With the end of the Cold War, the number, intensity, and lethality of wars were believed to be in decline [PDF]. However, new research from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington challenges the idea that war deaths are falling. The IHME paper claims war deaths are three times higher than previously thought and not decreasing. Beneath the surface, the debate shows an increasingly prominent and well-funded global health community flexing its muscle in the foreign policy arena.
The IHME was founded a little more than a year ago with a 10-year, $105 million grant from the Bill & Melinda Gates Foundation. The institute is tasked with evaluating a multitude of health programs worldwide as well as developing an overall report card on global health by 2010. IHME represents the Gates Foundation's hard-nosed drive for evidence-based policies and accountability, sussing out what works, identifying the causes of death — and what or who is to blame.
Lead author of the IHME study, Ziad Obermeyer, told Crosscut that previous estimates of war deaths "fit with an increasingly common view in the academic and political communities that technological innovations (â€˜smart' bombs, precision warfare, etc.) and strategic priorities in recent years have dramatically reduced the number of civilian war deaths ... " Obermeyer noted: "If civilian deaths can essentially be ignored in the political calculus, war becomes a less difficult and more defensible option."
The common view has been that battle deaths were in decline. War deaths, by definition, exceed battle deaths because wars also kill by disease or starvation, for example. Data on all war-related deaths have been scant. IHME's estimates are hotly disputed because the number and trend of deaths are highly sensitive to assumptions in their model. Changing the treatment of data from Georgia, for instance, dramatically swings the estimate of war deaths and also whether the trend has been up or down over the last half century.
Oddly, the debate over war deaths is not between hawks and doves. The view that Obermeyer and colleagues seek to revise largely derives from the aptly-named Peace Research Institute, Oslo, Norway. The deeper question is: Whose voice should be authoritative on foreign policy? From a global health perspective, the present keepers of the world order have made a hash of it: Just count all the dead and dying. The Gates Foundation believes a more intelligent approach is possible — and necessary.
Early in their foundation's work, the Gateses discovered a "failure of collective action" among developed nations and international bodies leading to, for example, underfunded vaccination programs and vaccine research. More recently, in a speech to the Council on Foreign Relations in June, Melinda Gates elaborated: "Bill and I have come to recognize that poor people cannot get adequate food, and education, and health care because they cannot express their needs in ways that matter to markets or that motivate governments." In words dense with ramification, she concluded: "Only the non-profit sector has the primary mission of serving the people who've been left out."
Global health advocates emphasize a borderless world and policies focused on health orchestrated by non-profits, as against the prevailing system centered on nations and national security. The people, policies, and basic paradigms all differ, at times starkly. However, because these problems are so complex, the Gateses once wrote, "government has to be involved in solving them." In turn, "that means we need to get these issues on the political agenda."
Recently, it's been more clear how they propose to change the international agenda. In 2003, the Gates Foundation funded a new Global Health and Foreign Policy Fellow at the Council on Foreign Relations. Publisher of Foreign Affairs, the Council arguably wields more influence on foreign policy than any other private body. The first Gates fellow, Pulitzer prize-winning journalist Laurie Garrett, authored "HIV and National Security: Where Are the Links?" [PDF] in 2005, arguing that AIDS epidemics — eventually — jeopardized security in nations suffering from them while other countries faced a possible threat of terrorists arising from the resulting, destabilized regimes. in such a way, global health policy and foreign and defense policies are tied together.
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