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DOD's Healthy Base Initiative Shows Promise in Building a Healthy and Fit Force

Washington, D.C. ? Since 2002, obesity rates among members of the U.S. Armed Forces have risen 61 percent. And currently, nearly a quarter of active duty personnel smoke. Across the United States, poor nutrition, obesity, lack of physical fitness, and tobacco use pose growing threats to the military’s ability to recruit, retain, and build a force that is ready and resilient. Today, the Bipartisan Policy Center commends the Department of Defense (DoD) for the release of its Healthy Base Initiative (HBI) report, which provides important lessons learned and recommendations on ways to create a healthier military community.

DoD’s report is the culmination of two years of healthy activities at 14 HBI pilot sites (add link) across all service branches. HBI’s goal was to create a culture of health at these locations by encouraging healthy lifestyles to improve military readiness and lower DoD health care costs. Each year, the department spends more than 3 billion dollars to treat obesity and tobacco-related illnesses.

BPC’s Prevention Initiative, chaired by former Agriculture Secretaries Dan Glickman and Ann M. Veneman and former Health and Human Services Secretaries Donna E. Shalala and Mike Leavitt worked with the Office of Military Community and Family Policy and Health Affairs on this important effort. It was one of 19 organizations and agencies to help implement the initiative. BPC’s role was to leverage evidence-based programs from the federal, non-profit, academic and business sectors that could be tested at military installations. It also collected lessons learned and recommendations from the HBI programs to inform DoD’s report. The HBI demonstration built upon and implemented a number of important recommendations from the BPC report
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“A fit and healthy military force is the foundation of a strong national defense,” said Shalala. “The effects of obesity and tobacco use are clearly taking a toll on our military community. We urge the DoD to continue and expand its HBI efforts to reach even more service members, families, retirees and civilians in the future.”

“This report is critical because it helps define the barriers and opportunities that DoD confronts in fostering a culture of health in the military community,” said Glickman. “Military installations are like towns. They have housing, schools, childcare centers, dining facilities, fast food franchises, grocery stores, hospitals and more. If we can prove that healthy living interventions work in the military sector, we can replicate those actions in the civilian sector and help reverse obesity and tobacco use across America.”

“Strategic interventions like HBI allow the military to test innovative programs, and if successful, create the environment to replicate these programs on a larger scale,” said Lisel Loy, director of BPC’s prevention initiative. “We can only tackle obesity and tobacco use if federal agencies, the private sector, non-profit groups, academia and local communities join forces to collaborate on solutions. The Healthy Base Initiative is an important step in this direction.”

HBI lessons learned and recommendations include:

  1. Pilot programs should continue. The majority of those who took part in the initiative would like to see the programs continue and expanded. To change behavior, programs must extend beyond two years to achieve health outcomes.
  1. Rigorous assessment and measurement tools should be used to improve future efforts. To ensure success, all programs and initiatives must be measured consistently. Standard reporting mechanisms and measurements should be developed, and funding for health and wellness programs should be contingent upon these mechanisms.
  1. The DoD Food System is complex and should be revamped to focus on healthy eating. Change is needed across the military system, from food procurement to preparation and presentation.
  1. Installations are designed for automobiles not pedestrians and cyclists and should be improved. Changing the physical environment of installations will take time. However, HBI programs that increased individuals’ access to physical fitness facilities showed an increase in active lifestyles.
  1. Doses of interventions must increase. Implementing one or two interventions in isolation is not enough to change behavior. They must be broad-based to have an impact. For example, if menu labeling is important, labeling should be implemented at every food venue.
  1. Tobacco use policy must improve. Tobacco-free workplace policies offer the single most important opportunity to promote tobacco-free living within the military community.

The HBI effort received the 2016 Award for Excellence from the Balanced Scorecard Institute for demonstrating significant breakthrough results using the balanced scorecard approach. HBI also inspired several new efforts within DoD to improve the health in the military community. For example: the Army is now pursuing a collaborative effort called Healthy Army Communities, which is designed to support healthier places to live, learn, eat, work, play, and shop on and off Army Garrisons. Since 70 percent of military personnel live off base, the Office of the Secretary of Defense is exploring how military installations can more effectively partner with community programs.

In addition, Secretary of Defense Ash Carter recently announced a new tobacco policy that: restricts tobacco use to designated outdoor areas 50 feet from entrances and air ducts; ensures that areas not designated for tobacco use be “tobacco free,” especially where children live, learn and play; calls for the price of tobacco at military sales outlets to match prices in the local community; enhances tobacco education and cessation programs; and directs each service branch to review policies to create smoke-free options in privatized housing. These are just a few examples of how the lessons from HBI can be carried forward to continue fostering a culture of health in the military.