• epidemiology

The majority of casualties in armed conflict are civilians and children are disproportionally affected both during and after armed conflict. Over 10% of the children in the world live in an area of armed conflict.1 It is important to recognise that in addition to the direct harm caused to children by armed conflict, children also experience considerable harm indirectly.

Arms sales and armed conflict are mutually dependent on each other. The latter increases the former and increases in arms sales increase the risk of armed conflict. Military expenditure is colossal and out of control.2 World military expenditure is estimated by the Stockholm Institute of Peace Research Institute to have been US$1981 billion in 2020.3 This is an increase of 2.6% from 2019 and 9.3% higher than in 2011.3 It is of concern that the increase in the continent of Africa was 5.1%.3 More money spent on military expenditure means that less is likely to be available for health and education.

As a case in point, India has the third largest expenditure on the military, having spent US$72.9 billion in 2020.3 This is despite India having a child under 5 mortality rate of 34.3 per 1000 livebirths and the second highest number of actual deaths of children under the age of 5 (824 000 children in 2019).4 Nigeria was the only country to have more young children die. Almost one-third of preschool children (31%) in India are stunted and 17% of preschool children have moderate–severe wasting.4

High-income countries such as the USA and the UK also have high military expenditure and inadequate expenditure on the health and education of children. The UK increased its military expenditure by 2.9% in 2020, despite the government being committed to austerity, which has resulted in an increase in food banks and the closure of many libraries. Child mortality rates in the UK remain higher than in Sweden, despite both having similar healthcare systems.

The USA consistently has the largest military expenditure. In 2020, it was US$778 billion.3 This is an increase of 4.4% since 2019.3 The under 5 child mortality rate in the USA is 6 per 1000 livebirths4 and this remains higher than neighbouring Canada with a mortality rate of 5 per 1000 livebirths.4

Governments rarely adequately invest in children—whether it be health, education or social welfare. The excuse is usually that there is insufficient money. However, there is always money available for bombs and wars. Many governments refuse to reduce military expenditure due to pressure from the arms companies and the media.

The proposal for a Global Peace Dividend therefore is to be welcomed.5 The proposal is both simple and radical. It is that the governments of all UN member states should negotiate a joint reduction of their military expenditure by 2% every year for 5 years.5 It was launched by over 50 Nobel Laureates and has already gained support worldwide. Political leaders, heads of non-governmental agencies and members of civic organisations have all expressed support.

The fact that it involves all nations means that no country is disadvantaged and at greater risk from its neighbour. It also should make armed conflict less likely. The proposal also suggests that the half the money saved should be ringfenced for a global fund, under UN supervision, to address three major problems: climate change, pandemics and extreme poverty. The other half of the money saved would be for individual governments to spend. It is estimated that the Global Peace Dividend would be worth over US$200 billion over the 5 years.

Health professionals, their professional organisations and journals such as BMJ Paediatrics Open have highlighted the negative effects of armed conflict on child health.6 The negative effects of austerity on child health have been extensively reported.7 Health professionals should therefore support the Global Peace Dividend and sign the petition (https://peace-dividend.org/).

One recognises that major arms manufacturers will oppose the transfer of investments from arms sales to health, education, the climate and social welfare. However, one has to recognise the success of arms control treaties. Additionally, the example of countries like Costa Rica which chose not to have an army and hosts the United Nations University of Peace shows what can be achieved. Major positive changes in society can occur when political leaders and governments are forced to make changes by public pressure. Paediatric health professionals have a responsibility to children to advocate on their behalf.