The veteran population in the United States disproportionately suffers from several physical and mental health challenges, but changes to the policies and processes that underlie veteran health could have a tremendous impact.
Veterans’ organizations in the public sector and government agencies like the US Department of Veterans Affairs (VA) are working to improve veterans’ access to healthcare and mental health services. Despite those efforts, more work is needed to make good on our nation’s commitments to honor veterans.
When it comes to the physical health and wellbeing of the veteran population, the statistics are disparaging. The suicide rate, which has been climbing in the United States in general, is even more devastating for the veteran population. According to the VA’s 2023 National Veteran Suicide Prevention Annual Report, the suicide rate for veterans is significantly higher than for nonveterans.
More work is needed to make good on our nation’s commitments to honor veterans.
Veterans who are unhoused, who have a mental health or substance use disorder diagnosis, or who reside in rural areas were among those most likely to die by suicide. Some racial groups had significantly higher rates of suicide than others; in 2021, American Indian and Alaska Native veterans (46.3 per 100,000), White veterans (36.3 per 100,000) and Asian, Native Hawaiian and Pacific Islander veterans (31.6 per 100,000) had the highest rates. The overall unadjusted suicide rate for veterans in 2021 was 33.9 per 100,000; for nonveteran US adults it was 16.7 per 100,000. Therefore, in 2021, veterans experienced a suicide rate more than double the rate for the country overall. In the same year, LGBTQ+ veterans, and younger people who left the military in more recent years were among the subpopulations at a heightened risk of suicide.
Veterans face unique health challenges. Due to their service, they are at a higher risk for musculoskeletal injuries, chronic pain, mental health issues and PTSD, traumatic brain injury, and chemical and noise exposure. Veterans also suffer from several chronic illnesses at higher levels when compared to the average US population, including coronary heart disease, stroke, skin cancer and other cancers, chronic obstructive pulmonary disease, emphysema, chronic bronchitis, arthritis, rheumatoid arthritis, gout, lupus, fibromyalgia, depressive disorders, and diabetes.
When considering the health needs and challenges of the veteran population, it is crucially important to understand that veterans are not a monolith and differences in military service have implications for health and wellbeing. For example, enlisted veterans tend to have poorer health, social, and vocational wellbeing than former military officers. Veterans who have been deployed to a war zone have more physical and mental health concerns than those who were not deployed.
Though the challenges facing veterans are significant, they are not insurmountable.
The health consequences of deployment are a mounting concern for veterans. As an article in Healthcare points out, “The physical demands on U.S. service members have increased significantly over the past several decades as the number of military operations requiring overseas deployment have expanded in frequency, duration, and intensity.”
Advocates for veterans’ health, many of them veterans themselves, have created nonprofits and other solutions that could help improve veterans’ health and wellbeing. They have also made important recommendations regarding the improvements needed to address veterans’ access to healthcare and the quality of care received.
Policies Veterans Need to Protect Their Physical and Mental Health
Though the challenges facing veterans are significant, they are not insurmountable. Nonprofit leaders and government officials have recommended policy changes, interventions, as well as program and process enhancements that could radically transform the state of healthcare for veterans, including those whose lack of social support and other circumstances make them more vulnerable to poor health outcomes. The recommendations include:
- Auto-Enroll Veterans into Healthcare Programs
With the number of health issues veterans experience, it is no surprise that healthcare is veterans’ top concern after they are discharged from the military. But many veterans don’t have access to care, and not all of those who have access enroll in a health plan. Though there were 18 million veterans in 2023, only about half were eligible for care through the VA, and only 6 million were using it. Veterans are not automatically enrolled in healthcare upon completing military service. For many, enrolling in healthcare services can be a confusing and arduous task. In a STAT article, Jenn Kerfoot, who’s also a veteran, argues that veterans who are honorably discharged should be auto-enrolled in health plans because “it shouldn’t be easier to enlist in the military than it is to get good health care.” By automatically enrolling veterans in healthcare programs upon discharge, we ensure that veterans can access the services they need to ensure their physical and mental health and wellbeing during what can be a very difficult transition.
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- Widen Access to Mental Healthcare
Military personnel consistently report higher rates of mental health stigma than civilian populations, which, in turn, also affects help-seeking behaviors. To add to the barriers preventing veterans from seeking mental or behavioral healthcare, many veterans are also part of subpopulations (such as particular ethnic and racial groups), that have their own stigmas regarding mental healthcare.
The challenges of the veteran population…reflect larger societal issues. Until we address these issues, we cannot effectively address the barriers to veterans’ health and wellness.
Veterans need mental healthcare that is responsive to their specific challenges, especially when their service involves deployment to a combat zone. Tailored therapeutic solutions that improve the delivery of clinical and crisis services throughout the veteran community could help mitigate some of the more severe and devastating consequences of mental health challenges, like suicide. But crisis interventions and clinical management should not be the norm and are no substitute for upstream solutions that promote wellness and social connection.
- Capitalize on Innovations in Veteran’s Health
While much of the social sector has experienced recent legal challenges to diversity, equity, and inclusion efforts, the military has maintained its ability to consider race in recruiting. As such, the VA is uniquely well-positioned to develop and launch new health innovations that work across racial and ethnic groups, genders, sexual orientations, and other differences. Therefore, the VA should be a leader in equitable health innovation, and work with other health agencies to help realize the promise of health innovation for all Americans. This is already underway with initiatives on women’s health research, 3D printing for medical and other equipment that enhances accessibility and/or mobility for veterans who are recovering from injuries or have disabilities, and the VA’s work on clinical telehealth for suicide prevention that is attuned to the cultural differences and social needs of veteran subpopulations; more work like this is needed.
A Holistic Approach to Veteran Health
The challenges of the veteran population, such as alcohol, drug, or sedative abuse; lack of social and familial support; unemployment; homelessness; economic instability; and poverty reflect larger societal issues. Until we address these issues, we cannot effectively address barriers to veterans’ health and wellness.
While there is still a long road to achieving parity in health with nonveterans, there are efforts to move the needle on veteran healthcare and wellbeing. Logan Spiewak, cofounder of the Boots to Health Foundation, spoke with NPQ about his efforts to serve veterans.
According to Spiewak, who is a Marine Corps veteran, when military personnel are discharged, many “don’t know which direction to head in.” He added that civilian life after military service can be challenging because it can be difficult to cope with the loss of structure that characterizes military service. The void left when the structure fades can sometimes lead to a downward spiral. Spiewak said that by the time veterans are referred to his program, many of them “need help, desperately.”
Boots to Health provides integrated help. According to Spiewak, “Every veteran that comes into the program is a little bit different, but my goal is to help them holistically, with their physical, spiritual, and nutritional wellbeing.” After the three-month program is complete, veterans who work with Boots to Health have a solid footing to build on. Spiewak emphasized the importance of his holistic approach: “The spiritual, the mental, the physical, everything ties together.”
Spiewak also works to provide the social support that too many veterans lack. He commented, “I just try to build this relationship with whoever comes in these doors. I want them to feel at home, at peace. I want to see improvement in their thinking…thinking good things, thinking positive thoughts. They’re being more productive for themselves and their families….I’ve been able to build these relationships with these individuals coming into the gym. I [sometimes] have dinner with the veterans that are referred to our program. That’s how we built this community around Boots to Health.”
When it comes to the future of veterans’ health and wellbeing, Spiewak sees signs of hope but also cautions that, as a society, we could be doing more to help our veterans. “Hundreds of thousands of people are entering the military and hundreds of thousands are coming out each year, so until we make a change…in the lives of individual [veterans] it’s going to be a repeated cycle.”
