DENVER—Few human undertakings have had such apparent and ceaseless negative impacts on human health and wellbeing as violent conflict. War might seem such an obvious assault on overall public health that it would hardly bear discussing at a scholarly meeting on that subject. But a slew of researchers are working around the globe to uncover some of the hidden aspects of contemporary warfare’s affronts to public health.

In the past 150 years, technology has helped to do away with the mass slaughter of soldiers like those on the battlefields of World War I. At the same time, however, the proportion of civilians killed in conflict has skyrocketed, from some 10 percent during the Civil War to close to 90 percent in some contemporary conflicts, Barry Levy, an adjunct professor of public health at Tufts University School of Medicine, noted here November 8 at the American Public Health Association’s 138th annual meeting. In fact, he said, “targeting civilians has become a strategy in many wars” today.

Aside from outright killing, broader civilian public health suffers during conflicts in large part due to the spectacular destruction war and unrest can bring on basic health, sanitation and environmental infrastructure. Hospitals get looted, and people are displaced—often into makeshift encampments that lack basic medical services and reliably clean water, Levy noted.

But modern warfare also works in less visible ways to undermine public health. Here are four offshoots of war that often fly under the radar:

Fueling illness
Jet fuel is an impressive chemical creation, but it is also made up of some nasty stuff. As Levy pointed out, keeping military jets, choppers and other aircraft aloft around the world leaves a cloud of hydrocarbons, sulfur dioxide and nitrogen oxides, which have been linked to respiratory and cardiovascular disease as well as cancer.

But it isn’t just the militarized regions that might suffer from the smog of war. Areas where the fuel is manufactured are also suspected to be at higher risk for negative health outcomes. A recent study found that people who live hundreds of miles downstream from a Las Vegas-area factory that makes the jet fuel component perchlorate have higher levels of the chemical in their urine. And that can lead to developmental and thyroid disorders, explained Paul English of the California Department of Public Health’s Environmental Health Investigation Branch.

Remote wounds
The arrival of remote-operated aircraft has given rise to new questions about the morality—and legality—of killing suspected insurgents with the press of a button thousands of miles away, noted Victor Sidel, professor of Social Medicine at Albert Einstein College of Medicine. In addition to the hundreds of estimated civilian casualties from the strikes, he explained, the act of such removed killing is likely to have a negative effect on the personnel, military or CIA, who carry it out. “Clearly the people who operate these planes are put in a terrible moral position,” he said. In contrast to deployed pilots, many of these individuals are living at home, where faced with the question, what did you do at work today, might have to say: “Well, I pushed these buttons and killed all of these people,” Sidel said. Anecdotal reports have suggested that these remote pilots, who actually get a much more detailed view of their targets than most fighter pilots, have higher burnout rates and suffer from the so-called whiplash transition after being seeing such vivid attack images then attempting to rejoin family life after work each day.