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Hatred-a public health issue

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Izzeldin Abuelaish at University of Toronto
Izzeldin Abuelaish
Neil Arya at University of Waterloo
Neil Arya
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Medicine, Conflict and Survival
ISSN: 1362-3699 (Print) 1743-9396 (Online) Journal homepage: http://www.tandfonline.com/loi/fmcs20
Hatred-a public health issue
Izzeldin Abuelaish & Neil Arya
To cite this article: Izzeldin Abuelaish & Neil Arya (2017): Hatred-a public health issue, Medicine,
Conflict and Survival, DOI: 10.1080/13623699.2017.1326215
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MEDICINE, CONFLICT AND SURVIVAL, 2017
https://doi.org/10.1080/13623699.2017.1326215
COMMENTARY
Hatred-a public health issue
Izzeldin Abuelaisha and Neil Aryab
aDalla Lana School of Public Health, University of Toronto, Toronto, Canada; bUniversity of
Waterloo, Waterloo, Canada
ARTICLE HISTORY Accepted1 May 2017
Hatred may be dened as a ‘negative emotion that motivates and may lead to
negative behaviours with severe consequences’ (Halperin 2008). Though these
sentiments might accompany it, hatred is not synonymous with extreme dislike,
aversion, resentment, anger, or rage. Hatred includes an intense and chronic feel-
ing, a judgment (of its object as ‘bad, immoral, dangerous’ (Navarro, Marchena,
and Inmaculada 2013)), and a tendency, desire, or intention to be violent, often
to the extreme of destroying its object. Most alarmingly, hatred involves the
dehumanisation of the other (Halperin 2008; Harris and Fiske 2009; Sternberg
2005), which serves as a gateway through which moral barriers can be removed
and violence can be perpetrated. From a peace studies point of view, hatred
might be seen as a prime and extreme, enabler of direct, structural and cultural
violence. As such, when contextualised within conict, hatred may manifest
as massive violence, mass murder, and genocide. Whether it engenders wide-
spread physical, psychological, or political violence, each will result inevitably,
in equally widespread health consequences. Many of the current violent civil or
civil-military conicts across the globe are either based on, or fuelled by, hatred.
Hatred self-perpetuates, usually through cycles of hatred and counter-hatred,
violence and counter-violence (sometimes as revenge) (Figure 1).
The neurobiology of hatred and a cycle of hatred and violence
An emerging understanding of the psychological, pathological, physiologi-
cal, and neurobiological consequences of hatred suggests that the link may
not be just metaphoric, but true literally, and measurable for the individual
experiencing it. As suggested by Harris and Thoresen, ‘it is plausible that the
physiological arousal associated with chronic experiencing of hatred or blame
might endanger health’ (Harris and Thoresen 2005). There may be evidence that
© 2017 Informa UK Limited, trading as Taylor & Francis Group
CONTACT Izzeldin Abuelaish izzeldin.abuelaish@utoronto.ca
2 I. ABUELAISH AND N. ARYA
this physiological arousal can lead to the accumulation of stress responses and
allostatic load.
There is data that suggest hatred itself is associated with several health
problems other than injury and death. Hate speech alone can cause a rise in
clinical anxiety levels, thereby potentially disrupting immune systems and allow-
ing growth of cancer and chronic inammatory disease (Garban et al. 2012).
Negative emotions such as depression, anxiety, anger and hostility have a ten-
dency to contribute to mortality and morbidity, including cardiovascular dis-
ease, osteoporosis, arthritis, certain cancers, Alzheimer’s disease, periodontal
disease etc. via immune dysregulation (Glaser et al. 2002).
Hatred thus, can aect the hater and the hated, the victim and the perpe-
trator. Hatred when leading to counter-hatred or counter-violence arising from
fear or self-protection, clearly can adversely impact the original hater’s health
more tangibly.
Hatred and violence as public health issues
The World Health Organisation estimates that 1.6 million die from violent causes,
including wars, gang and group murders, child abuse, youth violence, domes-
tic abuse and sexual violence, elderly abuse, and suicide, each year. Thirty-ve
people are killed every hour as a result of armed conict (Krug et al. 2002). As
such, hatred is a public health issue, warranting the attention of practition-
ers and academics alike (Dahlberg and Mercy 2009). Epidemiology is the study
of the distribution and determinants of health-related states or events in
specied populations, and the application of this study to the control of health
problems (Last 2001). We may be able to use epidemiology as a tool to explore
directions of causation. A public health approach to hatred therefore, might
involve investigating its pathophysiology and socio-epidemiology, identifying
modiable risk factors, prevention and management strategies.
Hatred as an infectious disease
Hatred can be conceptualised as an infectious disease, leading to the spread
of violence, fear, and ignorance. Hatred is contagious; it can cross barriers and
borders. No one is immune to risk. We are all potential victims and carriers.
Hatred is the disease and the result of exposure which leads to violence and
vice versa (Figure 2).
Hatred Violence
Figure 1.The relationship between hatred and violence.
MEDICINE, CONFLICT AND SURVIVAL 3
While documentation of this association specically has been minimal, there
is an urgent need to build immunity to hatred by emphasising prevention of its
upstream causes, rather than the downstream management of those inicted.
In recognising hatred as a public health issue, greater eort can be placed in
research assessing its impact on health, which is needed in order to structure
evidence-based public health interventions that target its root causes and pre-
vent the spread of violence. As such, to prevent or manage hatred also means
to prevent and manage a signicant amount of violence.
Risk factors
However, to prevent, mitigate, or treat the eects of hatred, or better still, hatred
itself, we must know its root causes. There are contributors to hatred (and there-
fore opportunities for intervention when we are capable of and ethically allowed
to do so) at every level – genetic, epigenetic, prenatal, neural, childhood, number
of lifetime stressors or traumatic events, ongoing stressors, physical, social, and
political environment (Glaser et al. 2002; Hobfoll et al. 2009; Navarro, Marchena,
and Inmaculada 2013; Nelson and Bedrosian 2012; Toyokawa et al. 2012). The
identication of these contributing factors also elucidates the need for investi-
gation and evidence describing the nature and strength of these associations.
We speculate that triggers of specic cases of hatred are likely to be cumulative
exposures to some kind of repetitive harm, often violent or provocative (physi-
cal, psychological, social, political, including deprivation and dehumanisation),
or to hate speech that thrives on ignorance. Thus, there may be a causal relation-
ship between exposure to these triggers and hatred as an outcome, warranting
further exploration from a public health perspective.
Primary prevention
In public health, the rst step is prevention, both at the individual and popula-
tion levels. Our most eective long-term preventative tool will be immunisation
Exposure to harm
Hatred Violence
Figure 2.Harm exposure induces the hate disease leading to violence, and vice versa.
4 I. ABUELAISH AND N. ARYA
to hatred through a multi-faceted approach that explicitly captures a social
determinants of health perspective, promotes advocacy eorts, and prioritises
the awareness and education of the population. These goals and intervention
designs will be guided by a set of key principles that will directly address the
symptomatic manifestation of hatred. These four principles include, knowledge
(to facilitate the understanding of the health consequences of hatred), practical
(to develop emotional self-awareness and conict resolution skills), critical think-
ing (to create immunity and protection from provocative hate speech, super-
stition, and the inuence of charismatic leaders or groupthink that promotes
rapid spread of hatred), and moral (to foster an understanding of mutual respect
and human rights).
Secondary prevention-mitigation
If these measures and principles fail to prevent harm that can then lead to
hatred, at the very least, they may still ensure that the response of individuals
and populations will be resistance or resilience rather than hatred (Hobfoll et
al. 2009). But if hatred has already taken root, as is the case in some current
conicts, it is not too late to prevent the worse health outcomes through inter-
ventions such as promoting cognitive reappraisal, i.e. changing the way one
thinks about others (Halperin and Gross 2011), and by encouraging openness
to understanding the plight of the other.
Long-term results, however, will require elimination of the specic triggers
and causes mentioned previously. In hatred, triggered by oppression, a major
part of the treatment will be removing the oppression, which may include lift-
ing political and economic barriers, providing concrete signs of recognition,
or truth-and-reconciliation and restorative justice processes. If the hatred is
ignorance-based (sometimes mutual), then what must be eliminated are super-
stitions and false narratives. Thus, public health interventions and advocacy
eorts aimed specically at addressing these structural issues will be needed,
and guided by the above prescribed principles. Only when these eorts are
mobilised will we be able to work towards a prescription for alleviating hatred
and its health consequences globally.
Conclusion
Hatred is a pressing public health issue demanding to be taken seriously by the
medical community, the public, governments and other institutions. Hatred is
an intense, destructive attitude. Its manifestations are war, disease, violence,
and cruelty, symptoms that compromise the health, welfare, and functioning
of human beings, both at the individual and population level. The global com-
munity must recognise hatred as a public health issue in order to move from
the management of hatred, to the active prevention of its root causes through
MEDICINE, CONFLICT AND SURVIVAL 5
promotion, education, and awareness. We must measure it and if unable to
prevent it, mitigate it.
Disclosure statement
No potential conict of interest was reported by the author.
Notes on contributors
Izzeldin Abuelaish is a Palestinian-Canadian physician and internationally renowned
peace and human rights activist who has dedicated his life to promoting health as a
vehicle for peace. Despite all odds, he has succeeded remarkably; aided by a great deter-
mination of spirit, strong faith, and a stalwart belief in hope and family. Dr. Abuelaish
has overcome many personal hardships, including poverty, violence, and the horric
tragedy of his three daughters’ and niece’s deaths in the 2009 Gaza War. Transforming
his loss into an opportunity for forgiveness and hope, he founded his charity Daughters
For Life, oering education opportunities for women and girls in the Middle East in
memory of his daughters. Dr. Abuelaish’s book, I Shall Not Hate: A Gaza Doctor’s Journey
on the Road to Peace and Human Dignity, an autobiography of his loss and transforma-
tion, has achieved worldwide critical acclaim and is currently published in 23 dierent
languages. Dr. Abuelaish’s work has received world-wide recognition and his extensive
list of awards and honors include 18 honorary doctorate degrees, 4 Nobel Prize nomina-
tions, the Mahatma Gandhi peace award, The Order Of Ontario, and the Queen Elizabeth
II Diamond Jubilee Medal.
Neil Arya is a family physician in Kitchener, Ontario He is the president of the Canadian
Physicians for Research and Education in Peace (CPREP) (www.cprep.ca), chair of the
Ontario College for Family Physicians Environmental Health Committee and of the
PEGASUS Global Health Conference to be held in Toronto in May, 2014 (www.pegasus-
conference.ca). He remains as an assistant clinical professor in Family Medicine at
McMaster University (part-time) and adjunct professor in Environment and Resource
Studies at the University of Waterloo.
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