Health Surveillance Mechanisms Used by Armed Forces Worldwide

Military Medicine, Dec 2004 by Rushton, Lesley, Capleton, Alexander C, Wickramatillake, Hemantha

Health surveillance is an essential tool in monitoring health in an armed force and in helping to protect the health of service personnel. This study used a literature search and direct contacts with individual countries to identify and evaluate health surveillance mechanisms used by armed forces worldwide. The study identified several health surveillance mechanisms ranging from periodic health assessments of personnel to complex databases of medical data linked to demographic and other supporting data. Essential elements of an effective health surveillance system are outlined, including the requirement that systems are adequately supported and allow the routine monitoring of health at the population level consistently throughout an armed force and consistently during times of peace and during operations. Areas for further research and development include linking of data on hazardous exposures, jobs and the locations of personnel with medical data, and the follow-up of personnel beyond their military service.

Introduction

Health surveillance and health screening, for which there is evidence of benefit, form an integral part of any effective health care system and should allow "... the routine, systematic collection, analysis, interpretation and reporting of standardized, population-based data for the purposes of characterizing and countering threats to a population's health, well-being and performance."1 This needs to be closely integrated with the timely dissemination of these data to decision makers and, to be effective, must be directly linked to preventive action.2

In civilian industry, health surveillance programs play an important role in monitoring trends in illness, injury, and exposure to workplace hazards and in helping to identify areas where preventive action can help reduce the impact of disease. Health surveillance in the military setting poses particular challenges due, for example, to a large mobile workforce, differences in operational practices between services, and a broad range of hazards to which personnel may be exposed. Developing an effective military health surveillance system requires multidisciplinary involvement not only of medical units but also, for example, of occupational and environmental health professionals and personnel departments. This multidisciplinary involvement is necessary to collect, collate, and organize the required data, which include demographic data, data that identify locations, jobs or tasks undertaken by individuals, and data on exposures of personnel to occupational and environmental hazards.

In recent years, the challenge of developing a comprehensive military health surveillance system has begun to be addressed by several armed forces worldwide, particularly in light of experiences following the 1990-1991 Gulf War conflict and operations in the former Republic of Yugoslavia, where inadequate health, exposure, and associated records hampered the investigation of health concerns after these operations.3-6 As part of a wider research program on health surveillance, the United Kingdom Defense Science and Technology Laboratory commissioned a review of health surveillance systems used by armed forces worldwide, with a view to learning from the experience of other armed forces to inform the development of the United Kingdom Defense Medical Service's health surveillance capability (Institute for Environment and Health: An Objective Assessment of Existing and Planned Health Surveillance Mechanisms Used by Armed Forces Worldwide (unpublished report). The aim of the project was to identify and compare health surveillance mechanisms, processes, and methodologies, existing or planned, in armed forces worldwide and to evaluate their effectiveness and suitability for adoption or modification and incorporation by the United Kingdom Armed Forces. This article summarizes the types of mechanisms identified in the review and discusses the common elements necessary for an effective military health surveillance system.

Study Design

Information about the health surveillance systems used by armed forces worldwide was obtained through a literature search and by direct approaches to individual countries. The literature search consisted of a search of 12 online databases to identify published material on health surveillance mechanisms used in armed forces. It was conducted in May 2001 and was updated in December 2001 and was restricted to references published in the last 10 years for which an English title or abstract was available. Additional references were obtained through the review of the reference lists of those articles obtained, ad hoc searches of the Internet, and from individuals in the countries contacted. Direct contact was made with a number of non-United Kingdom armed forces to request unpublished material about each country's health surveillance system and to administer a questionnaire. The questionnaire was developed based on guidelines from the Centers for Disease Control and Prevention7 and a short pilot study conducted within the United Kingdom Armed Forces. Additionally, a workshop was held in January 2002, at which the preliminary findings of the review were presented and discussed by representatives of the United Kingdom and overseas armed forces, civilian industry, and academia; the workshop also considered essential elements for an effective military health surveillance system. The information gathered from the literature search, from individual countries and the workshop were used to develop an overall understanding of the health surveillance systems used by armed forces worldwide and to critically evaluate approaches used for military health surveillance.