Jonathan Woodson, Department of Defense: National Prevention Strategy Series

Sep 11, 2012, 9:08 AM

World Suicide Prevention Day, co-sponsored by the World Health Organization, promotes commitment and action to prevent suicides. Almost 3,000 people commit suicide every day, and for every person who completes a suicide, 20 or more may attempt to end their lives. In the first five months of 2012, at least 155 military service members committed suicide—more than the number of service personnel killed in Afghanistan during the same time period.

As part of our National Prevention Strategy seriesNewPublicHealth spoke with Jonathan Woodson, MD, Assistant Secretary of Defense for Health Affairs in the Department of Defense, about suicide prevention as well as the department’s overall approach to wellness and prevention for military, veterans and their families.

Listen to the podcast and read the full interview with Dr. Woodson below.


NewPublicHealth: How has the Department of Defense incorporated the National Prevention Strategy into its work?

Dr. Woodson: The National Prevention Council, as you know, is a collaboration of 17 heads of departments and agencies and offices across the U.S. government, and it moves us as a nation from a system of focusing on sick care to one based on wellness and prevention. At the Department of Defense, we’ve moved from a concept of health care to health, meaning that we understand health really is a much more involved concept other than just freedom from disease. It relates to healthy communities and healthy and active lifestyles and also addresses mental wellness and spiritual wellness as well. For us to create a fit and ready force, we need to make sure that we’re paying attention to all these dimensions of health and wellness. So the National Prevention Strategy aligns perfectly with us, and that’s why we thought this was an excellent partnership for us to be involved with.

NPH: What are some of Department’s key efforts that align with the National Prevention Strategy?

Dr. Woodson: We have launched Operation Live Well, which looks at the concepts of active living, healthy eating, tobacco free living, mental and emotional well-being. This fits well with the Secretary’s concept of Total Force Fitness, which is that mental and spiritual fitness needs to be on par with physical fitness. The military services have long focused on physical fitness as a core area to produce an effective fighting force, but what we’ve learned most intensively over the last ten years of war is that we need to address with the same kind of aggressiveness the issues of mental and spiritual fitness, and related closely to that is building healthy communities, family relationships and bonds. All of these dimensions are important.

Our approach, which is directly in support of the National Prevention Strategy, looks to really create the best living environments for our service men, women and their families, communities that are active, communities that are informed, environments which permit healthy choices and make healthy choices easy to make. At many of our installations we are conducting military nutritional environment surveys to look and see where we can make improvements, and more specifically, what are our cafeterias serving and selling? How can we leverage our buying power to influence better choices from the vendors who are on our bases? We are making it easier for our troops to make healthy choices by color coding menus—a project called Go For Green, so that in the cafeteria it’s very easy to identify the healthy choices over the red choices, which are the higher sugar, higher fat choices that are unhealthy.

We are also looking at our environment to make sure that we can incorporate more activity in the workplace, and put constraints on the environment that permits smoking. Our population, interestingly enough, is really a microcosm of American society, and the health of America is very important to us. We know that 27 percent of individuals who would otherwise be of acceptable age to enter the military cannot because they’re too obese. And the number one reason for early discharge from the military during basic training and at first enlistment has to do with being overweight and not meeting physical fitness standards. So this is a problem for us on the front end.

But we’re also seeing increasing problems with having to discharge otherwise productive service members because they are not physically fit in mid-career as well. Wearing my other hat as the Director of TRICARE Management Activity [which administers the worldwide health care plan for eligible beneficiaries of the uniformed services, retirees and their families] we find that when individuals leave active service, they really, in fact, gain even more weight than the average population. We want to make sure that we encourage healthy choices and decisions throughout their military career so that it carries over into the retired status.

I believe that this is a moral obligation and, in fact, it will also allow us to achieve one other aspect of our quadruple aim eventually, which is reducing health care costs. But the real importance of it is making sure that people live long and healthy lives. Our focus is to build environments, build people who are empowered and enabled to make healthy choices, and therefore improve the conditions of their lives throughout their entire life cycle.

NPH: How is the Department of Defense addressing tobacco control in the military?

Dr. Woodson: Thank you very much for that question. It is important in our total concept of moving from health care to health, building a fit and ready force and making sure that our beneficiaries, even after they retire, live long and healthy lives. Tobacco is one of those issues that impacts heavily on prevention of disease, and the development of chronic diseases that can impair the ability to live long and healthy lives. For the military, this is of particular concern because, again, our responsibility is to build a fit and ready force to deploy anywhere in the world in support of the national defense, and we ask our troops to do amazing physical and mental things in support of that defense.

When troops smoke, it diminishes their ability to participate in physical activity, and of course, increases the incidence of respiratory diseases. During basic training we have smoke-free campuses, but what’s been disturbing about our experience is that once they leave basic training our rates of smoking actually increase beyond the average for the American population.

We’re looking to create more smoke-free campuses. We’ve extended our smoking cessation program and the intensity of those programs in screening for this in our patient-centered medical homes. We also understand it’s not just about what the health care provider does, it’s about whether or not the environments in which our beneficiaries live enable them to make good choices about their health. We’re looking at the issue of the availability and pricing of tobacco products and we’re looking at the issue of involving leadership, because we know our young troops are very much influenced by their frontline leaders. I must say that our enlisted leaders, who are the backbone of the military, are very enthusiastic about this because they understand the importance to preparing a fit and ready force.

NPH: Do you think that down the road, you might have some ideas to share with the general population from what you’ve learned in the military, particularly helping young people stop smoking or not begin at all?

Dr. Woodson: Absolutely. We have taken the position that we need to lead the way, that it’s so important to us as an organization in service to this nation that we can’t wait for new ideas to spring up in the private sector—although I will admit that we’re willing to steal shamelessly, if you will, any good evidence-based ideas that come along. But we want to lead the way in this effort in reducing tobacco use.

NPH: Dr. Woodson, I know that the whole country has read the recent reports on increases in suicide with such sadness. What are the current efforts at the Department of Defense to address this issue of the recent rise of suicide among service personnel and veterans?

Dr. Woodson: We’re taking a multidimensional approach to trying to meet and address and reduce these terrible statistics about suicide. This issue of the accelerated rate of suicides makes us focus more aggressively on building resiliency in the force and building healthy communities and families, because we think this is very important to the prevention of suicide.

But let me just take a step back. We know that we’ve been at war for over a decade. We’ve asked a lot of our men and women in the armed forces. Going to war changes everybody. I don’t think there’s a person who deploys and is in that environment and comes back the same way.

But some individuals are at greater risk—individuals that have legal issues, financial issues, relationship issues, and tend to be loaners and disconnected from units. And so a lot of our strategy looks at front-end prevention—building resilience. And we also want to give those in our care access to quality mental health. We’ve increased the number of mental health providers on active duty by several thousand, and in our network we now have nearly 60,000 providers. We are training our leaders at all levels to recognize those at risk, be able to respond, and create environments in which we reduce the stigma so that it’s not a sign of weakness but a sign of strength to ask for help. We’re increasing the number of peer-to-peer counselors because that seems to be very effective. We’re looking at how we craft comprehensive policies to enhance weapon safety because we know that firearms are operative in 43 percent of successful suicides.

We’ve invested a lot in research that is looking at all issues of prevention, diagnosis and treatment of both suicide and the aligned issues of traumatic brain injury and other mental health disorders, particularly post-traumatic stress disorder.

Suicide is often an impulsive act. It’s often a permanent solution to a temporary problem. As a result, we need to prepare communities better to recognize symptoms and respond or rescue individuals.

NPH: Thank you for that response. Can you tell us about the partnerships the Department is pursuing across government and in other sectors to achieve better health for service men and women and their families?

Dr. Woodson: We are looking into all sectors for partnerships: across the whole of U.S. government and agencies that include the Departments of Labor and Health and Human Services. We’re looking into the private sector, to corporations that produce services that men and women in the armed forces might need, particularly as we look to their transition back into communities. We are forming partnerships across all of the dimensions that we want to influence.

This commentary originally appeared on the RWJF New Public Health blog.