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NEWS | April 28, 2022

Health of the Force report examines COVID-19 pandemic impacts to Soldier health, public health response

By Douglas Holl U.S. Army Public Health Center

The U.S. Army Public Health Center released the seventh annual Health of the Force, or HOF, report April 18, 2022. The report focuses on Active Component Soldiers and presents Army-wide and installation-level data for more than 20 medical, wellness and environmental indicators.

“This year’s HOF report also includes a new COVID-19 metric section for a deep dive into surveillance data and methods, the effect of the pandemic on military healthcare utilization, effects on physical and mental health and local actions focused on Army Public Health Nursing and vaccination efforts,” said Dr. Erin Goodell, HOF editor.

The report also continues the discussion from last year’s report on health disparities faced by racial and ethnic minority Soldiers and introduces a focus on the unique health needs of female Soldiers.

“These features help to frame conversations and analyses necessary to effect real progress towards health equity,” said Dr. Lisa Ruth, HOF project manager.

Goodell pointed out some key takeaways in the report on the COVID-19 pandemic’s impact on Soldiers and readiness:

  • According to a survey of behavioral health outcomes in the context of COVID-19, most Soldiers reported COVID-19 stressors, fears and concerns, with junior enlisted and racial/ethnic minority Soldiers reporting more concerns.
  • Half of the Soldiers reported some negative financial impact because of the COVID-19 pandemic, and those with greater COVID-19 stressors, as well as those who experienced more severe financial impacts during the pandemic, were more likely to screen positive for depression or anxiety.
  • One in seven active-duty Families transitioned from being food secure before the COVID-19 pandemic to marginally food insecure during the COVID-19 pandemic.

“This information emphasizes the need for all of us in Army leadership to acknowledge the impacts on Soldiers’ behavioral health, especially for junior enlisted and racial/ethnic minority Soldiers,” said Col. Alisa Wilma, APHC director. “Behavioral health services, financial resources and leadership support are important to help mitigate the impacts of the pandemic on Soldiers’ behavioral health.”

Goodell said it’s important for readers to note that the data in this year’s HOF report were recorded during the first nine months of the COVID-19 pandemic when lockdowns were more commonplace. These public health measures resulted in reduced training schedules, social distancing, isolation, and less frequent deployment, all of which may have biased estimates upwards or downwards, depending on the metric.

“We caution against direct comparisons to previous Health of the Force reports, but we expect that as operations return to pre-pandemic levels, future reports will continue to accurately characterize the health of the force,” Goodell said.

In addition to looking at COVID’s impact on Soldiers, the report also spotlighted the work of Army Public Health Nurses and Army National Guard members, who were involved in all facets of the COVID-19 response. This included conducting emergency response, setting up field hospitals, comforting patients and driving vaccination efforts, Goodell added.

“These efforts were high-demand, but APHNs and Army National Guard accepted their roles and recognized the impact of public perception to public health,” Goodell said. “Their work at the front line of the COVID-19 response undoubtedly raised awareness of their importance by those within the Army medical community and beyond.”

Last year’s HOF first introduced race and ethnicity data into the report. Goodell says the social-ecological model demonstrates that racial and ethnic disparities in health often take place throughout a person’s life.

“Although everyone receives the same medical benefits through TRICARE, the data demonstrate that there are still important disparities for most conditions reported in Health of the Force,” said Goodell.

The current report reveals that racial and ethnic minority Soldiers have a higher occurrence of disease across several medical metrics compared to white (non-Hispanic or Latino) Soldiers. Goodell highlighted these findings from the report:

  • Hispanic or Latino Soldiers had the highest rates of COVID-19.
  • Black Soldiers had the highest prevalence of injury, behavioral health diagnoses, sleep disorders, sexually transmitted infections and chronic disease.
  • American Indian or Alaskan Native Soldiers, followed by Black Soldiers, had the highest prevalence of substance use disorder.
  • Obesity prevalence and tobacco use was highest among Native Hawaiian/Pacific Islander Soldiers.

“It is important to remind readers that these disparities often pre-date military service and may not be solely attributed to individual health choices,” said Goodell.

Goodell said this year’s report also had some interesting findings regarding female Soldiers, which comprise about 15 percent of the active component, and whose health needs may sometimes be overlooked across the entire Army enterprise. The current Health of the Force report features numerous vignettes on women’s health topics including contraception, menstrual suppression, pelvic floor health and musculoskeletal health during pregnancy, which are critical areas for Army Senior Leaders to understand.

“By gaining a more detailed understanding of women’s health, Army Senior Leaders can ensure that their entire force is provided with appropriate resources to optimize their health and readiness,” Goodell said.

This year’s Health of the Force report — and the inaugural Health of the Army Family report released in November — recognize the need to look at Soldiers holistically, which includes the family unit.

“Spouses of Soldiers reported job loss, involuntary furlough and reduced hours during the pandemic,” Goodell said. “In addition, numerous childcare centers were closed, forcing Army spouses to provide childcare during normal business hours. Therefore, the health of the force cannot be separated from the health of the Army Family, and Army leaders at all levels should continue to be cognizant of how disease and economic-related factors may impact force readiness.”

Readers are encouraged to provide feedback or seek more specific consultative services by contacting the APHC Health of the Force team through the “Contact Us” button on the APHC Health of the Force website, which also provides links to all previous year reports.

Read the 2021 Health of the Force report at

The Army Public Health Center enhances Army readiness by identifying and assessing current and emerging health threats, developing and communicating public health solutions, and assuring the quality and effectiveness of the Army’s Public Health Enterprise.