Veteran Health Disparities to Watch for and How Address Them

Navigating the complexities of veteran health disparities requires a nuanced approach. Veterans are a diverse group who can experience a number of health consequences related to their service. To gain a better understanding of these challenges and how to meet them, let’s delve into the factors that contribute to Veteran health disparities.

Factors fueling Veteran health disparities

When it comes to Veteran health disparities, there is not one simple root cause to address. The plurality of the Veteran experience means there are any number of difficulties to overcome when providing care to this population. While we cannot address all the causes of Veteran health disparities here, we will discuss three of the largest.

Living in rural communities

Rurality has always been a challenge when providing care to any population, because it’s harder to get medication and services to isolated areas. Research has also shown that it’s more difficult for people living in rural areas to get to cities or communities where medical care is more readily available.

According to the U.S. Department of Veterans Affairs (VA), “veterans in rural communities may face higher costs to travel from remote areas to access care.” The higher travel costs are exacerbated by the fact that rural veterans tend to be older, have poorer health, and have less financial security than their urban counterparts.

Gender and identity

When compared to men, women veterans face unique risk factors that contribute to health disparities. They are more likely to experience military sexual trauma, childhood adversity, and intimate partner violence. As a result, they are more likely to have PTSD than male veterans. However, women Veterans may find it hard to seek help for these issues because they:

• Worry they will be accused of trying to get out of work.
• Expect their problems to be dismissed as stress-related.
• Feel invisible and disconnected.

Additionally, about 1 million LGBTQ+ veterans live in the U.S., with over 134,000 veterans identifying as transgender or gender-diverse. When compared to heterosexual and cisgender veterans, LGBTQ+ veterans are at a higher risk for behavioral health issues. In part, their risk is higher because they are more likely to experience:

• Bullying, abuse, and discrimination
• Military sexual trauma, often by other service members
• Rejection from family, the military, and their community
• Intimate partner violence

Despite the prevalence of these experiences among this population, LGBTQ+ Veterans sometimes avoid the VA because they feel unwelcome or have experienced harassment.

Racial discrimination

Veterans with marginalized racial and ethnic identities face unique barriers to care. They are more likely than white veterans to be:

• Affected by discrimination and biased healthcare practices
• Less likely to seek behavioral health treatment
• Less adherent to treatment recommendations
• Matched with clinicians who do not share their culture, race, or ethnicity
• Treated with low-quality care
• Burdened with economic barriers to care (e.g., financial issues or lack of health insurance)

In addition, diagnostic criteria are largely based on samples from white Veterans and sometimes fail to address the ways symptoms appear in people from different backgrounds. Clinician bias can also affect diagnosis. For example, bias accounts for the tendency for Black and Latinx Veterans with bipolar disorder to be misdiagnosed with schizophrenia.

Ways to address Veteran health disparities

Now that we have a better understanding of some of the challenges facing Veterans and how they contribute to Veteran health disparities, let’s explore how your organization can help.

Address logistical concerns

Talk to the Veterans your organization works with about the challenges they have around getting access to health care. Given the high rates of various health conditions, Veterans may lack the basic requirements for a healthy life, including:

• Access to reliable transportation
• Housing and/or food security
• The ability to schedule and attend treatment

When you begin working with a Veteran, assess whether they are experiencing any of the above social determinants that could make accessing healthcare difficult.

Reduce stigma

The stigma surrounding Veteran health contributes to inequities in accessing support. The types of stigma Veterans can face typically fall into one of two categories:

• Self-stigma, which refers to negative beliefs that individuals hold about their own health and seeking help.
• Public stigma, which refers to negative beliefs held by others.

Programs aimed at reducing self-stigma typically include components such as education about health and stigma and techniques to change unhelpful thought patterns. These techniques help Veterans develop narratives to better understand their past and plan for the future. These techniques can empower Veterans and give them hope.

Social campaigns, such as the Real Warrior Campaign, can also help reduce public stigma by encouraging service members and Veterans to seek help for mental health issues. They do this by emphasizing that mental health care is health care, providing information on mental health concerns, and connecting Veterans and their families with resources.

Use trauma-sensitive language

If Veterans are receiving health care that isn’t cognizant and respectful of the trauma they have experienced, then they are not receiving equitable care. To ensure you provide Veterans with the care they need, practice using trauma-sensitive language.

There are several ways you can use this type of language. The most effective include:

• Focus on service, not status. Instead of asking “Are you a Veteran?” consider asking “Have you ever served in the military?” This approach is more inclusive and may reach Veterans who may be reluctant to discuss their military experiences, or do not identify as Veterans.
• Avoid asking invasive or insensitive questions, such as “Did you kill anyone?” If a Veteran chooses not to discuss their service, respect their decision whenever possible. When expressing gratitude for their service, do so genuinely and without prompting.
• Approach care without judgment or assumptions. When Veterans are open to discussing their military experience, strive to understand how their service impacts them today. Ask open-ended, conversational follow-up questions and refrain from making assumptions or passing judgment.