ONE MEDICINE
Force Health Protection - Prevention is Key!
by Jeff McKaughan, MMT Editor
MMT Editor Jeff McKaughan had a chance to talk with Brigadier General Michael B. Cate, Commanding General of the U.S. Army Center for Health Promotion and Preventive Medicine about force health protection and one medicine.
Q: Can we start with an overview of force health protection?
A: Using the words of recently revised Army doctrine [Field Manual 3-0], force health protection is simply “all measures to promote, improve, or conserve the mental and physical well-being of soldiers.” Multiple aspects of the Army Medical Department, such as preventive medicine, veterinary services, preventive dentistry, laboratory support, and psychological and behavioral health services, all contribute to force health protection. In addition, effective communication with military members, leaders, veterans, families and the public regarding military members’ health status and the health risks of military service is a key element of the FHP strategy.
Current force health protection challenges in our military include infectious diseases [many of them zoonotic], chronic diseases and conditions, occupational and environmental health, food and drinking water safety, non-battle injuries, psychological and behavioral health, health surveillance, and dissemination of public health information. All leaders, servicemembers, civilian employees and families have a role in protecting their own health, and the DoD has outstanding military and civilian experts ready and able to assist them.
Q: What do you mean by preventive medicine, and why is prevention important?
A: In the words of Army Regulation 40-5, “preventive medicine is the anticipation, prediction, identification, surveillance, evaluation, prevention and control of disease and injuries.” In other words, it includes any proactive approach to health that reduces the need for “restoring” health to individuals or populations.
Effective preventive medicine will improve the health of servicemembers, their families, beneficiaries and civilian personnel; reduce short- and long-term health risks; reduce health care costs associated with disease and injuries; improve performance; and mitigate the impact of large-scale public health emergencies. Prevention is arguably much more efficient, effective and convenient to our military medical readiness than restorative care.
Q: How do DoD public health professionals respond to disease outbreaks and requests for public health assistance?
A: Preventive medicine response teams can deploy on a moment’s notice to provide epidemiological consultation and disease outbreak investigations around the globe. Prevention and control are instrumental in mitigating the transmission of harmful pathogens between humans and animals—avian influenza, for example. DoD preventive medicine assets are working in concert with civilian partners on pathogen identification measures, drug prophylaxis, vaccine development, disease prevention, control measures and disease surveillance systems.
Examples of rapid-response investigation of disease outbreaks conducted by USACHPPM include hepatitis C, meningitis, tuberculosis exposure, adenovirus, drug-resistant Acinetobacter infections, infant botulism, and zoonotic diseases associated with indigenous animals at various locations.
Public health professionals provide immunizations, vector traps, animal testing and health care worker training to public health workers, physicians and veterinarians around the world. To assist in maintaining military readiness, they also provide immunizations to populations, where our military deploys, to reduce susceptibility to many diseases within the region.
In addition to providing public health services to deploying personnel, USACHPPM’s Global Threat Assessment Program performs pre-deployment occupational and environmental health assessments for Army, Navy and Air Force personnel embarking on humanitarian missions, civic assistance and medical/engineering support to underserved countries and populations. Right now, as part of the Beyond the Horizon program, troops specializing in engineering, construction and health care will provide much needed services to communities in need while receiving valuable training and building important relationships with partner nations [Honduras, Trinidad and Tobago and Suriname].
Q: What are the ways environmental health relates to human health?
A: Our military deploys personnel to more than 100 countries in any given week, and the infrastructures of many of those countries are poor. A critically strategic point in maintaining readiness for our servicemembers is environmental health. Preventive medicine personnel provide occupational and environmental health information needed to detect, assess and counter hazards. They monitor and assess air, water and soil samples for indigenous threats and other potential threats before and during deployments. Entomologists and other preventive medicine assets conduct insect-borne disease threat assessments in deployed areas, as well as at continental U.S. installations. These assessments provide commanders information on areas where vectors can be expected and precautions that must be implemented.
As the DoD deploys personnel all over the world, the health risks from unintentional or intentional food and water contamination are much higher than ever. Food, water, wastewater and industrial chemicals vaulted higher on our priority list of potential vulnerabilities to installations after 9/11. Collaboration between preventive medicine assets and veterinarians has contributed to the development of food and water vulnerability assessment methods and guidance documents. Such health risk assessment methods also provide short- and long-term health effects guidance for exposure to toxic industrial chemicals/materials that could be delivered by means of any ingestion pathway.
Q: What preventive initiatives are occurring in the area of injury prevention?
A: Initial training injuries in new soldiers are a significant problem for the Army. Approximately 42 percent incur one or more injuries during their first year in the military, and the total cost of training new recruits is a little under $2 billion. Preventive medicine personnel perform injury assessments to enhance the combat readiness and health of soldiers. These assessments reduce injury rates Army-wide through a systematic program that guides and supports Army and command prevention efforts. Since low physical fitness has been linked to injuries, injury prevention personnel assisted in developing a system to track the physical fitness of soldiers during initial entry training, as well as evaluating a new physical fitness program to improve warrior-task performance and reduce injury rates for deploying infantry soldiers. Hearing injuries have proven to be a common long-term health effect of combat in previous wars and are predicted to be so in current operations as well. New weapons and new vehicles are better and bigger and bring new health risks. Preventive medicine personnel developed the combat arms earplugs, which are required issuance to deploying soldiers. At the beginning of OEF/OIF, the rate of eye injuries was higher than anticipated due to blasts. As a result of rapid fielding initiatives, soldiers are now provided eyewear that meets protective standards and improves comfort.
Q: What other preventive medicine initiatives support the servicemembers, their families and civilians?
A: As a result of servicemembers returning from deployments with behavioral health concerns, the DoD is placing more emphasis on behavioral and psychological health initiatives such as suicide prevention, posttraumatic stress disorder and lifestyle choices. Army preventive medicine personnel sponsored a multidisciplinary epidemiological consultation to identify factors contributing to recent suicides among returning soldiers. To help soldiers and their families, a collaborative project at Fort Hood will facilitate the Health Promotion Council efforts to build resilience and to reduce adverse behavioral health and social outcomes through focused analysis and use of community data and health promotion councils.
Many of the health threats faced by servicemembers, their families and civilians are caused by lifestyle choices such as tobacco use, obesity and alcohol abuse. Health promotion efforts aim to reduce illnesses, injuries and other conditions related to these choices, and include various educational campaigns, most of which are online, real-time and customized for individuals. One of the newest Army programs, a focused fitness/weight loss program for post-partum soldiers, is being implemented on all installations.
Q: What is health surveillance, and how is the DoD working together on preventive medicine initiatives?
A: Health surveillance is the routine and systematic collection, analysis and reporting of health-related information. Surveillance serves as the bedrock for public health practice. By monitoring trends, preventive medicine personnel are able to react to health issues among our population, choose from among possible interventions, and measure the effectiveness of the interventions.
During the last year, the DoD achieved a major milestone with the creation of an Armed Forces Health Surveillance Center. This new center combines the Defense Medical Surveillance System, the DoD Serum Repository, and DoD-Global Emerging Infections Surveillance into a single organization that focuses on surveillance. The AFHSC will improve surveillance efforts throughout the DoD by eliminating gaps and redundancies in capabilities through collaboration with the Army [USACHPPM], Navy/Marine Corps [Navy and Marine Corps Public Health Center] and Air Force [U.S. Air Force School of Aerospace Medicine] public health hubs. Collaboration with other governmental or non-governmental surveillance organizations will occur to improve surveillance both within and outside of the United States, provide a single source for answers on DoDwide surveillance issues, and improve the surveillance training of public health personnel. The service public health hubs will continue to play a key role in addressing service-specific issues.
The Army and Navy have also operated a number of laboratories overseas for decades in such countries as Peru, Germany, Egypt, Kenya, Korea, Thailand and Indonesia. These hubs and laboratories represent a network of expertise in emerging infectious diseases. DoD-GEIS was established to help facilitate the ability of the laboratories and other public health assets to provide early warning of emerging diseases. These laboratories focus on the health care needs of the U.S. military servicemembers and also form a platform for national and international partnerships against emerging infectious diseases.
Q: What partnerships are being developed among preventive medicine experts within the DoD as well as civilian counterparts and others?
A: Preventive medicine personnel are working on several projects in partnership with other services, all related to human health, animal health and environmental health and the linkages between the three. Army preventive medicine personnel supported the U.S. Coast Guard with an outbreak of adenovirus 21 at Cape May, N.J.; preventive medicine personnel are currently working with the Division of Virus Diseases at Walter Reed Army Institute Research, the Air Force and CDC with an outbreak of the adenovirus 14 at Lackland Air Force Base, Texas.
Army preventive medicine personnel, along with other DoD partners [U.S. Air Force School of Aerospace Medicine] and Joint Task Force-Bravo [Honduras], have established positive collaborations with Honduran, Nicaraguan and El Salvadoran ministries of health. Preventive medicine personnel will focus on building laboratory capacity, training technicians to use the equipment, and expanding influenza surveillance activities to major population centers currently not monitored by the ministries of health or host country medical authorities. Army veterinarians and preventive medicine personnel work together in deployed environments to ensure food and water quality, safety and security—from intentional as well as incidental contamination. In the United States, this function extends to highvisibility events such as the Army-Navy football game and service conferences and social events.
With the standup of the U.S. Africa Command, preventive medicine personnel are also working with the Combined Joint Task Force-Horn of Africa to provide medical treatment and education, as well as diagnostic testing. Such health initiatives will require not only U.S. and military health professionals, but international collaboration will become more important.
Q: What do you see as the future of DoD force health protection?
A: In my opinion, preventing diseases, injuries and conditions in our soldiers, civilians and family members is the easiest, most convenient and cost-effective way to individual and population health as well as military medical readiness. Future health surveillance will include comprehensive collection of human health, animal health and environmental health data, effectively linking all aspects to bring actionable information to leaders as well as health care providers. Health promotion efforts will lead to drastic reductions in smoking, obesity and alcohol abuse, subsequently lowering the prevalence of associated health burdens. Research will aid us, with new technology and techniques to predict, identify and mitigate health risks even better than we do today.
And, finally, the organizational infrastructure for force health protection, with its wide-ranging spectrum of specialties, will be more efficient and effective, with improved standardization, quality and timeliness across the entire Department of Defense. Collaboration with other agencies, in the U.S. and other countries, will be much more seamless.
Not only will the future bring increased awareness and recognition of prevention’s value, enhancements in resourcing and renewed emphasis at all levels—individuals, units, services—will follow. Ultimately, the physical and mental well-being of our soldiers, sailors, airmen and Marines, civilian employees and their families will all be much better as a result. Prevention is key. •
For more information, contact MMT Editor Jeff McKaughan or search our online archives for related stories.