In this issue of the journal you will find five essays, each of which offers a response to my 2009 Question of the Year, How should academic medicine contribute to peace-building efforts around the world?1 My goal in having a Question of the Year each January is to foster deeper, more comprehensive thinking about issues important to medical schools and teaching hospitals, to open new avenues of exploration, and to engage readers with the journal in a new way. And when you read the essays submitted in response to this year's question, I believe you will agree that this goal is being achieved.
The five selected essays demonstrate how medical schools and teaching hospitals can provide education, research, and service activities to people and institutions in war-ravaged countries, implement scientific and medical exchange programs, and partner with academic health centers in other countries. These essays call on medical schools and teaching hospitals to adhere to peace-building values, to lobby their own governments, to promote a rights-based approach to health around the world, and to use the strength and influence of associations, organizations, and consortia to pursue a peace-advocacy agenda.
These action-oriented responses recognize that there exists a body of knowledge and a literature on peace studies, that there are important ongoing initiatives at academic health centers, and that there is much more to be done.
As I reflected on the 2009 Question of the Year and the submitted responses, the following foundational themes emerged again and again.
First, medical schools and teaching hospitals have important and substantive roles to play in the peace process.
Second, these roles must be grounded in an understanding of existing knowledge and literature, rational thought, and sound arguments.
Third, if medical schools and teaching hospitals are to be effective in their roles in the peace process, they must move beyond the notion that world peace simply is a good idea and begin to develop explicit, targeted strategies to assist with specific, defined phases of the peace process. For example, consider the following four phases of the peace process (1): preventive diplomacy (i.e., preventing violence through the use of diplomatic approaches to disputes), (2) peacemaking (i.e., stopping a conflict), (3) peacekeeping (i.e., preserving peace once it is attained), and (4) peace-building (i.e., preventing the recurrence of violence once peace is attained). While a medical school or a teaching hospital may not have the resources and skills necessary for peacemaking (which often requires military engagement), academic health centers certainly have the intellectual capital and inventiveness to contribute to peace-building initiatives (and that is one reason why I focused the Question of the Year specifically on that phase). One could also build a strong argument for a substantive role of academic health centers in preventive diplomacy.
Fourth, doing nothing is not an option. Each individual who works at an academic health center can and should contribute in some way. Not every individual must be a leader in this area or a vocal activist, or give speeches, write essays, and attend rallies. But if each individual, at the very least, develops a basic understanding of peace studies, learns more about what other medical schools and teaching hospitals are doing, and incorporates that knowledge into his or her everyday thinking, teaching, and practice, then we will have made good progress. Integrating these ideas into the culture of the academic health center will lead to new and better questions, which will lead to new and better studies and initiatives.
Finally, perhaps the most important notion–although not stated explicitly–underlying the responses to my 2009 Question of the Year is that peace is not simply the absence of war. Peace is a state of active engagement and healthy interdependency among different groups of people. Those who work at medical schools and teaching hospitals are in a position to catalyze this engagement, while the institutions themselves can and should be part of interdependent relationships that, collectively and over time, have the potential to prevent the recurrence of violence.
I thank the members of the journal's editorial board and professional editorial staff for participating in judging the submitted responses and for sharing insightful comments and perspectives.
Steven L. Kanter, MD