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Since 2016, America’s Health Rankings has examined important differences in the health of those who have served in the U.S. military compared with those who have not. The Health of Those Who Have Served Report continues to identify profound differences between those who have and have not served across health behaviors, social and economic factors, clinical care and health outcomes. This year, the report finds:
  • Those who have served continue to report a more positive outlook on their health, compared with those who have not served. However, for the first time, the percentage reporting very good or excellent health has declined.
  • Those who have served continue to report higher rates of chronic disease than their civilian counterparts.
  • Rates of mental health challenges, such as depression and frequent mental distress, are increasing at a faster rate among those who have served than those who have not.
  • Rates of mental health challenges differ among men and women who have served.
  • The percentage of those who have served who received a flu vaccination has decreased.
  • Those who have served report lower rates of avoiding care due to cost.

High Health Status

Those who have served consistently report a more positive outlook on health than those who have not served.

Self-reported health status is a measure of how individuals perceive their health and is used as an indicator of a population’s health. It is a subjective measure of health-related quality of life and is not limited to certain health conditions or outcomes but instead influenced by life experiences, the health of others in a person’s life, support from family and friends as well as other factors affecting well-being. Since the baseline reporting period (2011–2012), those who have served have had a higher prevalence of reporting that they have high health status. This year’s report finds 54.6% of those who have served indicate their health is very good or excellent, compared with 50.0% among those who have not served.
The difference in high health status between those who have and have not served is particularly pronounced among certain subpopulation groups. The prevalence of high health status is higher among Hispanic, Black, American Indians/Alaska Native and Hawaiians/Pacific Islander adults who have served compared with those who have not served. High health status prevalence is 1.5 times higher among Hispanics who have served than Hispanics who have not served (51.1% compared with 34.4%).
In addition, among those ages 18-49, those who have served also have significantly higher rates of reporting high health status than those who have not served. Among those ages 18-25, those who have served report 1.3 times higher prevalence of high health status than those in this age group who have not served. This difference is not seen among those ages 50 and older.
Among those who have served, the prevalence of high health status is higher among those with higher incomes, with a college degree and those ages 18-25.

For the first time the percentage reporting high health status has declined among both those who have and have not served.

Since the prior reporting period (2015–2016), the percentage reporting high health status declined 3% (from 56.3% to 54.6%) among those who have served and 2% (from 51.1% to 50.0%) among those who have not served. Among those who have served, the prevalence of high health status among males decreased 4% and decreased 7% among those ages 35-49 over the same period. Going forward, it will be important to examine whether these trends continue and what a decline in subjective measures of health may indicate for the health of those who have served, as well as the broader population.

Chronic Disease

Despite reporting high health status, those who have served consistently report higher rates of chronic disease than their civilian counterparts.

Chronic diseases often require long-term management and contribute to many of the leading causes of death. Since the baseline reporting period (2011-2012), those who have served have reported higher rates of several chronic diseases than those who have not served, including arthritis, cancer, cardiovascular disease, chronic obstructive pulmonary disease and pain.
Among adults ages 50 and older, those who have served have higher rates of chronic disease than those who have not served. For example, those who have served have a 1.5 times higher rate of cardiovascular disease (21.5% vs. 14.8%), 1.2 times higher rate of cancer (24.7% vs. 21.1%) and 1.2 times higher rate of COPD (12.4% vs. 10.6%).
Asian Americans who have served have higher rates of many chronic conditions compared with their civilian counterparts, including a 2.5 times higher prevalence of pain (23.0% vs. 9.3%), 2.2 times higher rate of cardiovascular disease (9.0% vs. 4.1%) and 1.5 times higher rate of arthritis (18.2% vs. 12.4%).
Among those who have served, females report higher rates of COPD, arthritis, cancer and pain compared with males. In contrast, males who have served report higher rates of cardiovascular disease than females who have served.

Obesity continues to increase

Obesity rates remain similar between those who have and have not served. Since the baseline reporting period (2011-2012), obesity prevalence has increased 12% among those who have served (from 27.6% to 30.9%) and 11% among those who have not served (from 27.3% to 30.2%). Obesity is one of the leading causes of preventable life-years lost among Americans. Weight stigma, or discrimination and stereotyping based on an individual’s weight, may also negatively influence psychological and physical health.

Mental Health

Overall, those who have served report a similar prevalence of mental health concerns as those who have not served.

A healthy mental state is essential to health and well-being. Poor mental health is a leading cause of disability in the United States and affects an individual’s ability to contribute to community and society. Mental illnesses range in severity, from mild, occasional symptoms to debilitating impairments that can lead to persistent disability and premature death from chronic disease or suicide. Certain experiences associated with military service may predispose people who have served to developing mental illness.
Those who have served reported prevalences of depression (18.5% served vs 18.7% not served), frequent mental distress (12.8% served vs. 12.7% not served), suicidal thoughts (5.4% served vs. 4.4.% not served) and any mental illness (19.8% served vs. 19.6% not served) that are similar to individuals who have not served.
Frequent mental distress refers to having had 14 or more mentally unhealthy days in the past 30 days. Having adequate social and emotional support may reduce the chance of those who have served experiencing frequent mental distress.
When someone experiences mental illness, seeking treatment is important. Nearly half of those who have served who experienced mental illness reported receiving mental health treatment (46.9%). This is similar to rates among those who have not served (43.3%). Negative beliefs and stigma surrounding mental health treatment may contribute to avoiding mental health care.

However, differences emerge when examining mental health concerns by gender.

Males and females who have served report higher prevalence of depression, frequent mental distress and any mental illness than males and females who have not served.
  • Depression is 1.3 times higher among males and 1.2 times higher among females who have served, compared with their civilian counterparts.
  • Frequent mental distress is 1.2 times higher among males and 1.1 times higher among females who have served, compared with males and females who have not served.
  • Any mental illness is 1.2 times higher among males and 1.3 times higher among females who have served, compared to male and female civilians.
In addition, the prevalence of suicidal thoughts among males who have served is 1.3 times higher than among males who have not served (5.3% vs. 4.0%). Males with service also have a 1.4 times higher rate of mental health treatment than males who have not served (45.2% vs. 32.8%).
It is also important to highlight that among those who have served, males and females report different prevalences of mental health concerns. Compared to males who have served, females who have served report higher rates of any mental illness, depression and frequent mental distress.

Since the baseline reporting period, those who have served experienced more than twice the rate of increase in frequent mental distress and depression than those who have not served.

The prevalence of frequent mental distress has increased 13% (from 11.3% to 12.8%) among those who have served since the baseline reporting period (2011–2012), while the prevalence among those who have not served increased 5%. The prevalence of depression increased 23% (from 15.0% to 18.5%) among those who have served during this same time period, while the prevalence among those who have not served increased 11%. Depression symptoms can impact all aspects of life, including how people think, feel and handle daily activities.

Additional Findings

Flu vaccination rates have declined among those who have served.

A flu vaccine is the best protection against seasonal influenza viruses. Veterans tend to be older and have higher rates of comorbidities compared with the general population which can place them at a greater risk of flu and flu complications. The percentage of flu vaccinations is 1.3 times higher in those who have served (43.8%) than those who have not (34.3%).
However, since the prior reporting period (2015–2016), the prevalence of flu vaccinations among those who have served decreased 13% (from 50.6% to 43.8%). Among those who have not served, the percentage of flu vaccinations decreased 7% since the prior report. This decline is concerning, because during military service, an annual flu vaccination is required and the importance of such vaccinations is stressed. If those who have served no longer receive beneficial vaccinations after separation from service, education surrounding vaccination may need to be improved.

Those who have served report higher rates of health insurance and lower rates of avoiding health care due to cost.

Compared with those who have not served, those who have served report higher rates of health insurance (92.5% vs. 86.6%) and lower rates of avoiding care due to cost (9.0% vs. 14.2%) than those who have not served. However, among those who have served, 21.1% of those with incomes less than $25,000 have avoided care due to cost, compared with 4.3% among those with incomes of at least $75,000. The high cost of health care in the United States is one of the leading factors in avoiding care. Cost concerns may lead people to forego screenings and treatment for minor problems that can worsen into serious disease.

Conclusions

The America’s Health Rankings 2020 Health of Those Who Have Served Report continues to shed light on the leading health concerns facing men and women who have served in the U.S. Armed Forces. The findings of this report not only reaffirm the distinct health and broader needs of those who have served, but also highlight encouraging improvements, persistent challenges as well as new and emerging concerns overall and for specific subpopulations of those who have served. The report offers important insights and direction to inform future areas of research, dialogue, advocacy and policy that improve the health and well-being of all those who have bravely and selflessly sacrificed and served this country.

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