Start focusing on veterans’ health before they enlist

Both campaigns laid out their plans for the military last week at a virtual convening with Military Times, a news outlet dedicated to covering service members and their lives, addressing what they would do for veterans. Formulating policies that exclusively focus on veterans is probably a necessary part of any presidential platform; a candidate wants a good portion if not all of the 17.4 million veterans in the country to support him. 

But to really help them, policy needs to utilize the time before they discharge from service. Actually, it has to focus on the time before they even enlist. 

It would be a new way of thinking about a class of people, but it’s the best way to protect their physical and mental health. 

Both President Trump and former Vice President Joe Biden’s outlines included their plans for suicide, PTSD, sexual assault and harassment, mental health, and VA health care accessibility. It’s standard fare when talking about veterans. 

Neither candidate mentioned that many service members enter the military already predisposed to suffer from some of these issues. 

The military disproportionately attracts recruits who have experienced a higher number of adverse childhood experiences (ACEs) than their civilian counterparts. ACEs include physical, emotional, or sexual abuse, emotional or physical neglect, caregiver substance abuse, caregiver incarceration, household violence or dysfunction, and divorce. 

The toxic stress a child endures when faced with ACEs affects neurological development, including eventual adult-responses to daily stress and even romantic relationships. This isn’t an isolated problem. One in six Americans experiences four or more ACEs. With each additional ACEs in a person’s childhood, their risk of physical and mental health concerns grows.

Almost 50 percent of Veterans Administration participants noted a personal history of four or more ACEs in a recent study. These experiences are traumatizing at the time, but they also affect those well into their adult years. 

The more ACEs a person experiences in childhood, the more likely they are to suffer from potentially lethal adult health issues like diabetes, cancer, heart disease, and suicide. Depression and anxiety are also consequences. 

This victimization sets up a cycle of trauma that ends up being hard to stop. These people are even more at risk of being either victims – again – or perpetrators of sexual assault and harassment. 

With so much research on the negative mental, physical, and emotional health consequences of ACEs, and with other research proving that the military disproportionately attracts recruits with a history of multiple ACEs, the logical conclusion is that addressing ACEs is a proactive way to manage bother servicemembers’ and veterans’ health. 

Researchers recently concentrated their efforts on discerning men’s and women’s emotional and social backgrounds who join the armed forces. Recruitment is about numbers, so historically, at least since voluntary enlistment started in 1973, the backgrounds of men and women who chose to join were less important than their current willingness to serve.

This is not to say that people with ACEs should be screened out. Seeking military service may be a sign of resilience and ability to overcome, as many people who suffer multiple ACEs thrive throughout their adult lives. And studies show many veterans with a history of multiple ACEs can experience a level of positive post-traumatic growth because of their military service. Rather, that personal history should be taken into account as servicemembers progress through their careers. Making people aware of potential lifelong health consequences of ACEs has the potential to mitigate later health effects. 

In fact, we can improve physical health if we pay attention to ACEs. One study examined how diabetes developed in Black veterans with ACEs, expecting that military service’s educational opportunities would moderate the onset of diabetes since education has been previously proven to do that. Instead, researchers found that this population developed diabetes as often as those without military service. When it fails to address ACEs and their outcomes actively, the Department of Defense is missing opportunities to improve veterans’ health while serving.

No study has examined ACEs’ financial cost in the military; it would be valuable information to have, especially when Congress approves the Department of Defense’s budget. We know from civilian research that the economic impact, including medical costs and loss of productivity, of ACEs is astronomical. One study released earlier this year found a cost of $113 billion in California. Another recent study found a cost of $5.2 billion in Tennessee alone. That’s just two states. 

Especially when one considers that complaints about military spending abound, advocacy and special interest groups often argue that some of the military budget — the largest expenditure by Congress — could be well spent on other preventative social programs. This is one area where military and veterans’ goals aren’t opposed to more progressive ideas of crafting a national spending plan. 

While it’s hard to get an idea in edgewise in the 2020 campaign, we should be discussing this now. Back during the primary season — which feels like it was years ago but left us only a few months before today — Sen. Amy Klobuchar (D-Minn.) was the sole candidate to address trauma in her platform. 

There are veterans health issues that require immediate attention like suicide and their current health statuses; looking into ACEs and their effect on people who enlist won’t bring quick relief to people who deserve treatment and care now.

But presidential platforms aren’t formal policy proposals. They’re aspirational documents that suggest new ways of thinking, not just what a candidate stands for, but what can be done. They’re the perfect place to communicate the idea that veterans’ health care should begin years before they exit the service. 

Kelsey Baker is a former Marine Officer and a Uniformed Victim’s Advocate.