Creating budgets for the Defense Department is always challenging. But determining where to cut and where to spend requires an intense analysis of high-cost line items.
Health costs — Medicare and Medicaid — continue to rise much more rapidly than spending in other sectors. The defense budget is not immune: military health spending has reached $50 billion annually, and is almost 10 percent of the overall defense budget.
This cost of health care for military personnel and their families will continue to rise — just as will costs in the private sector — as rates of dental care, bone injuries, obesity, diabetes, cardiovascular disease, and behavioral issues also rise unless we do something about it.
DoD is doing something about it.
We know that healthy behavior and a healthy environment lead to better health outcomes. And better health outcomes do more than just benefit the individuals involved; they save billions of budget dollars annually. To contain and lower health care costs, DoD must focus on prevention and work hard to change behaviors and environments which undermine both our health and our professional performance.
This is what we will discuss during our panel discussion today at the Partnership for a Healthier America’s annual summit taking place in Washington, D.C.
In 2009, 27 percent of potential military recruits could not qualify for service due to their weight and physical fitness — and that statistic is growing. In 2010, 59 percent of females and 47 percent of males who took the military’s entry-level physical fitness test failed. Moreover, more than 62 percent of soldiers who entered basic training had to have major dental work prior to graduation in order to be eligible for deployment.
Why are these young citizens-turned-soldiers in such poor health? A 2009 Army research study on new basic trainees showed that 85 percent ate fast food regularly, 53 percent used tobacco products, 29 percent drank soda as their primary beverage, and nearly 60 percent spent up to seven hours a day in front of a either a television, a computer, or both, prior to entering service.
But poor health is also emerging as a retention issue. The Navy, for example, loses an average of 2,000 trained personnel each year because those sailors fail to pass physical fitness tests, even though all of them receive several warnings before reaching the point of discharge. At a cost of $100,000 to $200,000 to train each sailor, the Navy is losing between $200 and $300 million in annual training investments — investments that will have to be made again to train replacements.
To ensure a strong military today and in the future, and to prevent the military’s health care costs from rising to unsustainable levels, DoD is putting programs and policies in place to promote good nutrition and physical activity among service members and their families.
One such initiative is the Healthy Base Initiative (HBI), launched in 2013 to combat obesity and tobacco use and to promote healthy behaviors and healthy environments at 14 pilot locations, installations and agencies throughout the country.
HBI developed an approach based on the National Prevention Strategy, which includes interventions in six key areas: healthy food options; active living; the physical environment; children, schools and families; health and wellness; and tobacco cessation. This year-long demonstration project will measure the efficacy of the interventions at specific locations and make recommendations on how they can be expanded throughout DoD; and perhaps show potential for our society at large.
Another program receiving even more attention is the Army’s “Fueling the Solider” Initiative. This was implemented in 2011 at 69 Army training bases with tremendous success. Young recruits received nutritional education and then were trained to “fuel” their bodies with nutritious food that replaced what they had grown up eating.
Menus were revamped to employ baking instead of frying; offer nutrient-dense foods, including whole grains and iron-rich proteins; replace “comfort” foods with performance foods like Greek yogurt, whole grain cereals, nuts, seeds and fruit; and offer only water, milk, 100% juice and sports drinks at “hydration stations.”
All food is labeled according to the Army’s “Go for Green” performance standards, which rate foods based on their performance-enhancing content. Even the vending machines carry these simple nutrition labels. Drill sergeants and new recruits alike have seen improvement in physical, emotional and mental performance.
The private sector also is stepping up. Companies like Sodexo, who work with the military and are focused on individual well-being and organizational performance, are using their research and resources to improve nutrition in the military by increasing the quality, taste, and appearance of healthy food, expanding service hours, and reinventing the dining environment to increase consumer demand for healthy products.
As leaders in our field, we implore the White House, Congress and business leaders to join us in continuing to invest in prevention as a way to help with recruitment, retention, resilience and readiness and to help us expand the knowledge gained from these programs into our society.
We know there is no quick cure for the nation’s obesity epidemic and rising health care costs. But if we deploy effort and creativity to focus on health promotion, we can improve health outcomes while bringing our health care budgets under control.
We sincerely hope what we learn from the Healthy Base Initiative, “Fueling the Soldier”, and similar health interventions will remain part of DoD’s strategy for years to come.
Dan Glickman is a Senior Fellow at the Bipartisan Policy Center and a former Secretary of Agriculture. Retired Lt. Gen. Mark Hertling is senior vivce president, Global Partnering, Physician Leader Development and Healthy 100 Initiatives, Florida Hospital. Charles Milam is the Defense Department’s principal director of military community and family policy. Tina Reddington is director of wellness, procurement, and sustainability for Sodexo.