Social Determinants of Military Health

[DRAFT] “Social determinants of health” is a public health construct of “conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.” They include health access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment (CDC).

Most military suicide prevention programs focus on intervention (ACE, ASIST). Some teach resilience skills based on positive psychology. What would it look like if we were to approach suicide prevention from a public health perspective, realizing that many interrelated factors are involved in promoting life or in causing pain. If we are going to decrease military and veteran suicide, we need to improve the environments in which service members live and work.

This is just a preliminary sketch of some ideas. I hope to flesh them out, and encourage others who are inspired to do so to join in.

1. Neighborhood and Built Environment. This would include the quality of housing, as well as elimination of toxins in construction and in the external environment (both in garrison, field, and deployment).
2. Health and Health Care. Are service members encouraged to get medical care (including mental health)? Does it meet professional standards? Do service members have the right to appeal, and to sue for malpractice? We need to expand health care for veterans, especially those with “bad paper.” Eliminate stigma. Stop using UCMJ to get rid of service members with service-related mental health conditions.
3. Social and Community Context. Are our neighborhoods safe? Is the community supportive of service members, veterans, and their families? Eliminate toleration of racism and sexism. Keep service members safe from sexual harassment and assault.
4. Education. Rebuild TRADOC. Develop critical thinking and an appreciation for the arts. Humanize all military education, building upon a foundation of respect and dignity. Improve on-base and civilian schooling. Ensure service members are in an MOS they enjoy, and that they get access to schooling both in their field and to expand their thinking and experience.
5. Economic stability. Service members should not be on food stamps. Raise their pay–give them a living wage. Increase benefits for family members. Improve the ability to find work after ETS/retirement, and increase civilian job retention for reserve component members post-deployment.