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Social Determinants of Health

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From:
Robert C Bowman <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Wed, 11 Oct 2006 11:35:50 -0500
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Some thoughts

The first is that "our" community, the one that understands how important
infrastructure is and how it takes decades and even centuries to build and
support it, has not yet translated these areas in a way that governments
understand, even some of the governments that should. We are particularly
poor about translate how much it would save in areas such as costs, public
safety, foreign defense costs from needing less from other nations, etc.

If we were more effective in this area, perhaps governments would be less
likely to destroy infrastructure as earlier in the year.

Our view of war has often been shaped by the recovery "successes" after
WWII with restoration of Germany and Japan. The building infrastructure
parts such as roads, bridges, factories, and utilities were leveled in many
parts of these countries. A perception of this as infrastructure is a very
limited view. The recoveries were rapid and unprecedented because the
people infrastructures were untouched and we clearly steered out of the way
of recovery: education levels, rising middle classes, unity of purpose,
professionals, people cooperation, local government, attitudes toward those
considered "lesser" including women and children. In many ways these were
strengthened during the war, although subverted by the WWII rulers who
stole to power and brought about the war.

We also fail to understand that the promise of improvement and a better
life can motivate humans to do just about anything, particularly those with
the least. Until we do a better job translating the lost human potential
and the real capabilities of all humans, we will have problems.

We should also be suspicious of any efforts with rapid progress in nations
or states or cities. Real progress takes great time and effort and
sacrifice, but most are not willing and then elect or allow leaders
promising faster progress and skipping important steps. Rapid progress
usually comes from taking from others in ways likely to cause damage.

The final though is how many millions will soon die regardless of the
current situation. There is no Gandhi to hunger strike, there is no return
to the former rule with genocide (more likely on two or three fronts than
one), there is no major Arab nation coalition move to come in and replace
the occupiers who have become a rallying point for dissidents (the best
early exit and a huge lost opportunity), there is no news media that
focuses on mediation and positive events (only the overwhelming horror and
violence all over the world brought to the attention of all in the world),
there is no UN, and a divided United States can't decide, nor could any
other nation at this point. Finally no one remembers the German civil wars
or the treaties that finally forced other nations to resolve to settle
matters in different ways - see Peace of Westphalia at end

There are only piles of piles of weapons and hatred all around. While these
were once focused outward and directed toward other nations (Kuwait,
others) they are now directed inward. Resistance leaders have even called
for materials to make weapons of mass destruction to rain down upon current
occupying forces but these will also contaminate those living in Iraq who
will have to deal with the consequences for decades or centuries.

Next door to Iraq is a ruler who believes in a future where a small
percentage of the world's population will survive destruction and this is
related to the coming of a savior. He is developing nuclear capacity
despite world opinion.

Nations recover when people have hope for the future. The few national
recoveries or even moves "up" in status have been "perfect storms"

The US itself was a perfect storm of resources, people, and opportunity,
including some of the best people from all over the world. Vikings had a
perfect storm, off the backs of others but it worked. Iceland devastated
her fragile nation, and recovered with the new opportunity in fishing and
hard work and belief in the future. (Collapse by Jared Diamond) The Romans
did well in a similar fashion and there was some benefit to being a part of
the empire and not having so many neighboring squabbles. The Dark Ages were
replaced by new optimisms, and challenges. Plagues produced labor shortages
and middle classes. Rises and recoveries in Japan and Germany were major
events and the absorption of East Germany has taken a toll on Germany but
overall potentially a better situation long term. Israel clearly was a
perfect storm. Those in east Africa at the recent Rural WONCA (FP) meeting
were the most optimistic and this may be huge for a better future there.

Robert C. Bowman, M.D.
[log in to unmask]

What people believe may still depend upon us and how we interact with
government and what we have learned from history

From Wikipedia on the Peace of Westphalia

Significance
It is often said that the Peace of Westphalia initiated modern diplomacy,
as it marked the beginning of the modern system of nation-states (or
"Westphalian states"). This interpretation comes from the treaty's role as
the first acknowledgment of each country's sovereignty. Subsequent European
wars were not about issues of religion, but rather revolved around issues
of state. This allowed Catholic and Protestant powers to ally, leading to a
number of major realignments. It also cemented Germany's internal
divisions, preventing it from uniting into one nation-state. It is the
Peace of Westphalia that is most often pointed to as the foundation for
studying international relations.

Modern views
In 1998 on a Symposium on the Political Relevance of the 1648 Peace of
Westphalia, then–NATO Secretary General Javier Solana said that "humanity
and democracy [were] two principles essentially irrelevant to the original
Westphalian order" and levied a criticism that "the Westphalian system had
its limits. For one, the principle of sovereignty it relied on also
produced the basis for rivalry, not community of states; exclusion, not
integration." [1]

In 2000, then–German Foreign Minister Joschka Fischer referred to the Peace
of Westphalia in his Humboldt Speech, which argued that the system of
European politics set up by Westphalia was obsolete: "The core of the
concept of Europe after 1945 was and still is a rejection of the European
balance-of-power principle and the hegemonic ambitions of individual states
that had emerged following the Peace of Westphalia in 1648, a rejection
which took the form of closer meshing of vital interests and the transfer
of nation-state sovereign rights to supranational European institutions."
[2]

In the aftermath of the 11 March 2004 Madrid attacks, Lewis ‘Atiyyatullah,
who claims to represent the terrorist network al-Qaeda, declared that "the
international system built-up by the West since the Treaty of Westphalia
will collapse; and a new international system will rise under the
leadership of a mighty Islamic state". [3]

Also, it is often claimed [1] that globalization is bringing an evolution
of the international system past the sovereign Westphalian state.

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