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Terrorism is a complex public health problem and it requires a systems approach
(November 2004)

Our world is beset with threats of and actual acts of terrorism. The situation is bad and it is getting progressively worse with the increasing concern that biological agents and nuclear bombs will be added to the conventional weapons now in use. Since such attacks are directed primarily at civilians and since there are usually many more injured than are killed outright, terrorism is clearly also a medical and public health problem. Therefore, as a topic, it belongs on a health promotion website.

Total prevention of terrorism is almost impossible. To minimize such acts requires a broad, holistic systems approach that befits a complex problem or issue. In contrast, the current approach of the United States, and other nations, is simplistic and linear. It is as follows:

Find the terrorists, kill or inactivate them, and, by so doing, hopefully, reduce the number of terrorists or the number of terrorist acts.

That approach is appropriate for rogue nations, criminals, fanatics, and some mentally disturbed individuals, but it often will fail because, in most cases, for every terrorist or terrorist cell or terrorist group that is dealt with, others will take their places unless we attend to the variables (factors) that underlie the development of terrorism and terrorists.

The following is a list of some of these variables that create a setting from which terrorism arises:

1. Climate-related issues, including global warming and the consequent very large numbers of refugees and displaced persons.

2. Population issues as population increases by 50 percent to 9 billion by the year 2050. These include: depletion of natural resources with resulting misery and poverty; crowding in unhygienic slums; animosities resulting from competition for water, land, and food.

A warmer climate with billions more people (almost all the increase in areas called developing) could produce hundreds of millions of refugees, massive under nutrition, emerging infection epidemics, grinding poverty and misery that, together, create the conditions in which resentment, rage, and desperation lead to support for terrorism and terrorist acts.

3. Acts of desperation by oppressed peoples. These are likely to be accentuated by global warming and population growth.

4. Revenge for “collateral damage” during wars. It is the angry relatives of innocent civilians who may become terrorists as seen in Chechnya and Palestine. This is also likely to be true in Iraq where there are tens of thousands of civilian casualties.

5. Reaction to oppressive regimes or against those who support such regimes. Supposedly, the latter, in part, set bin Laden off on his murderous rampage.

6. Religious issues. Awful slaughter has been done in the name of religions. If certain religions believe that non-believers cannot get to heaven and getting to heaven is the only important value, then it is easier for some fanatics within those religions to believe that slaughter of non-believers is acceptable behavior. The same is true of fanatics who believe in alleged doomsday prophecies that are coupled with entry into heaven.

Then, there is hate, envy, and perceived grievances (valid or not). And, terrorism is abetted by the inexorable march of science, giving us new technologies that can create awful biologic weapons or hideous bombs. Unfortunately, technologies that can be a boon to mankind are often also used to kill. That is true of: airplanes and ships; nuclear energy; advances in microbiology; and it will probably be true decades hence for nanotechnology.

Those using a systems approach would take all these variables, and others, include them all in a circular diagram with arrows pointing out their interrelationships. Thinking in systems terms and drawing a systems diagram allows one to figure out leverage points in the system where it can be beneficially altered.

In regard to terrorism, in addition to going after terrorists and consistent with a systems approach, we could take other constructive action. For example:

- We should be doing a lot more to prevent global warming.

- We should be providing much more encouragement for family planning around the world, increasing our funding by a lot and not putting stupid restrictions on programs.

- The United States could lead an international effort to provide everyone with safe water, immunizations, adequate sanitation, and adequate food. That worldwide effort would cost about $50 to $80 billion a year, a relatively small amount that could change attitudes and perceptions dramatically and reduce the ability of terrorist organizations to recruit (of course, if we are going to provide everyone else with immunizations, it would be nice if we managed to provide our own population with adequate influenza vaccine).

There are obviously other actions we could take. The point to emphasize is that terrorism is a complex issue and needs more than a bunch of simplistic measures. It needs a systems approach and imaginative ways of creating an environment in which terrorism and terrorists are less likely to arise or succeed.

There is another variable that everyone ought to think about very carefully. The United States is unrivaled in regard to military weapons. But, our military and supporting politicians are not satisfied. They are afraid that, in future decades, some nation might challenge us with sophisticated weapons. So, we are developing a whole new array of incredible weapons with astonishing computer capabilities: bombers; fighters; attack helicopters; unmanned reconnaissance and attack planes, bunker busting bombs, including nuclear bombs, and also massively destructive lasers and electromagnetic pulse weapons; and we are going to militarize space. Nobody will be able to challenge us in battle. In time of conflict, what will be left to our adversaries? One way to partially neutralize our fire power is to make us fight in cities, street by street, as is happening in Iraq. Another way is to attack us with a variety of terrorist weapons unleashed on civilians here and overseas, including bombs, dirty bombs, nuclear devices, biologic weapons, and, when available, ferocious nanotechnology weapons. Terrorism, now still relatively infrequent, could well become the norm for our adversaries who do not have our firepower - and it will be ever more sophisticated and lethal. Paradoxically, our military strength could inflict ever greater damage on ourselves.

It is a depressing scenario. Unfortunately, it is a realistic one and can, in my judgement, only be avoided by less focus on better ways to kill and more focus on a systems approach with constructive actions that will create a climate less conducive to terrorism and terrorist acts.