American philosopher Irwin Edman once said, “Life is always at some turning point.” The 1991 Persian Gulf War marked a turning point in veteran health research, resulting in a global explosion of scientific publications, public interest and investment in military and veteran health. Veterans around the world returned from the Gulf War with a range of health concerns, leading to huge financial investments in an attempt to understand health issues linked to this single conflict.

The global trend towards investment in veteran health research continues today, not only in terms of understanding the health impacts of deployments, but also in exploring the effects of military service over the life courses of veterans and their families.

Veteran health research is not new in Canada. Following the Second World War, Canada enjoyed a rich tradition of research in Department of Veterans Affairs’ hospitals, rehabilitation centres and health care facilities. The department’s 1963 Annual Report described 89 research studies underway at the time. This research capacity was reduced with the transfer of health care facilities to provinces and communities during the 1960s and ‘70s. However, the past two decades have witnessed a renaissance in Canadian veteran health research capacity.

This year, veteran health research will benefit tremendously from the establishment of the Canadian Institute for Military and Veteran Health Research, a Canadian-wide institute committed to linking the civilian- and military-conducted health research in a variety of fields relating to veterans, active military members, and their families.

There are now about 600,000 former Canadian Forces personnel who served since the Korean War living in the general population. Every year, thousands more enter the veteran phase of their lives. Since the 1991 Persian Gulf War, more Canadians have been affected by war than at any time since the Korean War. Veterans’ health changes over the course of their lives – whether before, during or after service – and conditions can last a lifetime. Veterans’ service-related health problems can affect and be affected by the health of family members. Much remains to be learned about their lives, and how best to assist them.

Challenges and opportunities
Managing new knowledge: Two kinds of research are needed to support veterans and their families: assess/summarize rapidly expanding new and emerging research findings, and produce new knowledge to fill gaps. Most modern military veteran health research has been conducted by other nations, notably the United States, Australia, and the United Kingdom. Canada’s researchers are closing the gap.

Health and disability: The 2006 New Veterans Charter, a suite of programs built on best practices for managing disability, addressed 1990s research showing that veterans were facing significant challenges re-establishing in civilian life. Early research focused on those receiving benefits from Veterans Affairs, but new research is shedding light on life after service.

Working together, VAC, DND, the CF and Statistics Canada broke new ground in understanding the health of veterans when findings from the Life After Service Studies program of research were released this year (see Table). These studies provide sound evidence for meeting the health and disability needs of modern Veterans.

Meeting veteran and family needs: VAC programs reach many veterans who have high health and disability needs. A key challenge is to ensure they receive optimal health care and sound management of their disability. Transition from military to civilian life is a process of physical, mental and social adaptation. While it goes well for many, others experience difficulties. Assisting veterans with their transition requires close coordination between partners. VAC and CF/DND have new measures for ensuring a smooth transition, including integrated personnel support centres. This is especially important for veterans with high health and disability needs.

Research can identify effective and efficient ways to implement best practices for improving veterans’ care. Canada’s provincial health care systems provide care to veterans after their release from service. Federal government programming complements this system, and research suggests that although access to health insurance and regular medical doctors is good among released personnel, there is a need to increase collaboration and communication among providers for chronic health conditions and management of disability. Recent literature reviews by VAC in workplace re-integration demonstrate the need for good communication and collaboration amongst veterans, care providers and employers.

Research is helping to identify pockets of vulnerable veterans, such as those who release medically, those with shorter periods of service, and those from lower ranks. Findings ways to reach out to veterans is crucial. Also, longitudinal studies – following the same group of veterans over time – would provide the evidence needed to evaluate the effectiveness of veterans’ programs and services.

Effects of service: Much remains to be learned about how military service affects health throughout veterans’ lives. The immediate impacts of acute injuries and illnesses are obvious, but connections between later life health conditions and prior military service on veterans and their families can be much less clear.

Value to society
Across history, military and veteran health research has resulted in innovations in physical, mental and social health care for all Canadians. Civilians such as police, Foreign Service staff, aid workers, and new Canadians from war-torn countries are increasingly exposed to war violence. Although the military context of veterans’ health sets them apart from civilians, mental health conditions, mild traumatic brain injuries, blast injuries and other disorders are similar for both groups. Advances in veterans’ health care and management of disability benefit all Canadians.

There is a wealth of opportunity for universities, businesses, communities and government to collaborate in this new era of veterans’ health research. The recently formed CIMVHR is a meeting place for collaboration.

David Pedlar, PhD, is research director, Jim Thompson, MD, is research medical advisor, and Wendy Lockhart, BA, BEd, is research knowledge manager with Veterans Affairs Canada.

Table: Findings from the Life After Service Studies program

· There is no “typical” veteran. Veterans who transitioned to civilian life over a recent 10-year period are diverse, ranging in age from 20 to 67 years. They come from all ranks, 12% are women, and 65% have deployed. While half served for 20 years or more, almost one-third served less than 10 years.

· While the majority reported an easy adjustment to civilian life, one in four found it difficult.

· Most are doing well financially, yet some are at risk of declines in income and/or persistent low income.

· Compared to the general population, these veterans reported lower levels of well-being and higher rates of musculoskeletal disorders, pain and disability.

· Although many were doing well, some had complex states of mental and physical heath, poor social integration, and thoughts of suicide.

· Men had an increased rate of suicide after release from the Regular Force.