Should Veterans Be Treated as a Health Disparities Group? Evidence from the First Gulf War

Background and Purpose: Changes in the composition and role of the American military since the end of military conscription, as well as the increasing number of veterans seeking and securing benefits for service-connected disabilities, suggest the need for increased consideration of post-service health access and health status when assessing the impact of military service on young Americans' life course (Angrist, 1993, 1998; Dole et al., 2007; Savoca & Rosenheck, 2000; Tanielien et al., 2008). Studies of military recruitment trends suggest that Americans from geographical areas with more unemployment and poverty may be disproportionately represented in today's All Volunteer Force (U.S. D.o.D., n.d.). Other recent research continues to find race-associated disparities among veterans using VHA services (e.g., McGinnis et al., 2003). These disparities clearly require continued investigation within the veteran population, concomitant with further investigation of disparities among sub-groups of veterans, such as those with PTSD, female veterans, and rural veterans. Additionally, further analysis of interaction effects of the GI Bill and health and disability benefits for veterans with varying levels of disability is warranted.

Methods: This study analyzes data from the most recent National Survey of Veterans (2001) to investigate the health status, health benefits, and health care utilization of 2773 Gulf War veterans in association with resumption of their civilian life trajectory. Descriptive analyses examined their health and disability status, how these veterans were insured, their patterns of VA health service utilization, and the reasons they gave for not utilizing VA health benefits and services. Hierarchical multiple regression analyses were performed to test the association of VA health service and benefit use and possession of private health insurance with resumption of expected post-service life trajectory (operationalized as level of educational attainment).

Results: Twenty-three percent stated their health status to be fair or poor, while 49.2% reported a service connected disability rating. Fifty-four percent of the veterans reported experiencing depressive symptoms in the past month. Among minority veterans, 29.1% reported their health status was fair or poor, as compared with 19.8% of Caucasians. Significant main effects associated with resumed life trajectory included health status, disability pension income, private health insurance, use of non-VA behavioral health services, and use of VA outpatient and environmental hazard treatment services. Findings indicate that this sample of veterans had poorer health status than previous veteran cohorts, did not fully utilize veterans' health care benefits to which they were entitled, and that veterans' health benefits did not appear to be a protective factor associated with resuming expected life trajectory.

Implications: This paper examines the argument that veterans may constitute a group with health disparities in American society, as with health disparities experienced by racial and ethnic minority groups, in that they have greater health risks and poorer health status than mainstream Americans and concomitant difficulty accessing health care so as to resume their expected civilian life trajectory after military service. Implications for health policy, social work practice, and future research are discussed.