Preventing Genocide

By Anthony Robbins

According to the New York Times, President Obama will create an Atrocities Prevention Board. You might well ask, what has this to do with public health? I might have had the same thought except for a Commentary that my co-editor and I published in the Journal of Public Health Policy. Elihu Richter, an old friend and colleague in environmental health - a mentee of the late Irving Selikoff, in fact - first explained why genocide prevention is public health. It was a struggle to get him to write on the topic, so we designed a harmless ruse. How about a book review of Paul Rusesabagina's An Ordinary Man, the story of genocide in Rwanda?

Richter said yes, and his Commentary "Genocide: Can We Predict, Prevent, and Protect?" retells critical parts of the story in Rwanda plus the genocides in Darfur, in Europe against Jews, and against Armenians. He also suggests approaching genocide as we do other public health issues: monitoring for warning signs of outbreaks and acting preventively:

We now know, from studying the timelines of many genocides, that there are early warning signs, and that there are circumstantial, extrinsic predictors and intrinsic initiators, triggers, and tipping points (8). But as neat as all this sounds, we are left with the paradox of prevention in the real world: if there are costs associated with
successful intervention, we only the count the former.

The proposal to criminalize and prosecute incitement by state authorities and their funded or protected surrogates is an example of applying the precautionary principle - environmental medicine's gift to genocide prevention (9). Policy towards genocide needs to move from interventions based on proof of intent after the event to actions to predict and prevent. The case for application of the precautionary principle to the prevention of genocide derives from the fact that the consequences of doing nothing - a false negative - are catastrophically greater than intervention triggered by early warning signs which turn out to be false positives.

Scholars have proposed odds ratios for certain circumstantial predictors and risk factors for genocide: past genocides, frequent internal wars and regime crises, authoritarian governments, exclusionary or racist ideologies, exclusion of political parties, a history of past warfare and defeats, vulnerable minorities with elite status, and low openness to external trade (10,11). Any of these may be warning signs calling for interventions that may employ a mix of political, economic, social, and military carrots and sticks...

Richter suggests roles in genocide prevention for epidemiologists and other public health professionals:

First, epidemiologists should ensure that standards similar to those for rapid investigation of reports of communicable disease outbreaks are applied to reports of atrocity crimes and incitement - clearly the next role for WHO's Injury Prevention Programs. Previously, the UN's sloppy investigation of the genocide in Darfur had the effect of manufacturing doubt concerning the results of a far more rigorous investigation by the US State Department, a study that did find that there was a pattern of organized intent to destroy a population ''in whole or in part''.

Second, we in public health should be vigilant against the hijacking of medical metaphors to dehumanize - a highly specific early warning sign. Epidemiologists should lead the way in setting up an international surveillance network modeled after the systems for monitoring and reporting warning signs of epidemic diseases for monitoring hate language and incitement in state-sponsored media, textbooks, and places of worship. These systems need to be insulated from political pressures and use standardized diagnostic criteria that are defined in advance.

Third, we in public health should aim to broaden classic definitions of genocide to include ecocide - the destruction of life, reproductive capacity, and habitat of populations resulting from wanton or reckless industrial practices. Should ecocide be classified as a crime against humanity?

Fourth, we have a responsibility, as individuals, and as organized professionals, to not be passive bystanders, but to speak out publicly on genocidal threats. I take strong exception to the notion that speaking out on such threats, if based on a careful review of the evidence, is somehow a slide down the slippery slope of politicization. Not to speak out is to slide down that slippery slope. One lesson of the Holocaust: silence makes one a complicit bystander to genocide.

We commend Richter's Commentary to the President and those who will be on the Atrocities Prevention Board, but also to all of our colleagues in public health who can lend to this worthy cause our experience in prevention.

Anthony Robbins, MD, MPA is a Professor of Public Health at Tufts University School of Medicine and co-editor of the Journal of Public Health Policy. He directed the Vermont, then the Colorado, state health departments and the National Institute for Occupational Safety and Health before serving as professional staff to the House Energy and Commerce Committee.