What Hezbollah can teach public health

The most successful armies learn from their adversaries. There is no doubt Hezbollah is an enemy of public health. We'd say the same of the Israel Defense Forces (IDF), but it's Hezbollah which has more to teach public health. Here's what we're getting at.

The New York Times has an excellent story about how the vaunted military might of the IDF has been checked by the disciplined fighters of Hezbollah fighting in their own villages. This shouldn't be a surprise but people have bought the myth of IDF military invincibility, just as they bought the myth of US military invincibility before Iraq. But it isn't the style of warfare that has lessons for public health. That's about killing. It's Hezbollah organization that's of interest:

"We are now into the first great war between nations and networks," said John Arquilla, a professor of defense analysis at the Naval Postgraduate School, and a leading analyst of net warfare. "This proves the growing strength of networks as a threat to American national security."

In a talk that Mr. Arquilla calls Net Warfare 101, he describes how traditional militaries are organized in a strict hierarchy, from generals down to privates. In contrast, networks flatten the command structure. They are distributed, dispersed, agile, mobile, improvisational. This makes them effective, and hard to track and target.


Net war is the battle of the many, organized in small units, against conventional militaries that organize their many into large units. These network forces are not ignorant. They are computer literate, propaganda and Internet savvy, and capable of firing complicated weapons to great effect.

"The pooling of information is certainly a characteristic of these kinds of insurgencies," said Daniel Benjamin, who served on the National Security Council under President Bill Clinton before joining the Center for Strategic and International Studies. "In Iraq, for example, the lessons on how to build and place I.E.D.'s have spread and been assimilated in record time. There is certain to be the insurgent equivalent of a PowerPoint presentation on Hezbollah's successes that will make the rounds of the insurgent and terrorist Web sites."


The United States also has to take into account Hezbollah's global reach -- it is blamed for the attacks on Jewish and Israeli targets in Argentina in the 1990's, and its cells operate in Latin America, across the Middle East and in Southeast Asia, and it could attack American interests in any of those places.

Critical to the American response, military officers and academic experts say, is that the United States acknowledge that its takes a network to fight a network. American intelligence agencies and the military proved it can fight this kind of war, as it did in Afghanistan to rout Al Qaeda, when intelligence officers and small groups of Army Special Forces worked with local fighters to call in devastating air strikes and drive the Taliban from power. (New York Times)

If we use our word processors to do a Global Search and Replace of H5N1 for Hezbollah, we wouldn't be too far off. But like the IDF and the US military, our public health generals are fighting the last war, not the next one. Instead of strengthening the traditional horizontal organization of public health, since 9/11 we have destroyed it and tried to replace it with a vertically organized Incident Command Structure and its chain of command. This makes particularly bad sense for responding to pandemic disease. When you interrupt the vertical organization by taking out a node you interfere with what is going on below it. Fighting H5N1 or any other pandemic agent will be done community by community, not by calling in the federal equivalent of an airstrike with high tech weapons.

Self-sufficient communities whose people work together and who share information with other communities will be the bedrock of response to a pandemic. The information sharing has already begun on this site, many others and especially on The Flu Wiki.

Sometimes killers can also tell us something about how to save lives.

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One thing I'd mention is that the hierarchical and distributed command structures - cathedrals vs. bazaars, to use Open Source terminology - have very different focuses. The former is devoted primarily to enforcing a lower bound on performance - anyone who just can't program gets fired. The latter is devoted primarily to ensuring that talented people can act to full effect.

In the context of warfare, the cathedral approach is a necessary evil for an army in the field; otherwise, it's absolutely guaranteed that they're going to suffer casualties when some idiot messes up. The density of soldiers per unit area is too great for anything else to be practicable - mistakes are too costly.

Guerilla forces, on the other hand, suffer almost no repercussions if they lose a few troops, apart from the risk of their other members being tracked down when the victims are interrogated. Thus, it's practical for them to set up a distributed environment whereby idiocy results in death but genius results in massive success.

The risk with a distributed system for healthcare is that there's no intrinsic compensatory mechanism for dealing with the idiots. You'll get some moron consistently messing up, and the oversight simply won't be there to halt his swathe of destruction before many people have died. You'd need to introduce some other mechanism (possibly analogous to peer review) to prevent this.

I do agree that the governmental tendency to respond to a problem by trying to build a new Death Star is waaay too strong.

By Corkscrew (not verified) on 01 Aug 2006 #permalink

Pretty good description Revere. One organism trying to get it up on the next organism all the while fighting over the resources. On the other hand, bugs dont have ideologies.

By M.Randolph Kruger (not verified) on 01 Aug 2006 #permalink

Organizing at the block level seems useful for pandemics. Unfortunately, there's a bunch of blockheads on my block. They get my white rice and one of those small, really sad tasting, imported canned hams that SAMS likes to foist off three at a time. Brown rice, Hatch green and canned chicken here.

By tympanachus (not verified) on 01 Aug 2006 #permalink

Revere, Excellent insight. I agree completely that our military approach in Iraq and the IDF's in Lebanon are obsolete. However, there's big bucks to be made for the powers that be (Bush and Co.) in furthering the might of the military industrial complex, so their all consuming greed will not allow them to see the situation realistically, much less allow them to comprehend the consequences (global hatred of the U.S.) rationally. And,
the same rationale can be used to explain their lack of will to change their approach to national healthcare. To them (Bush and Co.), there is no money to be made in saving lives, and pumping money into our delapidated healthcare system is way too costly and certainly has no cost benefit ration to them. It's all about money.

But...haven't GW et. al. been lambasted for saying that the pandemic flu response needs to be more local, and not "top dependent"? Which is it, better with less govt intervention, or better with more govt intervention?

Mike: They haven't been lambasted by us for that. We have said repeatedly that this is a correct position on DHHS's part, i.e., that the feds would not be able to ride to the rescue. What we have taken them to task for is that they have simultaneously crippled the ability of local communities to act on their own.

hey, my startup (smart, fast, nimble, effective, resource starved) software company got bought by a fortune 15 corp. giant. at the small company, something needed doing, you just did it. problem solved, get back the important tasks. at the big company "we've got a process for that". the result is that it doesn't get done for days while you sit around and steam. sound familiar? the federal government, usa military command, what have you is more about turf, budget, process, and cya than about delivering to the customer the desired product tomorrow for a competitive price.

Corkscrew, thanks for that post, it stimulated my thinking.

Interesting theme altogether.