War as a public health issue

23 May, 2024

BMJ GH: The 12 dimensions of health impacts of war

Dear Neil / HIFA

I thought this would interest the network.

KInd regards


Global rates of armed conflicts have shown an alarming increase since 2008. These conflicts have devastating and long-term cumulative impacts on health. The overriding aim in these conflicts is to achieve military or political goals by harming human life, which is the antithesis of the moral underpinnings of the health professions. However, the profession has rarely taken on a global advocacy role to prevent and eliminate conflicts and wars. To assume such a role, the health profession needs to be aware of the extensive and multiple impacts that wars have on population health. To facilitate this discourse, the author proposes a novel framework called ‘The Twelve Dimensions of Health Impacts of War’ (or the 12-D framework). The framework is based on the concepts of social and environmental determinants of population health. It has 12 interconnected ‘dimensions’ beginning with the letter D, capturing the adverse impacts on health (n=5), its social (n=4) and environmental determinants (n=3). For health, the indices are Deaths, Disabilities, Diseases, Dependency and Deformities. For social determinants of health, there are Disparities in socioeconomic status, Displacements of populations, Disruptions to the social fabric and Development reversals. For environmental determinants, there is Destruction of infrastructure, Devastation of the environment and Depletion of natural resources. A relatively simple framework could help researchers and lay public to understand the magnitude and quantify the widespread health, social and environmental impacts of war, comprehensively. Further validation and development of this framework are necessary to establish it as a universal metric for quantifying the horrific impacts of war on the planet and garner support for initiatives to promote global peace.

The 12 dimensions of health impacts of war (the 12-D framework): a novel framework to conceptualise impacts of war on social and environmental determinants of health and public health


HIFA profile: Saroj Jayasinghe is the Professor of Medicine of the University of Colombo and a consultant physician in the National Hospital of Sri Lanka, Colombo. Professor Saroj Jayasinghe qualified from Faculty of Medicine with MBBS honours from the University of Colombo. He works as a specialist at the National Hospital of Sri Lanka. Recently he was appointed as the head of the Department of Medical Humanities of the University of Colombo, the first such department in the region. He is a HIFA country representative for Sri Lanka. https://www.hifa.org/support/members/saroj sarojoffice AT yahoo.com