Amy Hagopian joined us ‘On the Soapbox’ to discuss war, public health, the American Public Health Association, and hope. She is professor emeritus at the University of Washington School of Public Health and served on the editorial board of the American Journal of Public Health and as chair of the International Health Section of the APHA. We did not know at the time that I would be transcribing this interview amidst an increasing anti-war movement, this time against a United States war with Venezuela. Amy shared her perspectives in front of a background adorned with art, family photos, a Ceasefire Now poster, and the Armenian flag.
I grew up mostly in upstate New York. When I was a teenager, the war in Vietnam was in full force and I was very drawn to the anti-war movement. I turned thirteen in 1968, which was a pretty pivotal year in that anti-war movement and I found myself organizing demonstrations, joining organizations, organizing my own high school, doing that sort of work. I went off to college in Seattle at the University of Washington and did my undergrad in journalism. It was sort of the Watergate era and journalism was kind of a heroic profession then before certain degradements occurred. Then, I went to grad school in public health. I wasn’t very good at pretending to be objective.
I joined the anti-nuclear weapons movement in Seattle in the 70s and 80s. We have the Trident nuclear submarine here which is 20 miles from downtown Seattle and the biggest nuclear weapons cache in the country. So kind of a remarkable thing that a lot of people know nothing about. We’re also near the Hanford Nuclear Reservation in Eastern Washington where many nuclear weapons were made starting with the bombs we dropped on Nagasaki. The plutonium for the Nagasaki bomb was made at Richland at the Hanford Reservation. They made a giant mess of that large piece of land and displaced Indian tribes and farmers and other people who were living there and contaminated the whole place and are contaminating the Columbia River on which many of us rely for all sorts of things. The military industrial machine in America has prominent locations around the country including your state and mine where they are up to no good.
So, in my public health career I ended up getting a PhD. I’ve dabbled in various sorts of areas of interest all of which I see a common thread, which is, I’m interested in how the maldistribution of power and wealth undermines health and that happens in many different ways and places. My PhD dissertation focused on the migration of health professionals from poor countries to rich countries. Certainly, people have the human right to migrate wherever they wish, in my opinion, and under international law, but when doctors leave poor countries where they were trained, it does also undermine the right to health in those countries. And you know the way to resolve that contradiction is to make the practice of medicine in home countries much more rewarding and interesting and better resourced. People don’t want to naturally leave the countries where they were raised and where the grandparents of their children live and that sort of thing. They do it because they feel driven out by poor working conditions, poor remuneration plans, poor organization, and those are fixable problems, so that was what I was interested in there.
In more recent years I became interested in helping the public health profession understand how war and militarism undermines all sorts of areas of public health that most public health practitioners don’t connect to the origin. And I’d say many state and local health workers in local health departments are busy working on things like homelessness, the opioid crisis, suicide, all these areas of despair without ever connecting it to the, what I think are, underlying causes like the wars we are fighting all over the world. So I have a bit of a campaign to try to help public health connect those dots and pay more attention to these underlying issues, which is supposed to be the bread and butter of public health: thinking about underlying causes.
In some of your previous interviews and writings, you mention conflict epidemiology. I was wondering if you could share a little bit more about that and if that is a concrete way that you see public health practitioners including this understanding of underlying causes in their work.
Conflicts obviously produce a lot of death and distress and disease and health problems of various sorts and I think for those of us who are committed to measuring health problems, the global burden of disease, need to a better job of counting deaths as well as diseases mechanisms we can connect to wars and conflicts on the ground.
I’ve been involved in a few projects along those lines we did. When the U.S. invaded Iraq in 2003, our faculty started to think about what we can do that might be a two track diplomacy sort of thing and we ended up creating a sister university relationship with the University of Basrah in Iraq. We created a friendship and collaboration with a pediatric oncologist and brought her to Seattle. She talked at a conference here and then we helped her process the leukemia data she had been keeping for the entirety of Basrah pediatric leukemia and analyze that data and write a report that was published in the American Journal of Public Health. So, you know, that was a bit of conflict epidemiology.
Leukemia is one of those diseases that results from exposures, but we had no exposure data, so we couldn’t really say anything definitive about what exposures were related to it. But the patterns of leukemia pretty much paralleled the Iran-Iraq war and other exposures that seemed to be associated with conflict that were happening. That led me to get involved in the mortality count that we did in Iraq in 2011. It was published in 2013 in PLOS Medicine, where we did a household survey, a door-to-door survey, trying to measure mortality that we could then relay to a national count. I think it was a useful contribution to the field and you know that accounting for the mortality of a war is not done in all conflicts and should be.
We also did a survey in Baghdad trying to measure injuries associated with the war which included skeletal injuries, burns, you know those sorts of things, and wrote papers about how those mapped onto the war and its various levels of escalation. I am working on a book now called Conflict and Health and will have forty-some chapters from contributing authors on a number of topics, many of which get very little attention in public health. There is so much work to do in this field and yet there is no grant money, there is no career path for young people interested in this work because who would it benefit to finance that kind of work right? So it doesn’t get financed sadly.
I’m excited to read that book, I’ll keep an eye out for it! I read an article that was published on October 7th of this year talking about how the American Public Health Association (APHA) canceled your registration and your membership and barred you from meetings for the next two years. How would you characterize their approach to discussions related to Palestine and what factors do you think shape that approach?
APHA has struggled over the years to take any meaningful position on health justice in Palestine. A small group of us within the association—getting larger, we now have 300 members in our Palestine Health Justice working group—have been trying to pass a resolution through the APHA Governing Council for fifteen years without success. There are forces within APHA that for some reason have been successful in persuading their colleagues that standing up for Palestine health justice is equivalent to being antisemitic, which couldn’t be further from the truth and is silly. There are so many Jewish people affiliated with our cause and members of the Palestine Health Justice working group. It’s a fundamental value in Jewish religion and among Jewish communities to work for justice and to defend people who are trying to sustain their sovereignty and well-being. It’s not a Jewish value to obliterate the entire population of Gaza or shoot children in the head who are standing in line for food or to starve people, this is not consistent with Jewish values.
So there’s nothing antisemitic about opposing Israel’s attacks on Gaza and yet nonetheless there are people who persuaded the brass at APHA, the powerful people, to take the stand that such work is antisemitic. I was singled out for punishment because I was Chair of the International Health Section which championed this cause. You know, I do think it’s a little bit wrapped up in some of the Trump Administration crackdowns on academia. The Anti-Defamation League has involved itself in the oppression of people trying to do this work and they are using their power to define what is antisemitism, to persuade people and universities and who are running these professional and academic associations to conflate pro-Palestinian work with antisemitism. It’s an error and I think history will prove them to be wrong on this but we’re suffering through the consequences now. So I’ve lost membership in my beloved association; I have worked so hard for more than 20 years to build the association and bring students to the Association and do good work in the Association. I miss it and I’m very sad about the decisions they made. It just feels very antithetical to what we claim to be.
Some might argue, myself included, at certain points of APHA history, that they take a seemingly apolitical approach to public health in many instances. This is not true for the entirety of its history, but sometimes it feels like when it mattered most, there was an apolitical approach taken. Would you agree and do you have any thoughts about why that might be and how that is detrimental to the field?
If I understood your question correctly, I would say I agree.
I think public health’s greatest accomplishments have been more political than biological, and public health has managed to muster some bravery in our history to go up against big industries that seek to pollute us to death or poison us. You know, public health stood up for making cars safer which has saved many many thousands of lives thanks to Ralph Nader who brought this all to our attention back in the day. Public health has stood up to the tobacco industry, another powerful entity in the American corporate landscape. So many deaths have been attributed to cigarette smoking and tobacco use, and public health has worked on that problem. It seems sort of banal to speak of it now is a brave thing, but it was at the time to go up against these powerful interests. And public health managed to be brave and I think we should lean into that respectable past and those accomplishments and realize that bravery is again called for today on a lot of fronts. We have probably the worst EPA administrator in American history right now who is making it okay to poison us in many ways through changes in regulation and legislation and public health hasn’t said enough about this. I understand there’s such a fire hose coming out of the Trump Administration right now, it’s hard to keep up with what we should oppose and what we should focus on, but environmental degradation is clearly a key priority of this administration. When we slack off on protecting the environment and protecting humans from poisonous exposures, we’re supporting big powerful corporate interests and the people who run America.
Thinking about APHA, public health, what do you think are the implications for the public health field when issues related to Palestine are not openly discussed or institutionally supported through advocacy?
Well, you know, we have stood by for more than two years now while Israel just unleashes every possible cruel pummeling attack on the people of Gaza and you know they’re not attacking Hamas, they are attacking the people of Gaza and these are mostly children. They’ve ruined every university in Gaza, and Palestinian people value education very highly. Their universities were excellent institutions where they trained doctors and teachers and all sorts of people who were expected to help elevate their society like educated people are expected to do in all our societies. And universities here stood idly by while Israel bombed every university in Gaza. We didn’t say anything, Public Health stood idly by while aid was withheld, while UNRWA was shut down, nothing was said about any of this. We would keep trying to put resolutions forward and these never succeeded because they would get derailed by people who support Israel, right or wrong. Which, you know, as an old lady I’ll say that used to be what we said about America’s intervention in Vietnam. We used to say we needed to be pro-American, right or wrong, and that’s just such a ridiculous approach to the world. Nobody’s worth defending, right or wrong, and I’m so disappointed that APHA cannot offer a coherent response to the attacks on the people in Gaza and defend Public Health there. It’s just such a disappointment…people are being starved deliberately and on purpose.
You mentioned earlier how some people have convinced people with decision-making power within APHA that any support for Palestine is antisemitic. I’m curious to know your thoughts on if you think that the reason for APHA’s stance is simply because they feel it’s antisemitic, or do you think that perhaps there are other systems of power or structures of power that people may support as well, such as the military industrial complex or resource extraction?
APHA is a very large organization, 25,000 people, so saying APHA believes something or another is probably too big in generalization. We need to focus on powerful people within APHA. There’s an executive board, there’s a governing council, and there are executive staff people, and these are the people who are most under the influence of pro-Israel forces within APHA. When processes are opened to more democratic ways of operating, when larger groups within APHA get to vote on things or get to participate in decisions, those are usually better. It’s in every one of these fancy professional academic associations, there are people who seek roles on the board for careerist reasons, they want good resume stuffers to advance their careers and this is a really unfortunate motivation to be involved. It’s just not motivated by principle or desire to really improve the public’s health. It’s motivated by advancing your own self, which is not a respectable purpose for being engaged in my view. I hate to generalize that everybody in APHA feels this way, I don’t think that’s true, I think if we were to open it to the democratic process, we would win on a Palestine resolution.
There are conservative people in every profession, but I’m going to guess that there are very few members of APHA who would have voted for Donald Trump. Therefore they think, you know, they are righteous in some way, but clearly there’s more to it than that. There’s so many ways in which American military power is exerted around the world and support of terrible expeditions and projects everywhere- Africa, Middle East, South America, you know it’s just terrible. Everywhere we’re trying to exert our power and our influence and you know you might wonder why does America keep pursuing these wars that we never win? I mean even Israel couldn’t win this two years in, with all the might that they had to build here, they didn’t win. The United States hasn’t won a war since World War II, which was a long time ago and we’ve been involved in several wars since then. So why do we keep doing this? Why do we keep engaging in wars we don’t win?
I think there is an answer to that and the answer is that it’s very profitable for some people and some companies and some interests to be building more machines and selling equipment to corrupt governments around the world. What’s going on in Sudan right now, to know that United States weaponry sold to the United Arab Emirates is being used to eradicate people in Sudan is just heartbreaking. Yet very few news outlets really talk about that very much or let us know about it. I would just say one of the most important things a public health worker can do is to stay informed about what’s really happening in the world. Follow a good news diet, follow respectable sources of truthful information that reveals where the interests are and whose interests are being served every time a bomb drops.
I feel like that needs to be written down in every course syllabus. Going off of that, can you describe more why awareness of global political events is important for practitioners practicing or making public health decisions at the local level and how they are related?
Because local level health problems are often generated elsewhere and brought home to roost. The military recruiting that goes on in our high schools and brought home to roost, the the military recruiting that goes on in our high schools is harvesting bright young boys and girls—and they are children when they’re in high school—to go fight these ridiculous wars abroad or to sit behind it computer screen and drop drones on people to their detriment. This does not enhance the health of the people engaged in these activities and you know the report that came out recently that the leading cause of death in active duty Air Force service members is suicide? The leading cause of death among active duty Air Force workers is suicide. What’s going on with that and why do public health workers not see that as our jurisdiction and something for us to worry about?
You also talk about domestic violence and how domestic violence really is an issue of war, and similiar to suicide, these are things within the public health domain. Connections need to be made to how these global events impact the decisions that we make locally and how the decisions that we make locally impact the way we situate ourselves in the global.
Yes, there is that study by Holly Prigerson, which is now an old study, but her finding was that of all the incidents of domestic violence in the United States, all of them, more than 20% are attributable to combat exposure—somebody in the military. This is kind of a startling finding for such a widespread problem with multiple etiologies and that is a study that didn’t get the attention that it deserved at the time and and has not been repeated and should be.
The people who come back from these wars, what kind of employment do they find when they do find employment. Well, maybe, serving local police departments and studies have shown that police officers who have military backgrounds are much more likely to engage in violence against the citizenry of the communities that they serve in because that’s what they learn to do. This is not hardly a surprising finding and we’ve certainly suffered a lot of police violence in this country over many decades. In recent years, much of this can be tied to our sense of militarism as a value and of exposing our young men and women to military experiences abroad.
Are there any words of hope or advice for young public health professionals entering this type of work or interested in this type of work that you would like to share?
Well, I tend to lean into hope because that’s what we’ve got right? So, I tend to be a hopeful person. I think you’re onto something when you say public health is political and also I think people who want to make a difference in the world have to be willing to get their hands dirty in politics. And local politics are kind of fun. In Seattle, we just elected a wonderful new mayor who is going to make this city healthier, I’m convinced of it. She is a socialist, she cares about public housing, she cares about public transit, she’s going to make the living conditions better for people here, which is going to improve our public health. We have to be willing to get ourselves involved in local politics to advance public health in general and to move this country’s values.
Public health is a great profession and it’s this magnificent stew of science, as well as politics, as well as practice, on the ground education, and that sort of thing. There’s a lot of room in public health to find your niche, your area of expertise, the things you’re good at and apply them to making communities healthier. I would say learn real skills, including quantitative skills and research skills and you know learn what you can and then get a fun job where you can apply this stuff!
