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Overview

Men and women who serve in the United States Armed Forces play essential roles in maintaining the safety and security of our country. Nearly 23 million Americans living today have served on active duty in the U.S. Armed Forces – 2.4 million of whom are currently on active duty or in the National Guard and Reserves, and more than 20 million retired. The health and well-being of those who have served continue to be a national priority.
United Health Foundation, in partnership with Military Officers Association of America (MOAA), is pleased to update America’s Health Rankings® Health of Those Who Have Served Report this year to highlight trends and insights about the similarities and differences in health within groups of those who have served, as well as between those who have served and their civilian counterparts. The data update captures trends over six years, comparing recently available 2015-2016 data to a baseline1 of 2011-2012 data. This important work builds on United Health Foundation’s ongoing commitment to leverage data to improve the health of men and women who have served.
America’s Health Rankings continued its collaboration with an advisory steering group of leading military, veterans and public health organizations to update the report. The update features 31 health measures, including 10 new measures focused on mental health and opioid misuse. These new markers of health provide a more complete picture of the health of those who have served and offer greater data-driven insights into the strengths and challenges associated with the health of these individuals.

Those Who Have Served Continue to Report Better Health, But Face Greater Chronic Disease and Behavioral Health Burdens

Those who have served are more likely than civilians to report that their health is very good or excellent – a difference that has generally not changed since 2011-2012.
However, despite generally reporting better health, those who have served still have higher rates of chronic disease and behavioral health concerns, and little to no improvements have been made on many important markers of good health. For example, those who have served experience higher rates of the following chronic diseases than civilians:
  • Arthritis (24.7% vs. 22.8%)
  • Cancer (10.9% vs. 9.8%)
  • Cardiovascular disease (9.8% vs. 7.2%)
  • Chronic obstructive pulmonary disease (6.3% vs. 5.8%)
  • Functional impairment (25.8% vs. 20.8%)
Many chronic disease rates for those who have served have not improved since 2011-2012, especially among 50+ year olds who have served.
Similarly, those who have served have greater behavioral health concerns, including smoking, smokeless tobacco use, excessive drinking and insufficient sleep.
Rates of smoking (from 23.5% to 19.9%) and excessive drinking (from 23.4% to 21.4%) have improved among those who have served, but rates of smokeless tobacco use and insufficient sleep have remained consistent.

Those Who Have Served Still Experience Significant Mental Health Challenges

This year’s report highlights that men and women who have served have higher rates of depression, anxiety and frequent mental distress2 than civilian men and women. Additionally, the rate of depression among those who have served has increased 9% overall since 2011-2012 and as much as 32% among those who have served aged 26-34. During this time, little improvement has been observed in rates of anxiety and frequent mental distress among those who have served.
As highlighted in the Health of Women Who Have Served Report, women who have served face distinct mental health challenges. Among women who have served, the rate of suicidal thoughts increased nearly threefold and anxiety rate more than doubled since 2011-2012.

Improvements in mental health treatment are highlighted in this year’s report. The percentage of those who have served who have any mental illness and have received mental health treatment in the past 12 months increased 23% since 2011-2012. Nonetheless, despite these improvements, half of those who have served who have a mental illness have not received mental health treatment during that time.

Encouraging Markers of Preventive and Primary Care Among Those Who Have Served

The report also documents access to and use of health care services by those who have served. Across several measures, these men and women fare better than their civilian counterparts, including:
  • Colorectal cancer screening (72.4% vs. 66.0%)
  • Dental visit (69.6% vs. 65.2%)
  • Flu vaccine (50.6% vs. 37.0%)
  • Unmet medical need due to cost (8.7% vs. 14.1%)
Those who have served also have higher rates of health insurance coverage than civilians (92.7% vs. 86.9%), a trend that has improved since 2011-2012. However, those who have served are still less likely to have a dedicated health care provider than civilians (75.2% vs. 77.1%) and have not experienced improvement on this marker.

Notable Trends Among Key Subpopulations of Those Who Have Served

Several notable trends and differences in health among subpopulations of those who have served – both improvements and challenges – are highlighted in the report. These findings add to the strengths and challenges of different groups across populations illustrated by the America’s Health Rankings database.
Improvements
  • Higher rates of very good or excellent health cut across groups among those who have served, with minorities, younger individuals (18-25 year olds) and those with lower levels of education and income more likely to report high health status than their civilian counterparts. This trend has continued since 2011-2012.
  • Smoking, physical inactivity and obesity rates declined among 18-25 year olds who have served since 2011-2012.
Challenges
  • The rate of smokeless tobacco use among 18-25 year olds who have served is nearly four times the rate of civilians aged 18-25 and has not improved among this cohort since 2011-2012.
  • More than half of those who have served aged 26-34 report insufficient sleep compared to slightly more than one-third of civilians aged 26-34, a rate that has not improved since 2014.

Stimulating Dialogue and Action to Improve the Health of Those Who Have Served

The Health of Those Who Have Served Report remains a leading national resource to monitor trends over time and identify key areas of concern and opportunities for improvement. United Health Foundation and MOAA encourage policy-makers, health officials and community leaders to engage in meaningful dialogue about the findings of this report, especially exploring solutions to health challenges where little improvement has been observed since the initial report in 2016. The insights from this year’s report can spark cross-stakeholder collaboration and drive action in improving the lives of service members and veterans and the health of the communities where they live.
[1] Baseline reporting refers to 2011-2012 data, while this year’s reporting refers to 2015-2016 data. Some exceptions to these timeframes exist based on data availability and full data sources are available online.
[2] Percentage of respondents who reported their mental health was not good for 14 or more of the past 30 days.

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