A decade ago, Veterans Affairs Canada’s Gerontological Advisory Council brought to public attention something serving military and veterans have always known: military service has long-term effects on health, and we’re not just talking about war wounds.

At the time, the council was concerned that there be adequate services to support veterans of the world wars and the Korean War as they aged, noting that chronic health conditions sometimes occur decades after the initial injury, when the link to military experience is not easily recognized.

While the report detailed much information on the effects of aging on health, there was a considerable gap in knowledge about specific effects of service on veterans’ long-term health. The council cited Australian research which showed that 50 years after the Korean War, veterans were one and a half to three times more likely than civilians to have chronic medical conditions such as arthritis, heart and liver disease, kidney disease, diabetes and cancer. But why?

That gap has begun to close, but we still have a long way to go.

Results of what is believed to be the first analysis of the overall health status of a representative sample of Canadian veterans published in the Journal of Military, Veteran and Family Health in 2015 is interesting both for what it revealed—and what it couldn’t.

A team of researchers from the University of Toronto and the Institute of Health Policy crunched data from a survey of 3,154 regular force veterans leaving the services between 1998 and 2007. They found, among other things, that being in the army and being deployed overseas increased risk of chronic health conditions. Health risks rise as veterans’ income drops. Veterans with mental health problems were likely to also have physical health conditions as well. Female veterans are at higher risk for respiratory conditions.

But it was not possible to relate health risks to specific deployments because veterans were not asked where, when, how many times and for how long they had been deployed. Not all health problems were on the list of conditions queried, and veterans weren’t asked about the severity of their conditions. But there was enough data for researchers to conclude there is a link between military service and veterans’ chronic health conditions.

Such information is important, the authors note, not only so civilian doctors can better care for their veteran patients, but also so Veterans Affairs Canada and the Department of National Defence can design programs for high-risk military personnel making the transition to civilian life.

It predicts an
increased call for
VAC services as these
veterans, most of
whom are still serving,
leave the services.

Veterans’ long-term health was the focus of at least a half dozen research reports at the 2015 Military and Veterans Health Research Forum in Quebec City, and an encouraging number were joint VAC/DND studies.

One such cross-linked operational records from Afghanistan, DND casualty and release information and VAC data, and found that Afghanistan veterans have reported more problems adjusting to civilian life and are more likely to report post-traumatic stress disorder and mental health problems than other veterans released between 1998 and 2007. It predicts an increased call for VAC services as these veterans, most of whom are still serving, leave the services—timely information as VAC and the Canadian Armed Forces are currently considering how to smooth the transition from military to civilian life.

A joint VAC-Queen’s University study found that mental health problems are associated with difficult adjustments to civilian life. And the prevalence is higher among recent veterans than the general population, veterans of earlier eras “and possibly the serving population.” Their conclusion recommends strong transition support services and access to effective mental and physical health services.

While it’s great that attention is being drawn to the issue of programs and support for veterans, there’s not—at least not yet—much talk about what can be done to mitigate veterans’ health issues while they are still in uniform, aside from mental health resilience training.

In the U.S., which has the advantage of greater numbers of veterans (and researchers!), studies have identified a downhill spiral in which trauma makes veterans more vulnerable to stressors later in life. Other research has found some veterans seem to have developed resilience to chronic health problems through the positive effects of military service—lifelong relationships with comrades, self-confidence and interconnectedness. Can positive experiences balance or negate effects of trauma with benefits to long-term health?

  There is an increased call for such long-term, more personalized studies as that begun in 2013 by Ibolja Cernak at the University of Alberta supported by a grant from Alberta-Northwest Territories Command of The Royal Canadian Legion. She is tracking health developments of 150 CAF personnel from pre-deployment training, through deployment, their post-deployment careers and transition to life as a veteran. Such research, she has said, will identify components of resilience and susceptibility to physical and mental health impairments and help develop interventions.

Perhaps one day interventions during and after service may result in no difference in rates of long-term health problems between veterans and civilians.

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