University of Hamburg and WZB Berlin Social Science Center, Germany.
Soc Sci Med. 2024 Oct;359:117252. doi: 10.1016/j.socscimed.2024.117252. Epub 2024 Sep 2.
What are the health effects of violent conflict? It is well known that wars kill civilians away from the battlefield and long after the fighting has stopped. Yet why this happens remains only partially understood. While we have good evidence that factors such as the destruction of infrastructure, political neglect, and the out-migration of health workers - what may be called supply-side factors - negatively affect health outcomes, we know much less about how violence shapes the attitudes and behavior towards healthcare use among civilians exposed to violent conflict - what may be called demand-side factors. Here, I theorize that exposure to violence suppresses civilian demand for healthcare through two mediating channels - mistrust of government institutions and fear of future violence - with adverse consequences for health outcomes, particularly child health. To test this theory empirically, I combine information from over 80,000 interviews conducted in 22 conflict-affected countries in Africa with individual- and context-level measures of exposure to violent conflict. Exposure to violence is associated with significantly lower levels of political trust and increased fear of future violence, which in turn predict lower healthcare utilization, lower immunization rates, and higher infant and child mortality. To fully address the health consequences of armed conflict, it is essential that we better understand the attitudinal and behavioral correlates of exposure to violence.
暴力冲突对健康有哪些影响？众所周知，战争不仅会在远离战场的地方杀死平民，而且在战斗停止很久之后还会继续造成平民伤亡。然而，造成这种情况的原因我们只是部分了解。虽然我们有充分的证据表明，基础设施的破坏、政治上的忽视以及卫生工作者的外流等因素——可以称之为供给侧因素——会对健康结果产生负面影响，但我们对暴力如何影响接触暴力冲突的平民对医疗保健的态度和行为——可以称之为需求侧因素——知之甚少。在这里，我推断，接触暴力会通过两个中介渠道——对政府机构的不信任和对未来暴力的恐惧——抑制平民对医疗保健的需求，对健康结果产生不利影响，特别是对儿童健康。为了从经验上验证这一理论，我将来自非洲 22 个受冲突影响国家的超过 80000 次访谈的信息与个人和环境层面的暴力冲突接触指标相结合。接触暴力与政治信任度显著降低和对未来暴力的恐惧增加有关，而这反过来又预测医疗保健利用率降低、免疫率降低以及婴儿和儿童死亡率升高。要全面应对武装冲突对健康的影响，就必须更好地了解接触暴力的态度和行为相关因素。
