The role of research
In late August, ministers and senior officials from Canada, the United States, the United Kingdom, Australia, New Zealand, as well as South Korea, Germany, Denmark, France and the Netherlands gathered in Ottawa to discuss collaborative research, policy development and programs for veterans.
In their final communiqué, the ministers acknowledged the growing importance of research to deliver insight and intelligence into the long-term effects of military service, especially in the areas of mental health, complex health needs and families. They also noted the value of a burgeoning network of research institutes, including the newly created Canadian Institute for Military and Veteran Health Research, in the coordination of research initiatives.
The event was hosted by Steven Blaney, Minister of Veterans Affairs Canada (VAC). Recently, his Assistant Deputy Minister for Policy, Communications and Commemoration, James Gilbert, joined Commodore Hans Jung, the Canadian Forces Surgeon General and commander of the Health Services Group (CFHS), to discuss the role of health research in the lives of Canada’s military personnel and veterans.
How does research on health-related issues help meet your respective mandates?
Jung: A strong science and technology foundation is a prerequisite to the fulfilment of every senior medical officer’s duty as the statutory adviser to commanders on all matters related to health. Thus, structuring our efforts to collect and analyse health-related data is critical to building upon this foundation and optimizing our health practices and programs. Operational, occupational and environmental health hazards and needs evolve continually. Innovative research on health issues related to military operations and populations is therefore an essential and fundamental requirement to the fulfilment of our mandate. We actively seek, create and exploit S&T to promote, protect, and restore the health of our fighting forces.
Gilbert: VAC research functions support the innovation that is essential to meet our mandate. Research informs effective programs, services and benefits that best fit the needs of Veterans and their families. Research plays a key role in clarifying issues in controversial times: during the 1990s, when parliamentary committees and experts called for significant changes in how Canada provided for serving personnel, veterans and families, the Veterans Care Needs research program played a pivotal role in supplying evidence to shape new solutions.
Could you describe some of your organization’s current health-related research?
Jung: The Surgeon General’s Health Research program is necessarily diverse given the CFHS’s responsibilities not only to restore health that has been compromised, but also more fundamentally to proactively promote good health and protect CF members from illness and injury. Therefore, we conduct an extensive and ongoing research program in many areas of military health: operational medicine, trauma care, occupational health, mental health, health care resource management, primary care, epidemiology/population health. There are too many to fit in one article, but an outstanding example of a recent study publicly announced is the CF Cancer and Mortality Study.
Gilbert: Two of our most recent research projects are the Life After Services Studies program and the Workplace Reintegration for Veterans With Mental Health Disorders. The first is a program of research exploring the military-to-civilian life transition experience. It’s a partnership among VAC, CF/DND and Statistics Canada and consists of an income study, a transition to civilian life survey, and the previously mentioned CF cancer and mortality study. The findings were used to evaluate the new veterans charter programs. They are also helping to fill the current gap in research on military-to-civilian transition.
The latter project, funded by a Canadian Institutes of Health Research grant, is a partnership with the University of Sherbrooke focused on successful workplace reintegration for veterans with mental health conditions. Among other things, it produced a literature review that identified gaps in knowledge about how best to assist veterans with work when they have mental health disorders, and a qualitative study that identified barriers in returning to work for veterans with mental health disorders. The findings from this work will be used to develop practical applications to help veterans.
What is the most pressing research need?
Gilbert: Working together with a number of partners such as DND, universities, Statistics Canada and our allies in other countries, VAC’s primary areas of focus include increasing knowledge of the effectiveness of interventions to support transition from military service to civilian life, the needs of veterans who were Reserve Force members, veteran mental health and the effectiveness of mental health treatments and the impact of military service on families.
Jung: There are simply too many to list. However, given our recent experiences in Afghanistan and other operations, military mental health and trauma protection and care are always high priorities.
What impact has the war in Afghanistan had on this field?
Jung: The war has permitted us to develop enhanced trauma management interventions and processes rapidly given the pressure of circumstances, the volume of casualties, and the facilitation of research through use of the Joint Theatre Trauma System, its integral trauma registry (the largest combat trauma registry in the world), and our internal clinical and operational lessons learned processes. Trauma care in the civilian setting has been greatly advanced by techniques and procedures that were developed on the battlefield. Our current conflict in Afghanistan is no exception. The CFHS has been fully engaged in the research and development of new trauma management techniques for the battlefield. The CFHS has developed an extremely robust and well-regarded training program in tactical combat casualty care, termed Tacmed, for its combat medical technicians. And CFHS researchers have made significant improvements to TCCC protocols that have been adopted worldwide.
Gilbert: Like all wars, some who served suffered physical and mental injuries and illnesses. Many recovered, but some have ongoing problems with health and disability when they transition to civilian life that will affect the quality of their lives, and their families.
What other major military events in recent decades have influenced health research?
Gilbert: Since the 1991 Persian Gulf War, more Canadians have been affected by military service-related injuries and illnesses than any era since the Korean War. These veterans and their families live in a nation with very different health care and social support systems than had existed just after WWII. Canadian research on the new generations of veterans in the 1990s made their challenges clear, and the Life After Service Studies have broadened our understanding to include the majority of former Canadian Forces personnel not participating in VAC programs, but many questions still need answers.
Jung: Most notable are probably concerns about linkages between exposures during the first Gulf War (and subsequent operations such as in the Balkans) with the development of various illnesses. Also, we’ve seen a greatly increased operational tempo (primarily international peace support operations) far beyond anything experienced during the Cold War after the Korean War, with more and larger deployments to non-NATO parts of the world presenting infectious, occupational, and environmental hazards not encountered in industrialized nations. Also, intelligence revelations of new chemical, biological, and directed-energy weapons threats; expanded military health research efforts within academia among our major allies; and downsizing of armed forces and their budgets.
How does this type of research effect the general population?
Jung: Many of history’s greatest advances in medicine resulted from the experience of warfare. For example, the practice of triage was first pioneered by Dominque Jean Larrey during the Napoleonic Wars. Closer to home, the first practical method for transporting blood was developed by Canadian surgeon Norman Bethune during the Spanish Civil War. CF experience and research related to current operations have enhanced knowledge in such areas as pre-hospital trauma care, brain injuries, trauma surgery, coagulopathy, transfusion medicine, health and physical protection and mental health.
Gilbert: First and foremost, this type of research would ensure that veteran programming continues to be informed by current and relevant evidence. Second, veterans’ health research has always produced innovations and advances that apply in the civilian world. Injuries and illnesses experienced by military personnel and civilians are similar, so lessons learned from military and veterans’ health research can be of great value to all Canadians. Advances in rehabilitation from blast injuries can even apply to elderly Canadians who suffer stroke, for example.
An interview with Commodore Hans Jung and ADM James Gilbert