The Public's Health: Veterans and Health Misconceptions | The Public Health Post

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There are 200,000 new veterans each year, adding to the 20 million Americans who have served in the military. Nearly five decades since our military went all-volunteer, and after almost two decades of constant war, we continue to misunderstand the military. Novelists and moviemakers depict veterans who are disconnected and marginalized. That is largely not so. The military is solidly middle class and, in many ways, a select group. High physical and educational standards—a high school degree required—means that 71% of young adults would fail to qualify if they tried to enlist. The military is also an ever more diverse group. Women now make up one in six enlisted, and both sexes are more ethnically diverse than the civilian population. Veterans are more likely to vote, volunteer, give to charity, and attend town meetings than non-veterans. Female and black veterans experience a wage premium (2% and 7% respectively) over non-veterans.  
The military, and veterans, therefore increasingly represent a rapidly diversifying middle of the country. But the health of the active military and veterans highlights the challenges our soldiers face. Since the first Gulf War in 1990, veterans have had worse mortality than the general population, due perhaps to multiple deployments and survival from injuries that would have killed soldiers in the past.
Aside from mortality, mental health problems are a particular concern. More soldiers kill themselves than are killed on our battlefields—20 a day, which is 50% higher than the civilian rate. The majority of these suicides are over 55 years old, although rates among younger veterans have been rising.
Beyond suicide, a key mental health concern among veterans is post-traumatic stress disorder (PTSD). PTSD, itself disruptive, foreshadows increased risks of physical health problems, substance use/misuse, homelessness and violence. Less studied, but equally important, are high rates of depression and anxiety in this group. Rates of chronic pain and physical disability rates are also unfortunately high. All of these make the Veterans Health Administration’s unique expertise in mental health care provision and rehabilitation services all the more crucial.
Despite these health challenges, only 30% of veterans use Veterans Health Administration facilities. Yet our current administration is reducing this access further in a move toward privatization of veterans’ health. This does veterans a disservice, shortchanging one of the fundamental social contracts we make with each other: soldiers protect us and keep us safe, and we promise to look after them when they finish their service. Their health is the public’s health.

Michael Stein & Sandro Galea