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Those who have served in the United States (U.S.) Armed Forces comprise nearly 10 percent of the U.S. adult population or almost 23 million, including 1.3 million on active duty, 1.1 million in National Guard and the Reserves, and over 20 million veterans.3,4 The health and health care needs of people with military service differ in several important ways from civilians, differences which are grounded in the unique experiences and exposures of serving on duty and in combat, as well as in transitioning to civilian life.
Our nation looks to men and women in uniform to serve and protect our country, and it is incumbent on us to respond to their health and health care needs. Central to our obligation is a better understanding of their health circumstances. The objective of this report is to document and offer insight into the distinct and changing health profile of those who have served so that we may work to assure their well-being now and in the future.
Shifting Demographics
Over the last 50 years, the number of active duty personnel has declined significantly from 3.5 million during the military draft era to 1.3 million as part of today’s all-volunteer force.5 The U.S. Department of Veterans Affairs (VA) projects the veteran population will further decrease by nearly 40% over the next three decades to 13.6 million.4 During this time, the share of male veterans is expected to decline significantly, while the female veteran population will nearly double in size. Racial and ethnic diversity among veterans will also increase, and people of color will account for one-third (32.8%) of the total veteran population by 2037.4 The composition of veterans by wartime eras is also changing, with Gulf War-era veterans (spanning from 1990 through present) now comprising the largest share of all U.S. veterans, surpassing those from the Vietnam era.4
Evolving Health Needs
The changing face of military and veteran populations creates unique health challenges and new demands on the health care system. Although most service members return from active duty and combat without physical injuries, and receive education, employment, and other financial benefits associated with service, many face serious and lasting health effects.
As those who have served age, the burden of chronic disease will continue to grow, especially among aging baby boomers who served in the Vietnam and Korean Wars. Women who have served—and who increasingly make up a larger proportion of this population—also face unique challenges. Despite being more highly educated and having higher incomes, for example, women with military service have a greater prevalence of many physical and mental health concerns than civilian women.6
In addition, those returning from the most recent Gulf Wars, including Operation Enduring Freedom in Afghanistan (OEF) from 2001-2014, Operation Iraqi Freedom (OIF) from 2003-2010, and the ongoing Operation New Dawn in Iraq (OND) from 2010-present face unusual combat-related circumstances. As a volunteer force and the largest, longest lasting mobilization of National Guard and Military Reserves, these service members face more frequent and longer deployments as well as exposure to and survival from extreme stresses of combat. These changes and circumstances have contributed to unprecedented rates of behavioral and mental health concerns, such as Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI).7 Finally, while in previous wars, physical training and fitness standards for those who served appeared to protect against mortality risks, referred to as the Healthy Soldier Effect (HSE), research shows the effect may be waning among veterans of recent wars in Iraq and Afghanistan.8,9
These changing dynamics point to the continued need to monitor the health of those who have served from a broader population perspective, including measures of behaviors, social conditions, and policies that influence health.
Report Objectives
The America’s Health Rankings® 2018 Health of Those Who Have Served Report builds on the 2016 Edition to provide an updated, comprehensive national portrait and trends of the health and well-being of those who have ever served on active duty in the U.S. Armed Forces. It remains the only national resource to provide comprehensive population-based data over time on the health of men and women who have served, filling an important and ongoing gap in the field. It is intended for a broad range of audiences including advocates, policymakers, government officials, and constituents at the national, state, and local levels to:
- Describe the health of those who have served across 31 measures of behaviors, clinical care, policy, community and environment, and health outcomes. Comparisons between those who have and have not served are examined overall and by age, gender, race/ethnicity, education, and income.
- Provide trends on health and well-being improvements and challenges over time for those who have served overall and in comparison to those who have not served by age, gender, race/ethnicity, education, and income.
- Build awareness of the breadth and magnitude of health concerns facing those who have served overall and for specific population groups.
- Stimulate dialogue and action to inform health priorities and improve the health of those who have served, recognizing they are an evolving segment of the U.S. population facing distinct needs.
[3] U.S. Department of Defense. 2016 Demographics: Profile of the Military Community.
[4] U.S. Department of Veterans Affairs. Veteran Population Projections 2017-2037.
[5] Pew Research Center. The Changing Face of America’s Veteran Population. November 10, 2017.
[6] America’s Health Rankings Health of Women Who Have Served Report, 2017.
[7] Burnam MA, Meredith LS, Tanielian T, and Jaycox LH. Mental Health Care for Iraq and Afghanistan War Veterans. Health Affairs, (2009): Vol. 28 (3).
[8] Hinojosa R. Cardiovascular disease among United States military veterans: Evidence of a waning healthy soldier effect using the National Health Interview Survey.
[9] Oster C, Morello A, Venning A, Redpath P, and Lawn S. The health and wellbeing needs of veterans: a rapid review. BMC Psychiatry.(2017): Vol. 17(414).