The Social Determinants of Health and Genocide: Towards a Public Health Integrated Framework of Genocide and Mass Violence

Abstract

This paper makes a normative argument about transformations of public health as a necessary condition required in any transitional justice process. We seek to bridge the gap between the fields of genocide and public health to understand the recursive relationship between genocide and the social determinants of health. We show that structures and institutions established during genocide create enduring impacts on the public health outcomes of victim and survivor groups even after the ousting of the original perpetrators. Our comparative analysis of the Rwandan Genocide and the colonial genocide of Indigenous communities in Canada surveys the available public health literature and argues that perpetrators of genocide deliberately design public health systems for the explicit purposes of destroying target communities over the longue durée. When these systems are insufficiently transformed, post-genocide societies face significant barriers to transitional justice and reconciliation as a direct result of their impacts on survivor communities. In Rwanda, delayed addressal of the HIV/AIDS epidemic engineered by the Hutu Power regime continued to victimize Tutsi women decades after the mass killings have ended; in Canada, legacies of family separation and the Indian Residential School system have straddled Indigenous communities with high rates of comorbidities and early death consistent with colonial genocide policies.