BMJ  2003;327:E184-E185 (4 October), doi:10.1136/bmjusa.03020006 (published 26 March 2003)

BMJ USA: Education and debate

Commentary: Arms sales, health, and national security

Council on Foreign Relations, New York, NY. LKorb{at}cfr.org

From BMJ USA 2003;Feb:108

A call for US leadership

Since the end of the Cold War, it has become clear that the main threat to global peace and security is instability in the international system. As the world's only superpower, the United States must take the lead in preserving stability. But the United States exerts its leadership not only with its hard power—that is, its economic and military might—but also with its soft power—that is, the values it preaches and practices.

The sources of instability in the contemporary international system range from terrorists and tyrants who seek to obtain weapons of mass destruction to failing states that can become a haven for these terrorists and tyrants. For example, when the world abandoned Afghanistan after the Soviet Union withdrew, chaos ensued as the warlords struggled for control. The Taliban eventually stepped in and imposed a fundamentalist totalitarian regime and provided a haven for Osama bin Laden and his al Qaeda group. These terrorists used Afghanistan as a training ground for those who not only attacked the World Trade Center and the Pentagon on September 11, 2001, but also attacked the American embassies in East Africa in 1998 and the USS Cole in 2000. To remedy this situation, the United States had to lead a coalition to remove the Taliban and install an interim government. But the cost was high. Not only were thousands of lives lost on 9/11 but the United States alone has spent over $30 billion to date on its military operations.

Even if a failed state does not become a haven for terrorists, it can create problems for the world community in a number of other ways, for example, in the health area. If a government cannot control disease among its population in this era of globalization, the diseases are likely to spread. In addition, a disease-ravaged population retards economic development substantially, making it very difficult for the government to preserve domestic tranquility.

This is why the article by David P Southall and Bernadette A M O'Hare is so timely. They argue that health problems in poor countries in Asia and Africa are exacerbated by arms sales. The authors note correctly that even if the arms trade were curbed, the health problems in these countries would persist because many of these nations are also burdened with massive debt and corrupt bureaucracies and have suffered natural disasters. But there is no doubt that exporting arms, particularly small arms, into these poor countries has fueled the conflicts and that these countries have massive health problems.

The question of why developed countries do not curb this arms trafficking naturally arises. After all, it is in their self-interest to prevent these conflicts and to stop them from getting out of hand. The answer is that the developed nations place their short-term interests before the long-term interest of the international community. In particular, why does the United States not take the lead in curbing this arms trade? After all, it was the United States that had to spend its blood and treasure in Afghanistan and Somalia.

The first reason is greed. Exporting arms is big business. The United States exports more military hardware than the rest of the world combined—about $20 billion a year. It not only generates profits for the defense industry but also helps the US balance of trade and reduces the cost of weapons to the Pentagon. Recently the United States sold Poland $3.6 billion worth of fighter planes. While Poland is not as poor a country as those described by Southall and O'Hare, it certainly has more pressing needs. In fact the US government was so anxious to sell the arms that it lent the money to Poland.

The second reason is the traditional US reluctance to accept limitations on its sovereignty. This is especially true of the Bush administration, which has practiced an extreme form of unilateralism. It has unsigned the United Nations Rome Statute, which established the International Criminal Court, and has refused to sign the protocol to enforce the treaty banning biological weapons. It refused to join a pact to curtail the international flow of illegal small arms because in its view—and that of the National Rifle Association—it infringed upon the American right to own guns.

Southall and O'Hare have pinpointed a real problem. The question is, will the United States take the lead in dealing with it? The answer at present is no. But history has shown that the cost of not dealing with it will, in the long run, be substantially higher.

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Competing interests: None declared.

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