The Cost of War on Public Health: An Exploratory Method for Understanding the Impact of Conflict on Public Health in Sri Lanka

Abstract

PurposeThe direct impact of protracted conflict on population health and development is well understood. However, the extent of a war's impact on long-term health, and the opportunity costs, are less well understood. This research sought to overcome this gap by asking whether or not health outcomes in Sri Lanka would have been better in the absence of a 26-year war than they were in the presence of war.MethodsA counterfactual model of national and district-level health outcomes was created for Sri Lanka for the period 1982 to 2002. At the national level, the model examined life expectancy, infant mortality rate (IMR), and maternal mortality ratios (MMR). At the district level, it looked at IMR and MMR. The model compared outcomes generated by the counterfactual model to actual obtained health outcomes. It looked at the rate of change and absolute values.ResultsThe analysis demonstrated that war altered both rate of change and absolute health outcomes for the worse. The impact was most clearly evident at the district level. IMR was poorer than predicted in 10 districts; of these 8 were outside of the conflict zone. The MMR was worse than expected in 11 districts of which 9 were not in the conflict zone. Additionally, the rate of improvement in IMR slowed as a result of war in 16 districts whereas the rate of improvement in MMR slowed in 9.ConclusionThis project showed that protracted conflict degraded the trajectory of public health in Sri Lanka and hurt population health outside of the conflict zone. It further provided a novel methodology with which to better understand the indirect impact of conflict on population health by comparing what is to what could have been achieved in the absence of war. In so doing, this research responded to two public health challenges by providing a tool through which to better understand the human and opportunity costs of war and by answering a call for new methodologies.

Health status of returning refugees, internally displaced persons, and the host community in a post-conflict district in northern Sri Lanka: a cross-sectional survey

“…Conflicts are increasingly affecting countries with higher incomes and longer life expectancies, resulting in conflict-affected and displaced populations experiencing an elevated burden of chronic diseases [ 4 , 5 ]. Even during the conflict, although not uniformly across the country, Sri Lanka’s life expectancy increased (68 years in 1982 to 72 years in 2009) while overall fertility rate dropped (4.3 in 1970 to 2.3 in 2012), leading to population aging and a higher prevalence of NCDs [ 33 – 35 ].…”

Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem

“…Specifically, over 30 years of prevailed internal political unrest has induced a substantial toll on the healthcare system in the region, as the north and east were the primary conflict zones. The armed conflict adversely affected the projected public health trajectory, resulting in overall worse health outcomes post-war [125], and despite post-conflict healthcare system reconstruction being underway, unmet needs remain. These include water and sanitation systems, access to healthcare facilities, general health awareness programs, lack of basic health knowledge, human resources for health, and inadequate infrastructure.…”

Shadows of Conflict in Northern and Eastern Sri Lanka: Socioeconomic Challenges and a Way Forward

“…The health sector was also impacted, with an estimated 90 percent of vacancies in the specialist cadre and a shortage of medical officers in the province (estimated at 50 percent) (Provincial Planning Secretariat 2009). Compared to the preconflict period, maternal mortality rates (MMr) and infant mortality rates (IMr) worsened Johnson 2017).…”