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“The General has nothing more at heart, than the Health of the Troops.”

– General George Washington1

“The prevention of disease is the highest object of medical science… . Medical officers … strengthen the hands of the Commanding General by keeping his army in the most vigorous health, thus rendering it, in the highest degree, efficient for enduring fatigue and privation, and for fighting.”

– Major Jonathan Letterman, Medical Director, Army of the Potomac2

“Probably no activity pays in the military service such huge dividends as preventive medicine.”

– Major General Merritte Ireland, Army Surgeon General3

Military service is a hazardous occupation. Although the image that often jumps to mind is of service members—soldiers, sailors, airmen, and Marines—under fire in combat, the reality is that relatively few ever find themselves engaged in direct fighting with an adversary, and most separate from the military after one term of service (about 5 years). However, the process of becoming a service member (training), the military occupational specialties required in today’s armed forces, and deployments to austere or less-developed areas of the world, expose the majority of military personnel to a wide range of potential health threats. This creates a challenge for preventive medicine physicians and other public health specialists, but one that makes for an exciting career and yields tremendous rewards.

The potential exposures of any one service member over his or her time in service, and the resulting health effects, are dependent on many factors, including predisposing characteristics (e.g., genetics, pre-existing conditions, fitness level), job-related activities (e.g., physical training, weapons training, use of equipment), and location (e.g., type of installation, deployment-related threats, climate). A service member’s lifecycle is characterized by frequent displacement, usually every 2–3 years, periods of separation from family members for training or operational missions, and job-related tasks that are frequently associated with physical and psychological stressors and may expose the individual to a variety of known and unknown biological, chemical, and physical agents. Preventing illness and disability in service members is critical to any military’s ability to effectively complete its mission, and it is preventive medicine and public health experts who develop and assist commanders in implementing the policies, programs, and countermeasures to maintain the health and readiness of the force.

Military operations take many forms, from traditional warfare to humanitarian assistance, disaster response, and other stability and support operations, collectively known as Operations Other Than War. In today’s world, most military operations are joint, meaning more than one branch of service is engaged, and they are increasingly multinational. Although large conflicts are fairly infrequent and last for a few years at most—the ongoing operations since 9/11 being exceptions in modern history—the U.S. military is engaged continuously in missions around the globe and maintains a presence in most countries. The total number of military personnel stationed or deployed overseas has ...

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