Thursday, July 26, 2012

Prescription for global health: a strong ATT

by Andrew Kanter, MD, MPH, President, Physicians for Social Responsibility, US; and Robert Mtonga, MD, Co-President, International Physicians for the Prevention of Nuclear War
Unregulated transfer of conventional weapons undermines socioeconomic development, including global health. Each year, hundreds of thousands are killed and millions more maimed from armed violence. Annually, resources and funding that could be spent on public health, poverty reduction, expansion of primary education, the promotion of and equality of women, and environmental sustainability are diverted to manage the care of armed violence victims.  
The International Physicians for the Prevention of Nuclear War (IPPNW)’s Aiming for Prevention Campaign[i] has collected multiple “One Bullet Stories”—case studies, following the care of gunshot survivors through their hospital stay to emphasize the costs of a single gunshot injury. The first documented case was of a young boy from the Democratic Republic of Congo who was shot in the face by diamond thieves. His medical care, which included nine hours of surgical time to reconstruct his face, cost US $6,000. This same amount of money could have been spent to fund one year of primary education for 100 children or full immunizations for 250 children. This doesn’t even include the additional indirect costs of ongoing rehabilitation and follow-up care, psychological effects to the victim and his family, and lost wages.
Similarly, in Zambia, a study conducted in 2005 showed that, on average, the care of a single gunshot victim sustaining minor injury cost US $3,000. During that time period, Zambia’s annual per capita health expenditure was US $18. This is comparable to the health care costs of over 160 Zambians to fund the cost of care for a single gunshot injury. 

Another case study from Nepal found that it cost approximately 3 ½ years of a father’s salary to provide treatment for his young daughter who had been hit by a stray bullet in a firefight. This was equivalent to the cost needed to fully equip an entire health center for her village.

The overwhelming burden to the health care system by the medical costs of gunshot injuries is not limited to developing nations. A study[ii] conducted on hospital data from Maryland and New York showed that, in 1994, the average cost of hospital care for a single gunshot injury was US $17,000. Taxpayer money was used to pay nearly 50% of this cost. The authors further estimated the lifelong cost of a single hospitalized gunshot injury at US $35,367 or, overall, US $2.3 billion per year.  

Why should we as health professionals have to choose between providing care for a single gunshot victim instead of providing care for an entire community? Given the scarcity of resources in much of the developing world, and, in some locations, even in the developed world, this is not an exaggerated dilemma.  

Strengthening the necessary requirements of sustainable development directly increase peace and security. As stated by the United Nations Secretary-General Ban Ki-Moon on 3 July 2012, upon the opening of the ATT Diplomatic Conference, “the world is over-armed and peace is under-funded.” Last year, US $1.7 trillion was spent worldwide on the military—equal to US $249 per person. The US alone spent almost half of this total amount—US $711 billion. In sub-Saharan Africa, the annual military spending was approximately US $20 per person. In comparison, the annual health expenditure is US $24 per person in sub-Saharan Africa.[iii]

Limiting access to firearms has been shown to prevent injuries and reduce societal costs. In a later speech that same day to the press, the UN Secretary-General remarked that the lack of international standards in the trade of conventional weapons “has made it easier for [these weapons] to fuel armed conflict and crime, to commit acts of terror, and to perpetuate political repression and grave human rights violations.”

Over 1700 health care professionals from across the world have called for a strong, legally-binding humanitarian-focused Arms Trade Treaty. We are on the frontlines, managing the care of those injured daily by armed violence. Every minute, one person worldwide is killed by conventional weapons. We have a prescription to the UN delegates: it is now time for you to step-up and prevent the unnecessary loss of countless lives. You must commit to a strong ATT to improve the health and future of the world.

[ii] Cook PJ, Lawrence BA, Ludwig J, Miller TR. The medical costs of gunshot injuries in the United States. JAMA. 1999; 281(5):447-454.
[iii] Stockholm International Peace Research Institute. SIPRI Yearbook 2012: Armaments, Disarmament and International Security. Solina, Sweden; 2012. (