Influence of Words as Determinants of U.S. International and Domestic Health Policy: Part I, The

Journal of Allied Health, Fall 2005 by Elwood, Thomas W

A question worth pondering is the extent to which the American invasion of Iraq will have an impact on the nation's soul comparable to what occurred during the conflict in Vietnam. The latter incursion was instrumental in dulling the spark of the national spirit, a form of national soul depletion that lasted for several years. Although it is too soon to predict the outcome, the Iraqi adventure has the potential to produce a similar effect.

The Mob at the Gates

The Mob at the Gates became a paramount concern in the United States as a result of the events of September 11, 2001. Somewhat symbolically, the collapse of the Twin Towers of the World Trade Center in New York City resulted from two commercial airplanes on flight paths originating from the "gateway" Logan International Airport in Boston. The attack in New York and a similar aerial assault on the Pentagon revealed in startling fashion just how permeable this country's borders are to external threats of a terrorist nature.

Powerful words in the form of "al Qaeda" and "weapons of mass destruction" (WMD) were a driving force behind the subsequent invasion of Afghanistan and the military thrust to replace Saddam Hussein as the leader of Iraq. Linking his regime to the threat of future attacks provided the rationale for invading his country. Just as easily, it might have been asserted that Saddam had in his possession chemical or biological agents, but clearly those terms lack the stimulating and provocative effect of WMD.

U.S. troops remain in Iraq two years after arriving in that land, and there does not appear to be an immediate timetable for their withdrawal. The task at hand presently consists of ending the killing and maiming of military personnel and Iraqi civilians by insurgents. Once it became evident that there were no WMD to be found in Iraq, a new term-democracy-began to be used to justify American involvement. This democracy argument was buttressed by concern for a long history of "human rights violations" in Iraq.

The underlying belief expressed by the Bush Administration is that creating a democracy in that country will trigger a chain reaction leading to the production of democratic governments throughout the Middle East. Yet, critics from other countries, particulary in Western Europe, tend to view matters differently. They add another word to the list of reasons why the United States is so interested in Iraq, and that word is "oil."

Somewhat ironically, the use of military force to confront the Mob at the Gates contains within its destructive power the potential to improve health through advances in medicine. Gawande notes that the ratios of killed in action to wounded in action have dropped sharply from one American conflict to the next. During the Revolutionary War (1775-1783), 42% of the number wounded or killed in action were classified in the lethal category. World War II resulted in a 30% lethality of war wounds. Both the Vietnam War and the Persian Gulf War of 1990-1991 produced a lethality figure of 24%. The wars in Iraq and Afghanistan through November 2004 stand at 10%. The most recent decline is due primarily to leaner and more mobile medical units and faster periods of transfer from the battlefield to the hospital, which have reduced the time lag between incurring an injury and reaching surgical care.2