During war, the news media often focus on civilian injuries and deaths due to explosive weapons. But the indirect health impacts of war among civilians occur more frequently—often out of sight and out of mind. OUPblog - Academic insights for the ...
During war, the news media often focus on civilian injuries and deaths due to explosive weapons. But the indirect health impacts of war among civilians occur more frequently—often out of sight and out of mind.
These indirect impacts include communicable diseases, malnutrition, exacerbations of chronic noncommunicable diseases, maternal and infant disorders, and mental health problems. They are caused primarily by forced displacement of populations and by damage to civilian infrastructure, including farms and food supply systems, water treatment plants, healthcare and public health facilities, and networks for electric power, communication, and transportation.
Increasingly, damage to civilian infrastructure is caused by targeted attacks—as a strategy of war, resulting in reduced access to food, safe drinking water, healthcare, and shelter. When water treatment plants and supply lines are damaged during war, people often have no choice but to drink water from sources that may be contaminated with microorganisms or toxic substances. Healthcare facilities have been increasingly targeted during war; for example, during the first 18 months of the war in Ukraine, there were 1,014 attacks on healthcare facilities, which injured and killed many patients and healthcare workers, and caused much damage, which reduced access to healthcare for many people.
Globally, there are now more than 108 million people who have been displaced from their homes, many as a result of war. Most of these displaced people have been internally displaced within their own countries, often facing greater health and security risks than refugees, who have fled to other countries. And during war, many more people live in continual fear that they may be forcibly displaced.
Major categories of communicable diseases during war include diarrheal diseases and respiratory disorders. These diarrheal diseases result mainly from decreased access to safe drinking water and reduced levels of sanitation and hygiene, leading to increased fecal-oral transmission of bacterial and viral agents. Among respiratory disorders, measles is of great concern because it is highly contagious and associated with high mortality rates among unimmunized children. Another major concern is tuberculosis, which can spread easily among war-affected populations and is difficult to treat without continuity of care. Crowding in bomb shelters, refugee camps, and other locations during war facilitates the spread of both diarrheal diseases and respiratory disorders. Disruption of public health services leads to reduced access to immunizations and reduced resources to investigate and control outbreaks of communicable disease. During war, bacterial resistance to antibiotics increases because people have decreased access to antibiotics and therefore take inappropriate antibiotics or shortened courses of treatment.
Malnutrition often increases during war, thereby increasing the risks of acquiring and dying from many communicable diseases. Infants and children are at greatest risk of becoming malnourished and suffering from its adverse health consequences. Micronutrient deficiencies during pregnancy can lead to birth defects. And severe malnutrition during war can increase the risk of hypertension, coronary artery disease, and diabetes in later life.
During war, exacerbations of preexisting cases of noncommunicable disease increase, mainly because of reduced access to medical care and medications for treating common chronic diseases. For example, a survey by the World Health Organization in Ukraine in 2022 found that about half of the respondents experienced reduced access to medical care and almost one-fourth could not acquire necessary medications that they needed. Without these medications, people with hypertension were at increased risk of myocardial infarction and stroke, people with asthma were at increased risk of life-threatening attacks, people with diabetes were at increased risk of serious complications, and people with epilepsy were at increased risk of seizures.
War exerts adverse effects on reproductive health. Access to prenatal care, postpartum and neonatal care, and reproductive health services are frequently decreased. As a result, complications of pregnancy, including maternal deaths, occur more frequently and there are increased rates of infant deaths and of infants being born prematurely or with low birthweight.
Mental and behavioral disorders occur more frequently during war, including posttraumatic stress disorder (PTSD), depression and anxiety, alcoholism and drug abuse, and suicide. There are many contributing factors to increasing the risk of these disorders, including physical and sexual trauma, witnessing of atrocities, forced displacement, family separation, deaths of loved ones, loss of employment and education, and uncertainty about the future.
Violations of human rights and international humanitarian law occur frequently during war. In addition to those already mentioned, these violations include gender-based violence, summary executions, kidnapping, denial of humanitarian aid, and use of indiscriminate weapons, such as antipersonnel landmines.
The possible use of nuclear weapons represents a profound threat whenever nuclear powers are engaged in war, partly because these weapons could be launched by accident or because of misinterpretation or miscommunication. Even a small nuclear war could cause huge numbers of deaths and severe injuries and could lower temperatures globally, leading to widespread famine.
Environmental damage during war can result from chemical contamination of air, water, and soil; presence of landmines and unexploded ordnance; release of ionizing radiation from nuclear power plants or conventional weapons containing radioactive materials (“dirty bombs”); destruction of the built environment; and damage to animal habitats and ecosystems. In addition, war and the preparation for war consume large amounts of fossil fuels, which generate greenhouse gases, which, in turn, cause global warming.
Protection of civilians and civilian infrastructure during war and improved humanitarian assistance can reduce the indirect health impacts of war. But the only way to eliminate these impacts is to eliminate war. The risk of war can be reduced by resolving disputes before they turn violent; by reducing the root causes of war, such as socioeconomic inequities, militarism, ethnic and religious hatred, poor governance, and environmental stress; and by strengthening the infrastructure for peace. Peace can be achieved and sustained by rehabilitating nations and reintegrating people after war has ended, strengthening civil society, promoting the rule of law, ensuring citizen participation, and holding aggressors accountable.
Barry S. Levy is the author of From Horror to Hope: Recognizing and Preventing the Health Impacts of War (Oxford University Press, 2022). He is an Adjunct Professor of Public Health at Tufts University School of Medicine and a past president of the American Public Health Association.
What are we doing here? What’s the point of existence?
Traditionally, the West has been dominated by two very different answers to these big questions. On the one hand, there is belief in the traditional God of the Abrahamic faiths, a supreme being who created the universe for a good purpose. On the other hand, there is the meaningless, purposeless universe of secular atheism. However, I’ve come to think both views are inadequate, as both have things they can’t explain about reality. In my view, the evidence we currently have points to the universe having purpose but one that exists in the absence of the traditional God.
The theistic worldview struggles to explain suffering, particularly in the natural world. Why would a loving, all-powerful God choose to create the North American long-tailed shrew that paralyses its prey and then slowly eats it alive over several days before it dies from its wounds? Theologians have tried to argue that there are certain good things that exist in our world that couldn’t exist in a world with less suffering, such as serious moral choices, or opportunities to show courage or compassion. But even if that’s right, it’s not clear that our creator has the right to kill and maim—by choosing to create hurricanes and disease, for example—in order, say, to provide the opportunity to show courage. A classic objection to crude forms of utilitarianism considers the possibility of a doctor who has the option of kidnapping and killing one healthy patient in order to save the lives of five other patients: giving the heart to one, the kidneys to another, and so on. Perhaps this doctor could increase the amount of well-being in the world through this action: saving five lives at the cost of one. Even so, many feel that the doctor doesn’t have the right to take the life of the healthy person, even for a good purpose. Likewise, I think it would be wrong for a cosmic creator to infringe on the right to life and security of so many by creating earthquakes, tsunamis, and other natural disasters.
Looking at the other side of the coin, the secular atheist belief in a meaningless, purposeless universe struggles to explain the fine-tuning of physics for life. This is the recent discovery that for life to be possible, certain numbers in physics had to fall in a certain, very narrow range. If the strength of dark energy—the force that powers the expansion of the universe—had been a little bit stronger, no two particles would have ever met, meaning no stars, no planets, no structural complexity at all. If, on the other hand, it had been significantly weaker, it would not have counteracted gravity, and the universe would have collapsed back on itself a split second after the big bang. For life to be possible, the strength of dark energy had to be—like Goldilocks’ porridge—just right.
For a long time, I thought the multiverse was the best explanation of the fine-tuning of physics for life. If enough people play the lottery, it becomes likely that someone’s going to get the right numbers to win. Likewise, if there are enough universes, with enough variety in the numbers in their ‘local physics,’ then statistically it becomes highly probable that one of them is going to fluke the right numbers for life to exist.
However, I have been persuaded by philosophers of probability that the attempt to explain fine-tuning in terms of a multiverse violates a very important principle in probabilistic reasoning, known as the “Total Evidence Requirement.” This is the principle that you should always work with the most specific evidence you have. If the prosecution tells the jury that Jack always carries a knife around with him, when they know full well that he always carries a butter knife around with him, then they have misled to jury—not by lying, but by giving them less specific evidence than is available.
The multiverse theorist violates this principle by working with the evidence that a universe is fine-tuned, rather than the more specific evidence we have available, namely that this universe is fine-tuned. According to the standard account of the multiverse, the numbers in our physics were determined by probabilistic processes very early in its existence. These probabilistic processes make it highly unlikely that any particular universe will be fine-tuned, even though if there are enough universes one of them will probably end up fine-tuned. However, we are obliged by the Total Evidence Requirement to work with the evidence that this universe in particular is fine-tuned, and the multiverse theory fails to explain this data.
This is all a bit abstract, so let’s take a concrete example. Suppose you walk into a forest and happen upon a monkey typing in perfect English. This needs explaining. Maybe it’s a trained monkey. Maybe it’s a robot. Maybe you’re hallucinating. What would not explain the data is postulating millions of other monkeys on other planets elsewhere in the universe, who are mostly typing nonsense. Why not? Because, in line with the Requirement of Total Evidence, your evidence is not that some monkey is typing English but that this monkey is typing in English.
In my view, we face a stark choice. Either it is an incredible fluke that these numbers in our physics are just right for life, or these numbers are as they are because they are the right numbers for life, in other words, that there is some kind of “cosmic purpose” or goal-directedness towards life at the fundamental level of reality. The former option is too improbable to take seriously. The only rational option remaining is to embrace cosmic purpose.
Theism cannot explain suffering. Atheism cannot explain fine-tuning. Only cosmic purpose in the absence of God can accommodate both of these data-points.
One of the greatest public health challenges of our century lies in the growth of neurodegenerative disorders. Conditions such as Alzheimer’s disease, Parkinson’s disease, and frontotemporal dementia stand as major contributors to disability and mortality in affluent and under-resourced nations alike. Currently affecting over 55 million individuals, their prevalence is expected increase significantly by 2050—especially in less developed countries, where risk factors are most impactful and mainstream clinical approaches least developed.
Language research in the fight against neurodegeneration
Against this background, researchers from various fields are searching for new, affordable, and scalable digital innovations to facilitate diagnosis and other clinical tasks across the globe. Speech and language assessments have emerged as crucial tools, offering robust insights for detecting, characterizing, and monitoring these diseases. For instance, individuals with Alzheimer’s often struggle with word retrieval, experience difficulties in constructing grammatically complex sentences, and exhibit challenges in understanding or expressing figurative language. These linguistic deficits appear in early and preclinical disease stages, differentiate Alzheimer’s from other forms of dementia, allow predicting the onset of core symptoms, and even capture brain anomalies that typify the disorder.
These clinical applications can be boosted through artificial intelligence tools. New digital technologies allow capturing specific alterations in recorded or written language samples in a non-invasive, patient-friendly, and cost-effective way. Such is the type of solution required to reduce clinical disparities across low-, middle-, and high-income countries. Multicentric research initiatives, large grants from leading funding agencies, and science-based companies are spearheading exciting projects to validate and expand this novel framework. However, a critical challenge looms large: the lack of linguistic diversity in the field threatens its scalability and undermines its potential for more equitable testing worldwide.
Disorders of language vs. disorders of languages
The field is marked with inequities. Less than 0.5% of the world’s 7,000 languages have received any attention in this research field. Also, although English is spoken by roughly 17% of the world’s population, it accounts for nearly 70% of all published studies on speech and language in neurodegeneration. Moreover, large language models and feature extraction tools are available for only a handful of languages. Of course, none of this would be a major issue if links between language anomalies and brain dysfunctions were universal across the world’s languages—if that were the case, we could rely on the abundant findings from English and apply them to patients worldwide, irrespective of their language. Unfortunately, the reality is much more complicated.
As it happens, cross-linguistic differences deeply influence the presentation of speech and language symptoms, challenging the universality of existing diagnostic criteria and candidate disease markers. For instance, a sentence production study showed that Italian-speaking persons with Alzheimer’s could be identified by their tendency to omit subjects, a phenomenon notably absent in their English-speaking counterparts. The distinction lies in the inherent structure of the languages. Unlike English, Italian allows deducing sentence subjects from verb conjugations (the Italian verb ‘camminiamo’ inherently implies a first-person plural subject, whereas the English verb ‘walk’ requires a preceding ‘we’ to convey the same meaning). More strikingly, linguistic anomalies may be diametrically opposed between languages. For example, research on Alzheimer’s shows that different pronouns (words like ‘I’, ‘their’, ‘ours’) tend to be overused among English-speaking patients and underused in Bengali-speaking patients—relative to healthy speakers of the same languages. This, too, likely reflects differences between both languages, as Bengali grammar includes many more (and morphologically more complex) pronouns than English. Succinctly, the linguistic markers that may signal a given disease among speakers of one language may not be relevant among speakers of another language.
Taking action
These findings underscore the need to consider language diversity when examining the linguistic impact of neurodegenerative conditions. Such is the call we raised in our recent article in Brain (García et al., 2023). Researchers must broaden the representation of languages, incorporating diverse linguistic communities to identify shared and distinguishing properties. Multicentric collaborations, harmonized protocols, and cross-linguistic tools must be forged for a more inclusive and comprehensive understanding of neurodegeneration across regions and cultures. The path forward requires overcoming core challenges, such as establishing robust pipelines for comparing outcomes across languages, disentangling linguistic and non-linguistic sources of heterogeneity, and securing funds for language research across underrepresented regions. Ideally, local-global connections should be prioritized to integrate country-specific needs and resources with leading worldwide trends.
Promisingly, strategic efforts are being made in this direction. Consider, for example, the International Network for Cross-Linguistic Research on Brain Health (Include). Supported with initial funds from the Global Brain Health Institute, the Alzheimer’s Association, and the Alzheimer’s Society, Include aims to foster trans-regionally equitable approaches to language-based neurodegeneration research. The network has grown continually since its launch in November 2022. It now has over 140 members spanning 80 centers sites across 30 countries. Five network-wide projects are being run, targeting diverse phenomena across multiple languages in large cohorts of persons with Alzheimer’s, Parkinson’s, and frontotemporal dementia variants. Include is also leading awareness-raising actions, such as the Language Diversity and Brain Health webinar series, hosted in collaboration with the Bilingualism, Languages, and Literacy Special Interest Group of the Alzheimer’s Association’s Diversity and Disparities Professional Interest Area. Initiatives like these can make a difference towards fairer language-based research on brain dysfunctions.
The bottom line
Speech and language assessments hold a valuable key to unlocking generalizable insights on neurodegeneration. To harness their full potential, however, we must bridge the linguistic gap in research, embracing more diverse samples and more inclusive practices. These actions are vital to ensure that valuable tools for equitable brain health assessments do not turn into a new source of global inequity.
Many older adults struggle with isolation and loneliness. Could cats be the solution? At the same time, many humane societies have more cats to rehome than they can manage. Could lonely older adults be the solution?
Researchers at the University of Georgia and Brenau University developed a novel program where older adults were paired with a foster cat coming from a local humane society, with the opportunity to adopt. A Human-Animal Bond Research Institute (HABRI)-funded feasibility study explored the impact of this program on the older adult participants and the cats. Researchers explored how fostering a shelter cat could impact loneliness and well-being in older adults living alone. They also wanted to learn if these older adults would be more likely to adopt their foster cat after common barriers, such as pet deposit fees, were paid by the study. Could it really be a win-win situation?
The study enrolled adults aged 60 and older living alone and without any pets. Participants completed health surveys before placement with cats and completed follow-up surveys at 1-month and 4-months post-placement. Participants could choose to adopt their foster cat any time between 1- and 4-months post-placement. If participants chose to adopt their foster cat, the study paid the adoption fee, and a 12-month post-placement survey was completed.
Findings from the study revealed that loneliness scores significantly decreased at the 4-month mark after the cat fostering began. A similar 4-month improvement that approached statistical significance was observed for mental health. However, at the 12-month follow-up, loneliness scores were no longer statistically significant. The researchers suggest that these one-year reports were impacted by the COVID-19 pandemic, which resulted in a substantial proportion of older adults experiencing elevated levels of loneliness.
Alexis Winger and Ambi
Alexis states that before she got Ambi, “I lived alone, and the loneliness was becoming oppressive. Ambi has brought an end to oppressive loneliness. There are still times when I am away from people too long, when I have no one to talk to and lonelines settles in, but then Ambi settles into my lap or just runs through the room, and I am not alone. Ambi has brought me smiles, laughter, responsibility and love.”
The day that Alexis picked out Ambi at the Athens Area Humane Society to foster. Alexis states “I didn’t expect to find a cat for me at the first visit, but as I walked in, my eyes connected with hers in the end cage. The minute she was in my arms, she was mine.”
This is a picture and text message that Alexis sent to Sherry Sanderson, one of the researchers in the study, during the Pandemic.
Photo Credit: Alexis Winger
Alexis still gets lonely occasionally, but it is not the oppressive loneliness she felt before she got Ambi. Alexis says “Ambi has brought me an end to oppressive loneliness.”
Photo credit: Photo and text message Alexis Winger sent to Sherry Sanderson.
What about the cats? Almost all (95.7%) of study participants decided to adopt their foster cat at the completion of the study. Dr. Sherry Sanderson, the team lead and Associate Professor at the University of Georgia’s College of Veterinary Medicine, noted: “Our results show that by removing some perceived barriers to pet ownership, including pet deposit fees, pet adoption fees, pet care supplies and veterinary support, we can not only help older adults live healthier, happier lives but we can also encourage the fostering and adoption of shelter cats into loving homes”.
Dr. Kerstin Emerson, a Gerontologist in the College of Public Health’s Institute of Gerontology, Health Policy & Management at the University of Georgia, and an investigator from the study states, “In May of 2023, the U.S. Surgeon General stated that loneliness and isolation is an epidemic in this country, and their report placed an emphasis on the urgent need for a cure.” Dr. Don Scott, a Geriatrician and Campus Director of Geriatrics and Palliative Care from the Augusta University-University of Georgia Medical Partnership and also a researcher from the study, added, “The ill effects of loneliness and social isolation, particularly for older adults, are well-documented, and more strategies are needed to improve health outcomes for this population.” The investigators from this study plan to do a larger scale study. The hope is when an older adult seeks to prevent or ward off loneliness and isolation, they will collaborate with a support team prepared to explore feline companionship as part of an individualized holistic approach to care, and there will be programs in place and funding available to support this new approach to treating loneliness in older adults.
Judith Atkins and Bashi
Judith is semi-retired from nursing, but she still provides nursing care to some of the residents in the Senior Living Residence that she lives in. When recently asked what Bashi means to her, Judith sent back the following reply:
“He (Bashi) has been a comfort to two of my neighbors. While providing nursing care to a resident who was in hospice care, Bashi stayed with her until she died. I also took him to visit a resident with cancer and breathing problems when I went to visit. I also took Bashi to the nursing home to visit two people I took care of there.”
Judith went on to say, “He still enjoys catching balls and batting them into the hall closet, continues to steal straws from my drinks and claims all boxes. Best of all, he still likes my left shoulder to put his head on to make sure his world is okay. At night at times, I find him asleep on a pillow by my head. His love of people is unlimited, and he will try and go in any apartment with the door open to be loved on by strangers. He escapes into the hall to force me to exercise chasing him, and needless to say he is always the winner.”
Judith was ready to enroll in the study just days before the Pandemic occurred, and the Foster Cat Study was shut down for six months. Once the study resumed, participants were no longer allowed to go to the shelter to pick out their cats to foster. Rather Dr. Sanderson, would go to the shelter and send them pictures and videos of available cats they may be interested in. The picture on the left is from the very first time Judith met Bashi in her apartment. The picture on the right shows that their Human-Animal Bond remains strong. Photo credit: Sherry Sanderson
Judith and Bashi getting ready to make the rounds in the building to visit people. Photo credit: Sherry Sanderson
Judith and Bashi love to hold birthday parties at the Senior Living Residence where they both live. Here are pictures from Bashi’s second birthday party. Photo credit: (L) Sherry Sanderson; (R) Judith Atkins
1:1s are crucial in promoting positive outcomes such as increased employee engagement, higher retention rates, more innovation, and overall success for the team member, manager, and organization. A lot of focus is placed on the manager’s role in orchestrating 1:1s, where they are responsible for addressing direct reports’ practical and personal needs. However, it is also important to recognize that direct reports have agency in 1:1s and should play an active, not passive, role in the effectiveness of these meetings. When direct reports feel empowered to seek help, there are benefits to both the individual and organization.
As an employee, you need to take an active role in your 1:1s to get the most out of them. These 10 key behaviors are critical in making sure you are receiving the help that you need to grow in your career:
Know what you need: be ready to discuss your own needs, hopes, and goals, not just what you think you should say to your manager.
Be curious: do not just have a curious mindset, but also engage in curious behaviors such as asking questions, listening, and challenging yourself to discover new things.
Build rapport: get to know your manager on a personal and professional level by learning about their interests.
Actively engage: get the most out of your meeting by doing things like asking questions, expressing yourself, taking notes, and paying attention to non-verbal communication like maintaining good eye contact.
Communicate well: strive to be clear, concise, focused, honest and pay attention to voice infliction and tone. For difficult conversations, consider practicing before bringing them to your manager.
Problem solve: come to your 1:1 not only with your problems but also possible solutions. Be ready to constructively discuss counterarguments and differing viewpoints.
Ask for help (constructively): seek assistance from your manager that encourages independent problem solving. This includes asking to recommendations or help of others when your manager cannot assist you.
Ask for feedback: ask specific questions that focus on receiving suggestion on future behaviors such as “I want to improve at X, do you have any suggestions on how to get better at this?”
Receive feedback well: show that you are appreciative of the feedback by thanking your manager and asking further questions about issues that were raised.
Express gratitude: let your manager know you are grateful for their time and feedback.
Finally, as you proceed with these behaviors, it is important to keep in mind the science around asking for help. Namely, help-seeking behaviors have been categorized by social psychologists into two main types: autonomous help-seeking and dependent help-seeking.
Autonomous help-seeking can be understood as seeking information that enables individuals to be independent, accomplish tasks, and solve problems on their own. This tends to promote long-term independence—similar to the adage, “Give a person a fish and they’ll eat for a day but teach them to fish and they’ll eat for a lifetime.”
Dependent help-seeking, on the other hand, refers to searching for a “quick fix” and an “answer” from someone else. This style of help-seeking conserves time and effort and leads to immediate gratification, but typically doesn’t yield long-term self-sufficiency. Interestingly, job performance ratings have been shown to have a positive relationship with autonomous help-seeking, but a negative relationship with its counterpart—dependent help-seeking.
Bottom line: do your part in the 1:1 to maximize its value to you and approach it as an opportunity to learn to be the best you can seeking meaningful insights that enable you to thrive and grow both short-term and long-term.
