Introduction

Executive Brief Foreword Introduction DesignKey FindingsOverview Mental Health Physical Health High Health Status Access to Health Care and Preventive Services Substance Use Seniors ConclusionsAppendixTable 1. Measures Methodology 2022 Health of Those Who Have Served Advisory Committee

2022 Health of Those Who Have Served Report – Executive Brief 2022 Health of Those Who Have Served Report

Men and women who have served often face a variety of unique health challenges and needs. As of 2021, approximately 19 million Americans have served on active duty in the United States Armed Forces — 1.2 million of whom are currently on active duty or in the Military Reserves, and more than 18 million of whom are retired.1,2

These men and women who serve in the U.S. Armed Forces play a vital role in maintaining the safety and security of our country, and it is our duty to respond to and support their health needs. We must first understand their health-related circumstances and subsequently develop solutions to address the challenges they encounter. To do so, since 2016 the America’s Health Rankings® Health of Those Who Have Served Report has provided an up-to-date national portrait of the health and well-being of those who have served in the U.S. Armed Forces. In 2017, the Health of Women Who Have Served Report focused on the specific challenges faced by females who have served.

The 2022 Health of Those Who Have Served Report aims to expand on these reports, highlighting the needs of specific subpopulations, including older adults (ages 65 and older) who have served. The report illuminates 10-year trends and other findings about the similarities and differences in health and well-being between those who have served and their civilian counterparts, as well as within groups of those who have served. Through ongoing collaboration with an Advisory Committee of military, veterans and public health organizations, this important work builds on the United Health Foundation’s ongoing commitment to leverage data to improve the health of men and women who have served.

Shifting Demographics

According to the U.S. Department of Veterans Affairs (VA), the demographics of the U.S. Armed Forces will shift significantly over the next few decades.3 By 2046, the veteran population is expected to decrease by approximately 35% to 12.5 million.4 There will also be a slight shift in age distribution, as 33.3% of veterans will be younger than 50 and 34.1% will be 70 and older (vs. 26.8% and 37.1% in 2021). Racial and ethnic diversity will continue to rise among veterans: people of color will account for over one-third (38.2%) of the total veteran population, increasing from 25.7% in 2021. Gender diversity is also increasing as women become a larger proportion of the veteran population, projected to increase from 10.7% of veterans in 2021 to 17.5% by 2046.5,6

These changes come with new health challenges and place increased demands on both the health care system and individual communities. In addition, although many service members return from active duty and combat without physical injuries and receive education, employment and other benefits associated with service, some face serious and lasting mental and physical health challenges that need to be addressed.

Evolving Health Needs

The veteran population is changing rapidly. As the population continues to shift, emerging challenges related to veterans’ health and their access to health care will continue to grow. These burdens include increased risk for chronic diseases and cancer — especially for those that are now 65 years of age or older.7 Females who have served also face unique burdens; despite higher levels of education and income than civilian women, women with military service have a greater prevalence of physical and mental health concerns.8

Those returning from overseas deployments in recent years face unique combat-related circumstances and challenges as well. As a volunteer force and the largest, longest-lasting mobilization of National Guard and Military Reserves, these service members experienced more frequent and longer deployments as well as exposure to and survival of extreme stresses of combat in Iraq and Afghanistan.9 At the same time, there have been unprecedented rates of behavioral and mental health concerns, such as post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).10

These shifting dynamics emphasize the continued need for community leaders, public health officials, policymakers and other parties of influence to monitor the health of those who have served from a broad perspective that includes measures of the behaviors and social determinants that influence health.

Demographic shifts and unique circumstances of recent deployments result in growing health challenges.

Report Objectives

The America’s Health Rankings 2022 Health of Those Who Have Served Report provides a comprehensive national portrait that examines trends in 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 and trends over time on the health of men and women who have served. The report fills an important and ongoing gap in the field and is intended for a broad range of audiences including advocates, policymakers, government officials and constituents at the national, state and local levels. The report’s objectives are to: 

Describe the health of those who have served across 30 measures of social and economic factors, behaviors, clinical care and health outcomes. Comparisons between those who have and have not served are examined overall and by age, gender, race/ethnicity, education, income and metropolitan status.
Provide trends in 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.
Describe the health of older adults who have served across 11 measures of clinical care, behaviors and health outcomes.
Stimulate dialogue and action to address and effectively treat the unique challenges faced by the military community, and prevent these challenges from continuing to worsen.

1. U.S. Bureau of Labor Statistics. “Labor force participation rate for veterans was 46.8 percent in October 2021.” The Economics Daily, November 10, 2022. https://www.bls.gov/opub/ted/2021/labor-force-participation-rate-for-veterans-was-46-8-percent-in-october-2021.htm

2. Manzanetti, Z. “Military Active-Duty Personnel, Civilians by State.” Governing, 2021. Accessed May 15, 2022. https://www.governing.com/now/2021-military-active-duty-personnel-civilians-by-state - :~:text=There were a total of,from the Department of Defense

3. Schaeffer, K. “The changing face of America's veteran population.” Pew Research Center, 2021. https://www.pewresearch.org/fact-tank/2021/04/05/the-changing-face-of-americas-veteran-population/

4. Parker, K., Cilluffo, A. & Stepler, R. “6 facts about the U.S. military and its changing demographics.” Pew Research Center, 2020. https://www.pewresearch.org/fact-tank/2017/04/13/6-facts-about-the-u-s-military-and-its-changing-demographics/

5. Vespa, J. “Those Who Served: America’s Veterans From World War II to the War on Terror.” ACS-43, American Community Survey Reports, 2020. https://www.census.gov/content/dam/Census/library/publications/2020/demo/acs-43.pdf

6. National Center for Veterans Analysis and Statistics. “Veteran Population.” U.S. Department of Veterans Affairs, April 14, 2021. https://www.va.gov/vetdata/veteran_population.asp

7. Boersma, P., Cohen, R.A., Zelaya, C.E., & Moy, E. “Multiple Chronic Conditions Among Veterans and Nonveterans: United States, 2015–2018.” National Health Statistics Reports - Centers for Disease Control and Prevention 153 (2021). https://www.cdc.gov/nchs/data/nhsr/nhsr153-508.pdf

8. United Health Foundation & Military Officers Association of America. America’s Health Rankings Health of Women Who Have Served Report (2017). https://assets.americashealthrankings.org/app/uploads/hwwhs17_final.pdf

9. Burnam, M.A., Meredith, L.S., Tanielian, T., & Jaycox, L.H. “Mental Health Care for Iraq and Afghanistan War Veterans.” Health Affairs 28, no. 3 (2009). https://www.healthaffairs.org/doi/10.1377/hlthaff.28.3.771

10. Tanielian, T., Jaycox, L.H., eds. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. RAND Corporation (2008). https://www.rand.org/pubs/monographs/MG720.html

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