Page 112 - JSOM Winter 2024

efforts such as early hemorrhage control, blood transfusion, A Challenge for Military and Societal Health
5,6
and surgical care. Examples of basic combat functional areas
that have benefited from conditioning include marksmanship, Our 34th President, Dwight D. Eisenhower, formulized some
5
physical training, small unit tactics, and medical training. The of his core beliefs into what was termed the Great Equation,
quality, quantity, or lack of training and resultant absence or “Spiritual force, multiplied by economic force, multiplied by
degree of instilled competence and confidence may ultimately military force, is roughly equal to security . . . if one of these
be reflected in a sense of empowerment or helplessness during factors falls to zero, or near zero, the resultant product does
a traumatic event. likewise.” While a strong military is necessary for national secu-
rity, it is not sufficient to build and maintain national security.
Just as a society depends on its military for defense, so does the
A traumatic killing or life-saving event enabled by condition-
ing can also be amplified by a positive or negative societal military depend on the society within which it exists. U.S. Mili-
reaction. Regardless of the etiology, a traumatic event could tary Forces remained strong during the conflicts in Afghanistan
promote a posttraumatic response, with the magnitude deter- and Iraq, fulfilling their role in the Great Equation. Through
mined by the meaningfulness and intensity of the event as well a Joint Trauma System and continuous cycle of performance
as the nature and degree of societal reaction. Factors such as improvement, the military health system learned from and
preexisting adverse mental and social health conditions versus adjusted to realities on the battlefield and responded by im-
8
a supportive environment of faith, family, and community can plementing life-saving policies and procedures. In garrison, fi-
influence outcomes as individuals experience notably different nancial resources and social capital should have reduced stress
reactions to similar circumstances and traumatic events, rang- for Veterans and their families. However, many military person-
ing from debilitation to personal growth. nel returned home to discover anomie, a deficiency of shared
understanding and sacrifice, and a commensurate reduction in
both economic and spiritual force within their communities.
If conditioning can increase the effectiveness of killing enemy
forces and increase the effectiveness of saving lives, then proper
conditioning can effectively increase strength, resiliency, and The past decade has seen an erosion of social trust and cohe-
the threshold of stress. “Conditioning is everything. If you sion, the disappearance of cordial and apolitical perspectives, a
train as you will fight, you will fight as you train . . . If you precipitous and suboptimal military withdrawal from Afghan-
train to adapt to stress, you will adapt to stress as you were istan, a fractured support for the military cause, and difficulty
7
trained.” Stress from combat is inevitable; however, PTSD is achieving military service recruitment goals, all of which can
not. Stress does not always manifest as pathology. Some stress impact the rank and file of our military forces, our national de-
may even support hormesis or a favorable and adaptive re- fense, and the nature and degree of the societal reaction that
sponse by the body. Regardless, in addition to appropriate as- contributes to posttraumatic stress. The impacts of these stress-
sessment and selection, prevention through conditioning may ors are already evident among the military veteran population.
mitigate maladaptive posttraumatic stress and reduce the rate For example, recent research has revealed patterns of increas-
and degree of dysfunction and disorder. ing mortality rates and excess mortality from accidents, suicide,
and homicide among U.S. Military Veterans who served after
the September 11, 2001, terrorist attacks. 9,10 Any future large-
Military Health to Societal Health scale combat operation or other cause of military force attrition
warranting conscription could even further exacerbate this issue
People are affected by the relationships they develop and by the
communities in which they reside. Conversely, societies reflect and also precipitate mass protest, civil disobedience, and other
the character of their residents. The military as a profession is actions that might disrupt the remaining social fabric of our
unique and is typically accompanied by a distinctive culture nation. Additionally, this has not only impacted military and
and community that exists within a larger construct and soci- veteran health but many facets of health throughout our society.
ety. As a result, military personnel influence and are impacted
by both military and civilian communities. Often times, the The signs of lack of social cohesion in the U.S. are evident
health of Servicemembers and Veterans is representative of the in many key health and social development indicators (Fig-
current state of overall military health, which in turn emulates ure). For example, from 2000 to 2021, the drug- and alcohol-
greater societal health. Additionally, when society becomes induced mortality rates increased four-fold, from 11.2 to 44.3
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more atomized and increasingly distanced from the optimal per 100,000; maternal mortality rates more than doubled,
12,13
values required of a military force, it will prove more challeng- from 14.5 to 32.9 per 100,000 live births; homicide rates
11
ing to field a disciplined and professional force. This challenge increased 37.3%, from 5.9 to 8.1 per 100,000; and suicide
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can also occur if leadership focus is diverted away from the rates increased 35.6%, from 10.4 to 14.1 per 100,000. Over
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priorities, values, and standards that are otherwise innate to an the same period, life expectancy at birth also began to fall,
effective military that is able to deter and win wars. a trend that was already underway prior to the magnification
attributable to the COVID-19 pandemic. Since the 1980s, the
U.S. has increasingly outpaced other developed nations in mor-
A primary role of the U.S. Military is to support and defend 15
the nation and its citizens, along with its constitution, customs, tality and lagged behind them in life expectancy. Recent esti-
and traditions. Historically, the military has contributed to the mates suggest that this represents more than 12 million excess
15
cohesion and national security of the country as well as to its deaths from 1980 to 2021, which could have been avoided
many states and local communities. When the general popu- if the U.S. had simply maintained an average mortality com-
lation becomes nominally invested in the military, with fewer pared with other developed nations. These facts represent a
families experiencing sacrifice from military service, cohesion societal crisis that is unendurable and must be addressed.
and security may be compromised. This can also occur if the
military becomes distracted from its core values or intended In addition to increased mortality and decreased life expec-
mission, task, and purpose. tancy, many in the U.S. are suffering from pervasive loneliness
110 | JSOM Volume 24, Edition 4 / Winter 2024