Veterans are defined by Veterans Affairs Canada (2019) as any person who is serving or who has honorably served in:
Armed Forces and Merchant Navy Veterans who served during the First World War, Second World War or Korean War;
Former and current members of the Canadian Forces, including those who served in Special Duty Areas and in peacekeeping; and
Allied Veterans who:
have served with one of the Allied forces during the Second World War or the Korean War; and
have lived in Canada for at least 10 years or lived in Canada prior to enlisting.
In 2021, the veteran population in Canada was estimated to be 617,800 (Veterans Affairs Canada, 2019).
Veterans are charged with defending Canada's security, interests and maintaining peacekeeping missions. Upon their return, Veterans face many physical and psychosocial challenges, many of which have a profound impact on their health (Duquesne University, 2021). These health challenges put veterans at risk, as the transition from military service into civilian life can be daunting for some and has been ''characterized by decreased wellbeing, including compromised physical and mental health, social problems, role disability, disadvantages in determinants of health and decreased quality of life’’ (Thompson et al., 2013). Many soldiers face mental and social barriers to health in their everyday lives resulting in depression, anxiety, post-traumatic stress disorder, as well as food insecurity, homelessness, unemployment and difficulty in adjusting to civilian life. Veterans may also be plagued by physical injuries such as traumatic brain injury and loss of limb(s) (Duquesne University, 2021). These determinants make them a vulnerable population and can result in poorer health outcomes and health disparities (Duquesne University, 2021). In fact, Veterans account for approximately 4.4% of homeless individuals in Canada. In 2016, 2400 Veterans used emergency shelters (Veterans Affairs Canada, 2019). Furthermore, approximately 20% of Canadian Veterans are diagnosed with mental health disorders such as depression, PTSD and anxiety and 95% of those diagnosed are also afflicted with a physical health condition (Veterans Affairs Canada, 2021).
Chronic pain is a major challenge for Veterans. The Chronic Pain Centre of Excellence for Canadian Veterans (n.d.) reports that Veterans are twice as likely to suffer from chronic pain compared to others in the Canadian population. The extent of chronic pain among veterans is significant and underreported, because ‘’censorship of chronic pain discourse remains entrenched’’ (Thompson et al., 2020) in military culture where pain is ‘’something to be endured and not discussed’’ (Thompson et al., 2020).
While the military is responsible for the healthcare of members of the Canadian Armed Forces, Veterans must find healthcare providers in their respective provinces and territories once their military service is done (Reyes et al., 2021). As a result of transition to civilian life, veterans can face barriers in finding appropriate health care as it relates to their unique health needs such as:
· Military experience might not be fully understood by healthcare staff
· Veteran-centric care not available
· Financial costs for treatments not paid by the public health system or by insurance
· Geographical barriers (long travel times for specialized care) (Thompson et al., 2020).
With respect to chronic pain, limitations of the health care system in successfully managing this issue is another barrier for Veterans to address, thus it becomes paramount ''for clinicians working across the care continuum to be aware of such limitations to avoid railroading patients into purely medical treatments'' (Thompson et al., 2020).
A study conducted by Thompson et al. (2013) in which socio-demographics, health, disability and determinants of health were examined in relation to health-related quality of life as compared to the rest of the population suggests that a wide variety of biopsychosocial factors impact health, well-being and quality of life for Veterans in their post-military life. Their study also found that Veterans who were not Veterans Affairs Canada clients had low health-related quality of life scores, suggesting efforts be in place to ensure that programs reach all eligible Veterans (Thompson et al., 2013).
The health determinants are recognized in a framework entitled ‘’A Veteran Well-being Surveillance Framework’’ (2017). This framework identifies 7 'well-being' domains essential in the transition from military to civilian life. These domains allow for bidirectional causality, meaning factors in one domain can influence others in another domain (Besemann et al., 2018). These domains (also in the image below) are:
1. Employment or other meaningful activity
2. Finances
3. Health
4. Life skills and preparedness
5. Social integration
6. Housing and physical environment
7. Cultural and social environment
This framework is also utilized by the Centre of Excellence on Post Traumatic Stress Disorder (PTSD) and Related Mental Health Conditions, an organization recently established by the Government of Canada with a focus on Veteran mental health, suicide prevention and substance use disorder (Centre of Excellence on PTSD, n.d.). Furthermore, there are programs in place within the Canadian Armed Forces as well as charitable organizations that support transition into life after military service by addressing the domains, for example:
· Integrated Personnel Support Centers (IPSCs)
· Compensation and Benefits Directory
· Service Income Security Insurance Plan (SISIP): long term disability pension
· Helmets to Hardhats: organization providing opportunities in the construction field for inactive and active military personel
· VETS Canada: Veteran Emergency Transition Services, provides help with housing, and re-integration into civilian life, coast to coast
· Royal Canadian Legion: Canada’s largest Veteran support organization
· Military Families Fund and Military Family Resource Centres: connecting military families to programs and services.
Veterans face physical and psychosocial challenges that have a profound impact on their health. As we start to understand the extent of all the challenges Veterans face, the best way to honour our Veterans and their sacrifices and achievements is to support a seamless transition as they integrate back from military service to civilian life.
References
Besemann, M., Hebert, J., Thompson, J. M., Cooper, R. A., Gupta, G., Brémault-Phillips, S. B., & Dentry, S. J. (2018). Reflections on recovery, rehabilitation and reintegration of injured service members and veterans from a bio-psychosocial-spiritual perspective. Canadian journal of surgery. Journal canadien de chirurgie, 61(6), S219–S231. https://doi.org/10.1503/cjs.015318
Center of Excellence on PTSD. (n.d.). About Us. Veterans Affairs Canada. https://veteransmentalhealth.ca/about-us/
Chronic Pain Centre of Excellence for Canadian Veterans. (n.d.). Veterans Affairs Canada. https://www.veteranschronicpain.ca/
Duquesne University. (2021, Nov 9). Social Justice and Health Care for Veterans: Home. https://guides.library.duq.edu/veterans
Thompson, J. M., Heber, A., Zacharias, R., Besemann, M., Gupta, G., Hapidou, E., Buckley, N., Lamoureux, D., & Begley, K. (2020). Out of the shadows: Chronic pain in Canadian Armed Forces veterans - Proceedings of a workshop at the 2019 Forum of the Canadian Institute for Military and Veteran Health Research. Canadian Journal of Pain, 4(1), 199–204. https://doi.org/10.1080/24740527.2020.1796479
Velez, J. R., Thompson, J. M., Sweet, J., Busse, J. W., & VanTil, L. (2021). Cluster analysis of Canadian Armed Forces veterans living with chronic pain: Life After Service Studies 2016. Canadian Journal of Pain, 5(1), 81–95. https://doi.org/10.1080/24740527.2021.1898278
Veterans Affairs Canada. (2017, August). Monitoring the Well-being of Veterans: A Veteran Well-being Surveillance Framework. Government of Canada. https://publications.gc.ca/collections/collection_2017/acc-vac/V32-347-2017-eng.pdf
Veterans Affairs Canada. (2019, February 12). Mandate, mission, vision, values and ethics. Government of Canada. https://www.veterans.gc.ca/eng/about-vac/what-we-do/mandate
Veterans Affairs Canada. (2021, March). Facts and Figures Summary. Government of Canada. https://www.veterans.gc.ca/eng/about-vac/news-media/facts-figures/summary
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