Llately I have been thinking about the underreported or overlooked health consequences of war. The effects too complicated or dull to deserve a TED Talk or a spot on the evening news. One area that keeps coming up in my mind is the budgetary trade-off between security and health care provision.
Faced with an armed threat to their sovereignty or the survival of their regime, governments often prioritize defense spending over social service spending. Governments always face dueling pressures for allotting spending between “guns vs. butter”. However, during civil wars spending priorities often swing heavily in favor of the military. Military spending has been found to rise from (on average) 2.8 percent of GDP during peacetime to five percent during civil war. This has direct, negative impacts on health system budgets. During the Spanish civil war, the republican government created a Ministry of Health and Social Care to provide health services to citizens and prevent wartime epidemics, however “the military campaign drained public funds and the financial resources of the Ministry were tiny” (Baron and Perdiguero-Gil 2008, 108). A similar focus on the military has been documented in Mozambique, where government spending on health decreased from 10.7% to 4.6% during a five period in the war. Peroff and Podolak-Warren (1979) conducted a time-series analysis of appropriation requests by the US government between 1929 and 1979. They found some evidence of a trade-off in public expenditures relating to conflict, with Vietnam War producing the greatest effect during the study period. Apostolakis (1992) later conducted a more thorough analysis, using time-series data from nineteen Latin American countries between 1953 and 1987. The analysis found strong evidence of a trade-off between military spending and health. For example, every dollar increase in Argentinian military expenditures decreased health spending by 31 cents. Recently there has been renewed interesting in this trade-off. In an analysis of government spending during both intrastate and interstate wars, Iqbal (2010) found that states often favor defense spending over health care spending and that the effect is influenced by the severity of the conflict. Governments involved in minor conflicts increase the percentage of total government expenditures used for military spending by six percent, while they decrease the percentage for health spending by two percent. This represents a 25 percent decrease in health care expenditures. During major conflict the change was only more pronounced, with military and health expenditures as a percentage of total government expenditures increasing 12 percent and decreasing four percent, respectively — representing a 50 percent decrease in health expenditures.
Photo Credit: Clarissa
Christopher R. Albon is a political science Ph.D. specializing in armed conflict, public health, human security, and health diplomacy.
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{ 2 comments }
Chris
Does the pedulum swing back afterwards? Does spending direct to other-than-health reconstruction after the conflict?
Hey, Chris, this is an important question. However, it’s important to note that spending on health care by other actors – namely international donors and humanitarian agencies/NGO’s – vastly increases during most of today’s wars. You essentially get a situation where government doesn’t have to spend on health care because someone else is doing it for them (albeit in a piecemeal fashion that doesn’t really provide great coverage for the entire society).
TEJ’s question is super-important as well. In Congo, what we’ve seen is that health care spending has not reverted (although it was spotty to begin with), but rather that international actors have stayed in place of government, and, in some cases, increased their spending, in order to keep the health care system going.
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