“Peace and health are inextricably connected,” the Editors of the AMA Journal of Ethics introduce an issue of the journal devoted to Peace in Health Care published November 2024.

 

 

 

 

 

 

In this timely journal issue, we can explore nearly one dozen essays exploring the interrelationship between peace and health in various clinical, care, and community settings — including hospice, maternal/child care, built environments, and adjacencies looking at the use of psychedelics and music for quieting one’s inner voices.

You, the reader, will find your own favorite issues to explore based on your work, values, and interests. I’ll focus this post on one of the pieces that resonate with what I’m working on these days.

 

 

 

 

 

With my ongoing focus on social determinants and drivers of health for health equity and access, the first essay that caught my attention is on Government Obligations and the Negative Right to a Healthy Urban Environment. The authors are affiliated with Case Western Reserve with interests in bioethics and medicine. What drew me into this piece was the promise of connecting the dots between urban development, negative externalities flowing out of development, risks to social determinants of health, and the role of the public sector in ameliorating these risks to assure the health of citizens.

The authors assert that, “individuals and communities have a negative right to not have their space impinged upon by government-facilitated action or development that adversely affects their health.” Causing harm to public health then forces an “ethical obligation” on the part of public sector agencies to avoid harmful health effects as well as embedding design elements that would enhance peoples’ well-being and senses of peace.

The various government roles that have harmed public health in such cases often adversely affect marginalized or lower-resourced groups of people, and include,

  • Eminent domain, government’s mechanism which forces neighbors to leave their neighborhoods with the rationale of creating greater “public benefits” for locals — often biased against people of lower socioeconomic status
  • Zoning laws, which have been a risk of greater exposure of environmental hazards (e.g., dumping and hazardous materials storage) in lower-income neighborhoods
  • Redlining, which has resulted in certain neighborhoods (e.g., predominantly African-American communities) to be deemed less creditworthy, resulting in adverse health effects from a tuberculosis inequity to greater incidence of preterm births and later-stage cancer diagnoses, among other disparate health outcomes
  • Noise pollution, which can result in noise-induced hearing loss, psychological stress, sleep disturbances, and high blood pressure, among other conditions (think: living under a nearby airport air space)
  • Light pollution, with two different impacts
    • Inadequate lighting which can erode residents’ sense of personal safety after dark; and,
    • Harsh artificial lighting which can disrupt people circadian rhythms for sleep, result in sleep disorders, and increase risks for certain cancers
  • Urban heat islands (exemplified by the global heat waves of 2024 striking many parts of the world), and,
  • Gun violence, which literally threatens peace in urban and rural communities alike.

How to address these risk to personal and community peace?

“Stewardship of the ecological conditions for health and peace utlimately necessitates ogvnerment effot and leader and colalborative appraoches tom itigate the adverse effects of development,” the authors explain.

Consider the following ideas:

  • Embed urban green spaces that bring both a cooling effect as well as peaceful spaces in communities (whether small pocket parks or larger expanses)
  • Establish community gardens and CSAs where residents can collaborate to grow produce that benefits both physical/nutritional and social health
  • Design public spaces with more mindful lighting avoiding shining in residents’ windows
  • Identify cooling mechanisms that are both environmentally friendly and economical, whether fitted for individual housing or for public cooling centers,

among other strategies.

The authors conclude:

“Developing such interventions will not only serve to respond to the present issues at hand caused by urban ‘renewal’ and gentrification but also allow policy makers to begin addressing and interrupting the perpetuation of historical racial and ethnic socioeconomic inequalities that have brought forth environmental conditions — from tormenting heat to stray bullets — that prevent peace.”

 

 

 

 

Health Populi’s Hot Points:  The two editors of this issue, Timothy Nicholas and Grayson Holt, assert that,

“Peacemaking demands equitable, patient-centered clinical practices that optimize patient autonomy and dignity, all the while ensuring that patients feel heard, respected, and secure.”

To get there, they note that will require collaboration between health care organizations and policy makers.

 

 

 

 

 

 

 

The social determinants of health (SDoH) have been receiving a lot of attention from health plans, retail pharmacy chains, life science companies and to be sure, health care providers. (The graphic on SDoH comes out of my book, HealthConsuming – the morphing on health consumers to health citizens).

Private sector stakeholders such as health plans and Fortune 100 retail health care companies have putting resources into programs addressing various risks to the drivers of health, especially those focused on,

On the “guns are in the public health lane” issue, I greatly admire the efforts of Northwell Health CEO Michael Dowling looking to “bend the curve of gun deaths” in America.

But the health system itself cannot promote peace and well-being on its own without public sector (that is, government) support. The AMA Ethics article on urban development’s negative externalities for public and personal health makes this clear – say, for clean air and clean water (and gun violence, as well). The scale of such health risks requires a public sector policy solution, in partnership with local agencies and indeed health care stakeholders to help scale the solution in the community.

As I’ve been concluding so many of my keynotes and meeting talks, I refer back to the mantra…

“If you want to go fast, go alone.  If you want to go far, go together.”