The 2018 Health of Those Who Have Served Report documents the current health-related strengths and challenges facing those who have served, identifying where encouraging improvements have occurred, where challenges persist, and where new concerns have emerged. Overall, the report finds:
- Those who have served are significantly more likely to self-report being in excellent or very good health, despite having persistently higher rates of unhealthy behaviors, mental health challenges, and chronic diseases than those who have not served.
- Both men and women with military service report significantly higher rates of anxiety, depression, and frequent mental distress than men and women who have not served.
- Rates of chronic disease such as arthritis, cancer, chronic obstructive pulmonary disease (COPD), functional impairment, and pain are also significantly higher for men and women who have served than men and women who have not.
- Despite significantly higher rates of coverage and access to care to many preventive services, those who have served are less likely to have a dedicated health care provider than those who have not served.
- Those who have served report significantly higher rates of mental health treatment—which includes inpatient care, outpatient care, and prescription medication—than those who have not served.
- Since 2011-2012, there have been encouraging improvements in smoking, excessive drinking, health insurance coverage, unmet need due to medical cost, and mental health treatment among those who have served.
- Those aged 18-25 years who have served experienced substantial improvements in health behaviors.
- Since 2011-2012, women who have served have seen a significant increase in mental health challenges, with the rate of suicidal thoughts increasing three-fold and the rate of anxiety more than doubling.
In addition to overall population differences between those who have and have not served, the report documents significant differences between specific subpopulation groups. For example, minorities who have served generally experience positive socioeconomic and clinical care benefits compared to minorities who have not served. At the same time, some minorities face higher rates of unhealthy behaviors such as smoking and excessive drinking than their peers who have not served. While rates of chronic disease generally increase with age, those aged 50 years and older who have served have significantly higher rates of cancer, cardiovascular disease, and other conditions than those who have not served.
Since 2011-2012, those who have served experienced significant improvements in overall rates for six of the 31 measures: smoking, excessive drinking, mental health treatment, unmet medical need due to cost, health insurance, and employment. With the exception of mental health treatment, improvements among those with service coincided with improvements in rates among the general population.
Two key behavior measures improved since the baseline period among those who have served. Smoking rates decreased by 15% overall, dropping from 23.5% to 19.9%. During this same period, excessing drinking declined by 9%, from 23.4% to 21.4%.
Coinciding with the overall expansion of health insurance coverage since the implementation of the Affordable Care Act (ACA) of 2010, those who have served experienced a 5% increase in coverage rates from 88.2% to 92.7%. Almost all subpopulation groups saw significant improvements in health insurance rates, with those who have served who earn less than $25,000 witnessing a 17% gain.
Accompanying these coverage gains were improvements in access to care. Nearly 20% fewer people who have served reported unmet medical need due to cost in 2015-2016 as compared to the baseline period. The most notable declines in rates occurred among blacks and whites (28% and 20% respectively).
Mental health treatment rates also improved by 23%, increasing from 41.2% to 50.8% among those who have served. Whites and men who have served experienced significant improvements in mental health treatment compared with whites and men who did not serve (23% among both population groups).
Finally, employment improved significantly among both groups, with those who have served experiencing a 4% increase since 2011-2012, from 89.6% to 92.9%. Employment gains can be linked to the overall recovery that occurred in the economy during the last few years following one of the worst recessions documented in U.S. history in 2007-2009.
Continuing and Emerging Challenges
Despite some significant improvements in overall behavior rates and access to care measures, those who have served continue to face many health-related challenges. For example, those with military service continue to report significantly lower rates of having a dedicated health care provider—or one or more persons they think of as their personal doctor or healthcare provider. This finding has held steady since 2011-2012. In addition, men and women who have served continue to face a higher burden of many chronic diseases and mental health challenges, rates that have generally also remained steady. In terms of unhealthy behaviors, while smoking and excessive drinking rates improved, they still remain significantly higher in the current time period for those who have served than those who have not. Insufficient sleep remains an ongoing concern among those who have served, who continuously report a significantly higher rate than those who have not served.
Despite some significant improvements in overall behavior rates and access to care measures, those who have served continue to face many health-related challenges.
Those who have served have experienced some significant increases in mental health challenges since 2011-2012. First, the overall rate of depression increased by 9%, from 15.0% to 16.4%, and among 26-34 year olds who have served, depression rates increased by 32%, from 14.8% to 19.5%. Second, women who have served face a growing burden of mental health challenges. Since the baseline period, anxiety rates more than doubled from 8.3% to 19.2%, and the rate of suicidal thoughts increased three-fold from 1.8% to 7.0%
The sections that follow provide a summary of key overall and population-specific findings across behavior, policy, community and environment, clinical care, and health outcome measures. Complete data on all 31 measures can be reviewed in the Explore section.