Military Public Health

Abstract

Public health is a key contributor to military effectiveness. Successful operations depend on the underlying fitness of personnel and the maintenance of health through effective prevention of, or protection from, harmful environmental exposures and behaviours. Public health practice in the military covers the main domains of health promotion and improvement, health protection and the provision of quality health services. The information resources underpinning this work differ from those available to civilian practitioners, but it is possible to derive population level information from the joint personnel administration system, aggregated pseudo-anonymised military primary care data, deployed hospital, aeromedical evacuation and mental health databases, patient tracking systems and a number of surveillance systems covering, for example, climatic injury and communicable disease. Difficulty in identifying military patients as a sub-set limits the usefulness of many of the national and regional health information sources routinely used in civilian practice. The medical examination of individuals during the selection process screens out declared or detectable major physical and psychological problems and creates a healthy worker effect. However, military personnel are drawn from the civilian population and reflect the health behaviours of the groups from which they are recruited. Poor levels of dental health on entry and higher than average levels of cigarette smoking are present in sections of the military population. Harmful drinking behaviour is common. The prevalence of risk factors is not evenly distributed. The population is heavily skewed towards the under-30 age group, with males the predominant proportion. Nevertheless, sub-groups within the military population, such as females, personnel recruited from overseas and young personnel with low levels of educational attainment, have particular needs that require targeted approaches. An overall defence health strategy directs and supports the work of the chain of command in developing healthy polices and providing a healthpromoting environment as far as is possible. Paradoxes exist in military health promotion. Unlike their civilian counterparts, many among the Armed Forces population undertake high levels of physical activity. The development and maintenance of good physical fitness is essential to prepare all deploying personnel for the demands of operations. But the necessarily robust physical training results in sports injuries and overuse injuries that may require prolonged recovery periods. Surveillance of injuries and modification of training schedules and activities is an ongoing process moving towards an irreducible minimum level of sports and training injury. Individual behaviour is another area with conflicting drivers. The demands of operations may inherently steer the selective recruitment of individuals with tendencies towards risk-taking behaviour, and those who work well in groups, conforming to peer group behaviours. Clearly these qualities need control and direction rather than to be stifled, and the fine line managed by commanders is supported by focussed and pertinent health promotion efforts. …