Investing in active duty and veteran health worldwide

originally published in September 2020 on https://broadcastedge.blogspot.com/

Sweat Equity

Investment in members of the armed forces should include assurance of equitable health outcomes. In order to achieve this broadly, a culture change in healthcare must be initiated and matched in global partnership. 

An investment strategy could build from three initial considerations. 

? Culture

• Military culture is one of confidential defense, and disclosure of population health to outside agencies may spur hesitancy. This is true worldwide.
• World Health culture, and other international health agencies, do not include military or veteran health populations. The topic of occupational health to soldiers is not even acknowledged. The consideration to combat troop health is second to geopolitics, despite responsibility to individual and population well-being. 
• Occupational medicine culture leaves military and veteran health to isolated government departments. In some countries, there is no occupational or armed services health. 
• Government culture disregards voluntary, mandatory and other considerations to military and general health. Populations for armed services vary by country. 

Acknowledging alliances in military campaigns, military research and veteran health issues, can support culture without intrusion. 

? Programmatic logistics

• A global program to acknowledge military and veteran health will take navigation of geopolitics. 
• A global program requires funding. 
• A global program would require a role of assistant, not decision-maker. 
• A global program would require alternative goals: not leadership for countries; rather, coordination of useful data, tools, research, interventions. 

Start with a commitment of funding and labor. Distance with data and medical research connection is no longer an issue. 

? Foundation

• Foundations to voluntary inclusion in armed forces health require respect for individual national security, and require respectful liaison work.
• Foundations could start with combat/conflict related definitions and tools. Most major conflicts have been responded to with international assistance. 
• How does healthcare research and diagnostics define combat, chronic multisymptom illness, post traumatic stress disorder, Gulf War Illness, post deployment syndrome, substance abuse, toxic exposure and other terms variably used. 
• What tools do military health and veteran researchers use for assessments to cognition, mental health, deployment experience, and environmental exposures? Major research has been conducted with international academia. Alignment is a achievable. 

Begin the commitment with funding for military occupational health. Even if the funding comes from a $4 million organizational allocation, with matched $8 million non-taxable philanthropic contribution.  

Advancing health equity for volunteer and mandatory armed forces personnel supports our entire population health. It is a matter of sweat equity for health equity. 

Medicine has a responsibility to advance health quality of life and health equity for military personnel, beyond the plain view of conflict right and wrong. The world is best served when we secure the best health outcomes for armed forces. We can, should and will wrap our healthcare cape around those who entered the theatre as inspired heroes. 

The Sport of the Business

Shaping global health collaboration that is responsive to military health should be approached sincerely and pragmatically. Health and medicine must be removed from geopolitics in favor of values. 

?  Valuing the individual

  Active duty and veteran populations have unique health needs. Caring for these needs may or may not be conducted by specialized clinicians, and there is no formal global health guidance for military members affected by formal conflict.  

   * Global health experts must start to quantify and quality exposure. Great exposure work has been initiated, yet prevention and mitigation for new deployments is not coordinated. While exposure data pre-Gulf War was not as comprehensive, attention to exposure from Gulf War on has been formally analyzed. This is where global health exposure attention should cement foundation.

   On behalf of global peacekeeping efforts decades ago, troops from many countries experienced serious exposures. Academia and medicine has struggled to quantify and analyze metrics around them. A typical individual sent to the Persian Gulf experienced exposures including temperature extremes, sleep interruption, crowded conditions, small arms fire, explosions, contaminated produce, lack of hot water and demolition of munition. These people had chemical exposures to petroleum products used to suppress sand and dust, as well as burn waste in open air pit. They worked with solvents, corrosive agents and toxic particles with everyday vehicle repair and missile work. They wore flea collars and were exposed to unknown chemical doses. They ingested pills to protect against unknowns when chemical alarms went off and they were given anthrax vaccines with administrative records. They were given nerve agent antidotes and exposed to depleted uranium (DU). They were exposed to threat of harm, actual harm, prisoners of war and other interpersonal stress. None of this was measured in real time, and decades later, including over 18 years of post 9/11 deployment, there is no public reporting of exposure definitions and measurements in conflict zones.

  Progress in exposure data collection, sampling alongside units, advanced tech and advanced data storage are possible. Global health has yet to embrace this.   

   * Global health should help shape the value of military health continuum of care work, including metrics around transitions in general population healthcare. 

   * Global health should begin to examine individual health attention from developing and informal militaries, how these militia/militaries are designated and how they are categorized. Global health should seek understanding around exposures to unknown, unaccounted for violence. 

The nature of peacekeeping and conflict is a business we ask individuals to manage. How we value their health from a global perspective shapes their future - and our collective future. When the effort of diplomacy and peace fails, consideration, definition and measurement of conflict exposures be a global responsibility

Valuing the individual takes global health commitments to quantifying and qualifying exposure measures in real time. 

?  Valuing the population

   Active duty and veteran populations of deployment campaigns share similar health concerns and issues, without collective international attention. This leaves regional academia to support advanced militaries as all navigate a variety of payer systems. Valuing this population's health starts with acknowledging missed opportunities: 

   * Decades of reports are available in advanced countries, and these reports acknowledge international military studies, yet there has been no collective international reporting. 

  * For advanced military comparisons, health care delivery differences are a barrier to collaboration. Payer systems, IT infrastructures that are not interoperable, records maintenance, ill-defined fields and general health requirements are overwhelming. Volunteer militaries are often left in silos, and mandatory military populations may get lost in the mix. 

  * There is no formal measure around concepts of deployment, conflict and other experiences. Many militaries face internal experiences that go unaddressed.

  * Ongoing health studies in countries may include a general population comprised of mandated veterans, or of volunteer populations, and differences are not understood. 

Understanding military population health is not insurmountable. Data around military designation, health requirements of recruits, length of service, how militaries are categorized, age at time of recruit, payer systems for both active duty and veteran populations, medical record structure, entities responsible to research and major conflicts under health research/delivery spotlight could be starting points. 

A country's entire population is affected by the health of its individuals. To value a military's population health is to value the country's population health. 

? Valuing global health

    * Many military populations are ill-defined, vary in structure and may or may not have guided medical attention. They should be accounted for in global health, and this adds value to understanding global conflict. 

  * Quantifying and qualifying health needs, impact and costs add value to conflict prevention. Reports, metrics and global health oversight secure added weight to good diplomacy.

  * Conflict zones increasingly include civilian populations. Additionally, severe geopolitical fighting drives refugee migration. These non-military populations may be exposed to elements in which global military health collaboration could eventually offer insight. 

  * Conflict zones and deployment areas should be afforded ongoing global attention to exposures. How can environmental, chemical, noise and other elements be measured in oversight? How will this translate to health risk prevention and mitigation in the future? 

Initiation of global health programming argues benefit to informal conflict, developing countries, diplomacy advocacy and civilian populations. 

Global health should acknowledge the sentiment that feels formal military intervention is never acceptable. Global health should also acknowledge that military intervention will continue and we will never know the reality of alternative outcomes. Global health should not be a barrier to addressing an occupational and population health for military populations. 

Placing unbiased value on individuals, populations and greater global health is a start. Anything less is willful irresponsibility to individual health. Anything less than equal care for members of the military is, in fact, intentional grounding.