Updated on: November 13, 2019

The Intersection of Veterans and the SDoH

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Original story posted on: November 11, 2019

EDITOR’S NOTE: This story was first published by RACmonitor on Monday, Nov. 11 in honor of Veteran’s Day.

As a proud granddaughter of the Army, daughter of the Navy, and spouse and aunt of the Air Force, I’m humbled by the dedication of those who have served and continue to serve.

However, I am horrified at how veterans are identified as a rapidly growing face of the social determinants of health (SDoH). The stark realities are abundant and cover each of the SDoH domains.

Housing Insufficiency
Beginning with housing makes sense, as it has been the most-reported SDoH in 2019. The national point-in-time count conducted annually by the U.S. Department of Housing and Urban Development yielded 38,000 veterans without a home, with 23,000 unsheltered or living on the street.

Roughly 11 percent of the total adult homeless population are veterans: 91 percent are men, 9 percent women. The age demographics speak volumes:

  • 9 percent between ages 18-30
  • 41 percent between 31-50
  • 43 percent between 51-61
  • 2 percent are family units

For those veterans forced to deal with homelessness, more than half struggle with a diagnosed mental illness. Over 70 percent have substance abuse challenges.

The Social Determinants of Mental Health (SDoMH)
Veterans deal with considerable behavioral health issues and severe mental health diagnoses. At least:

  • 20 veterans die daily from suicide
  • Over 30 percent of veterans who were deployed in Iraq and Afghanistan have a mental health issue that requires treatment
  • Of that 30 percent, only half (if that) receive treatment
  • At least 19.5 percent of all veterans have endured a traumatic brain injury, with experts feeling the numbers could range to more than double that amount. These individuals face profoundly higher rates of:
    • PTSD
    • Depression
    • Suicidal ideation

Women veterans deal with more intense mental health challenges, often related to trauma:

  • 33 percent have experienced depression
  • Other studies reveal that as many as nearly three-quarters face post-traumatic stress disorder (PTSD).

Food Insecurity
Too many veterans and their families deal daily with food insecurity: over 1.5 million, to be precise. The rates of food insecurity among veterans of the U.S. wars in Iraq and Afghanistan is almost twice as high as rates among the general population. At this time, having sufficient and healthy food is an issue for:

Healthcare Access
Among the SDoH domains, the one arguably most surprising is how 2 million veterans lack health insurance, along with 3.8  million members of their households. Many of these individuals are members of working families who earn too much to qualify for Medicaid or care at the VA, yet insufficient amounts to afford private insurance. The first years of the Patient Protection and Affordable Care Act prompted a shift in these numbers, though at the time of this writing, up to 40 percent of all veterans still lack coverage.

Among uninsured veterans:

  • 26.5 percent said they couldn't get medical care because of costs
  • 31.2 percent delayed care due to costs
  • 49.1 percent hadn't seen a doctor within the past year
  • Another 66 percent didn't receive preventive care

An Unfortunate Reality
Veterans are an unfortunate face of the SDoH and SDoMH. Our listeners on Monitor Mondays reaffirmed the SDoH-related challenges faced by their veteran patient populations.

For those patients who identify as veterans, what is their most pressing SDoH-related challenge?
  • Insufficient health or mental health access
    67.33%
  • Lack of health insurance
    10.89%
  • Food Insecurity
    0.99%
  • Homelessness
    20.79%

To all veterans and their families, we are indebted to your service. As a society, there is no doubt, that we can and must do better. Follow this ongoing story and the State of the Social Determinants, weekly on Monitor Mondays.

Ellen Fink-Samnick MSW, ACSW, LCSW, CCM, CRP

Ellen Fink-Samnick is an award-winning healthcare industry expert. She is the esteemed author of books, articles, white papers, and knowledge products. A subject matter expert on the Social Determinants of Health, her latest books, The Essential Guide to Interprofessional Ethics for Healthcare Case Management and Social Determinants of Health: Case Management’s Next Frontier (with foreword by Dr. Ronald Hirsch), are published through HCPro. She is a panelist on Monitor Mondays, frequent contributor to Talk Ten Tuesdays, and member of the RACmonitor Editorial Board.

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