USSR, and has refused a call by the Soviets to implement an immediate moratorium on the further testing of space weapons. Instead, the Reagan Administration has opted to proceed with the development of advanced American space weapons, a strategy that undoubtedly will lead to an expensive and escalating arms race in space, creating higher levels of international instability.43
While the Reagan Administration may not be completely consolidated on the idea of winnable nuclear war, at the very least the Administration has demonstrated a belief in the extremely dangerous idea that nuclear war is survivable, illustrated by the 1982 Federal Emergency Management Agency (FEMA) program, that included a controversial crisis relocation plan, which was finally abandoned in early 1985, after having been rejected by about 120 jurisdictions representing 90 million Americans.44-50
- 2. Military Interventions and the Threat of Nuclear War
Not only has interventionism been the cause of widespread destruction and suffering, it has also increased the chances for nuclear war. On 19 occasions since World War II, the US has seriously considered the use of nuclear weapons, often to protect US interventionary troops. Examples include Korea in 1950, Guatemala in 1954, Lebanon in 1958, and Vietnam in 1968 and 1969-72.51
Interventionism continues to represent a major risk factor for the initiation of a nuclear confrontation; many military experts believe that the most likely scenario for nuclear war is escalation from a local conflict involving conventional military forces.52
Examination of the global implications of rising US militarism on the health and social welfare of the people of the world underscores the responsibility of health professionals to oppose these policies in all their manifestations. The very survival of the planet depends on a vigorous stand against rising military expenditures, increased nuclear armaments, new offensive strategies of nuclear warfare, and the military interventionism that could well provide the spark for a worldwide nuclear holocaust. Channeling resources away from militarism, towards health and social welfare, would accrue benefits to the people of the world that cannot be overstated—benefits that include the elimination of the major sources of endemic illness in the world.
The United States and other nations of the world have two choices: either to assert their power through military force, or to move to a reliance on negotiations, diplomacy, and mutual respect among all nations. Both as health professionals, and as people who wish our country to be respected in the community of nations, we want and urge the United States and all nations of the world to stand for peace.
III. Statement of Actions Desired
Because health professionals have a responsibility to prevent the major threat to the health of the world's people created by militarism, the APHA calls for a significant reduction in the US military budget, and voices its opposition to the pursuit of aggressive nuclear strategies and policies of military interventionism by all nations of the world. Specifically, the APHA:
- Opposes the development of "first-strike" and "winnable nuclear war" strategies;
- Opposes the militarization of space;
- Calls for a shift in funds from the military to budgets that would improve the health of the populations of the US and the world; and
- Recognizes the entire phenomenon of militarism as a serious public health problem facing the people of the world.
IV. Proposed Methods of Implementation
- Encouragement of APHA members to publish materials on this subject in a wide variety of health-related and popular journals.
- Initiation of discussions with other health, anti-nuclear, and anti-intervention organizations regarding common work to oppose militarism.
- Assistance from APHA's Public Health Education Section in the preparation of teaching curricula and the development of learning-aid methods on the subject of militarism and health, for use in medical, nursing, public health, and other health science schools.
- Congressional lobbying against US military interventions, the proliferation of nuclear weapons, and the growing military budget.
- American Public Health Association: Resolution 8117: Nuclear War and Nuclear Weapons. APHA Public Policy Statements 1948-present. Washington, DC: APHA, current volume.
- American Public Health Association: Resolution 7913: World Peace and the Military Budget. APHA Public Policy Statements 1948-present. Washington, DC: APHA, current volume.
- Abrams HL: Infection and communicable diseases. In: Adams and Collins (eds): The Final Epidemic. Chicago: University of Chicago Press, 1981.
- NCHS, Division of Vital Statistics (unpublished data).
- Sidel VW: Buying death with taxes: impact of arms race on health care. In: Adams and Collins, op. cit.
- New York Tunes, February 24, 1984.
- Labor Research Association: Economic Notes. LRA, March 1983.
- Newsweek, October 15, 1984.
- The Budget for Fiscal Year 1982. Washington, DC: US Govt Printing Office, 1981.
- The Budget for Fiscal Year 1985. Washington, DC: US Govt Printing Office, 1984.
- The Budget for Fiscal Year 1986. Washington, DC: US Govt Printing Office, 1985.
- New York Times, August 3, 1984.
- Center on Budget and Policy Priorities: End Results: The Impact of Federal Policies Since 1980 on Low Income Americans. The Center, September 1984.
- Mahaffey KR, Annest JL, Roberts J, Murphy RS: National estimates of blood lead levels: United States 1976-1980: association with selected demographic and socioeconomic factors. N Engl J Med 1982;307:573-579.
- MMWR 1985 February 8;34(5):66-68.
- Testimony of Steven M. Hessl, MD: Hearing before the Committee on Government Operations, House of Representatives, June 21, 1982, p 28. In: Claybrook J, and the Staff of Public Citizen: Retreat from Safety. New York: Pantheon Books, 1984.
- Freese B, Wolfe S: Decreased Law Enforcement at OSHA: FY 1982, November 8, 1982. In: Claybrook J, op. cit.
- Congressional Budget Office: The Environmental Protection Agency: Overview of the Proposed 1984 Budget, April 1983, p 1. In: Claybrook J, op. cit.
- Business Week, September 26, 1984.
- US News and World Report, August 15, 1983.
- New York Times, February 2, 1984.
- Dellums RV, et al: Defense Sense: The Search for a Rational Military Policy. Cambridge: Ballinger Publishing Co., 1983.
- Aldridge RC: First Strike! Boston: South End Press, 1983.
- Cochran TB, Arkin WM, Hoenig MM: Nuclear Weapons Databook. Vol I: US Nuclear Forces and Capabilities. Cambridge: Ballinger Publishing Company, 1984.
- Deudney D: Unlocking Space. Foreign Policy, Winter 1983-84;53:102-103.
- Brzezinski Z, Jastrow R, Kampelman MM: Defense in Space is not Star Wars. New York Times Magazine, January 27, 1985, p 29.
- Gelb LH: Vision of Space Defense Posing New Challenges. New York Times, March 3, 1985.
- Scheer R: With Enough Shovels: Reagan, Bush and Nuclear War. New York: Vintage Books, 1983.
- Sivard RL: World Military and Social Expenditures 1982. Leesburg: World Priorities, 1982.
- American Public Health Association Resolution 8306: The Health Effects of United States Intervention in Nicaragua. APHA Public Policy Statements 1948-present. Washington, DC: APHA, current volume.
- Findings from 2nd Annual US-Nicaragua Colloquium on Health, Managua, Nicaragua. October 1-5, 1984.
- Sivard RL: World Military and Social Expenditures 1983. Leesburg: World Priorities, 1983.
- Klare MT: American Arms Supermarket. Austin: University of Texas Press, 1984.
- US News and World Report, May 28, 1984, p 59.
- Lown B: Nuclear War and the Public Health. J Public Health Policy. 1982;1(3):19.
- Halloran R: Pentagon Draws Up First Strategy for Fighting a Long Nuclear War. New York Times, May 30, 1982.
- Scheer R: Six Month Nuclear War Plan is Submitted to Reagan. Providence Journal, August 15, 1982. (Submitted as testimony in Hearing before the Committee on Foreign Relations, United States Senate, December 14, 1982.)
- Wilson GC: Weinberger Lobbies Editors on War Policy. Washington Post, August 25, 1982.
- New York Times, March 18, 1983.
- Cox AM: Accidental Nuclear War. In: Cassel C, McCally M, Abraham H (eds): Nuclear Weapons and Nuclear War. New York: Praeger, 1984.
- US Department of Defense: Fiscal Year 1984-88 Defense Guidance. Cited in Washington Post, November 10, 1982.
- Gray CS, Payne K: Victory Is Possible. Foreign Policy, Fall 1980;39:48-57.
- New York Times, August 10, 1984; August 17, 1984; September 10, 1984; January 7, 1985.
- Center for Defense Information: President Reagan's Civil Defense Program. The Defense Monitor 11(5):1.
- Himmelstein D: Oakland MDs voice protest over DoD program. (letter) Am J Public Health 1981;71:861.
- Cassel C, Jameton A: Medical Responsibility and Thermonuclear War. Ann Intern Med 1982;97:426-432.
- Editorial: Armageddon: The Civil Defense Fraud. J Public Health Policy 1982;1:117-118.
- Geiger HJ: Illusion of survival. In: Adams and Collins (eds): The Final Epidemic. Chicago: University of Chicago Press, 1981.
- >Executive Committee, Physicians for Social Responsibility: Medical Care in Modern Warfare: A Look at the Pentagon Plan for the Civilian Sector. N Engl J Med 1982;306(12):741-742.
- New York Times, March 4, 1985.
- Blechman BM, Kaplan SS, et al: Force without War: US Armed Forces as a Political Instrument. Washington, DC: Brookings Institution, 1978.
- Gelb LH: Is the Nuclear Threat Manageable? New York Times Magazine, March 4, 1984, p 29; New York Times, March 21, 1984.
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