BRIEF FROM THE CANADIAN INSTITUTE FOR
MILITARY AND VETERAN HEALTH RESEARCH

Executive Summary - The Legacy

On behalf of the Canadian Institute for Military and Veteran Health Research,[1] Queen’s University is pleased to participate in the pre-budget consultation process of the House of Commons Standing Committee on Finance.

Canadians have acknowledged the tremendous sacrifices of the Canadian Forces in Afghanistan over the last ten years. The Government of Canada has provided unprecedented support to the men and women in uniform and the families who support them. The number of Canadian Forces casualties and the breath of their health problems arising from military operations are greater than those at any time since the Korean War. As Canada’s role in combat operations in Afghanistan comes to an end, the government should establish a legacy to this historical era by the endowment of a sustainable academic research program in military and veteran health, through the recently established Canadian Institute for Military and Veteran Health Research, an academic research consortium of Canadian universities led by Queen's University. Canada is alone amongst our major allies in not having such an Institute or national academic research program. The Canadian military brings great prestige and service to our nation. In return, Canada must fulfil the “social covenant” with the soldier and minimize the impact of military service on health consequences throughout the life course of our veterans.

The Canadian Institute for Military and Veteran Health Research has a mission to optimize the health and well-being of Canadian military personnel, veterans and their families by harnessing and mobilizing the national capacity for high impact research and knowledge mobilization. Canadian researchers have already made significant contributions to improving military and civilian healthcare. However, we must broaden the support for research in military and veteran health and ensure research priorities are aligned with current requirements. The Institute will ensure greater coordination of effort, optimize utilization of limited resources and capitalize on an expanded national capacity for research. It will create a bridge between the academic, healthcare and government research environments to ensure the outcomes generated are of the highest national and international standard. In support of this objective, to establish a national academic research program dedicated to military and veteran health, the House of Commons Standing Committee on Finance is asked to consider the following recommendations:

Recommendation #1. As part of the 2012-13 federal budget, allocate $30 million over the next five years for a national academically led research program in military and veteran health, guided by the government’s priorities and coordinated by the Canadian Institute for Military and Veteran Health Research.

Recommendation #2. Provide a greater incentive for the defence industry to invest in research related to military and veteran health, through initiatives such as enhancing the Industry Canada policy on Industrial and Regional Benefits (IRB) that leverages Canada’s procurement of defence equipment, by expanding the current credit for research in this area to at least a 15X multiplier.

A New Era

Since Confederation, Canada has acknowledged military veterans as “special citizens” because of their unique role in defending our nation. The government has recognized their sacrifices by compensating them for the health effects of military service. In addition, Canada, like other nations, has committed significant resources to assisting veterans with transition to civilian life and indeed Canadian veterans were the envy amongst our major military allies in receiving government support. Following World War II, veteran health research flourished in federal veteran hospitals. The research played a key role in providing sound evidence on which to base effective policy, programs and services. Immediately following the war, the focus was on re-establishment, rehabilitation and the management of sub-acute complications of war injuries and illness. When those veterans reached middle age, the focus switched to chronic health conditions and shifted again as they aged. However, Canadian veteran health research capacity diminished greatly in the 1960s and 1970s when Veterans Affairs Canada facilities were transferred to the Provinces along with the health professionals who worked in them. Veteran health research then had to compete for resources with diverse civilian interests with little recognition of the unique health consequences of the military occupation and operational environment. Veterans Affairs Canada and the Surgeon General of the Canadian Forces each have a limited research budget of $1 million. Defence Research and Development Canada has an extensive research program, but it has a primary focus on soldier protection. In comparison, our Australian allies have two national research institutes in this area with an annual budget of $10 million. The United States Department of Veterans Affairs has an annual research budget of over $500 million.

The veterans of the war in Afghanistan have joined the more than 750,000 living Canadians who have unselfishly served their nation in the Canadian Forces. The “new veterans” and their families live in a nation with very different veteran health care and social support systems than had existed previously and during a period when Canadian research on the new generations of veterans and their families is limited and disjointed within the academic community. Over the last 25 years, the Canadian government has called upon the Canadian military to deploy to war zones and humanitarian missions around the globe, including the former Yugoslavia, Kosovo, Rwanda, Central Africa Republic, Sierra Leone, Lebanon, Sri Lanka, Pakistan, Afghanistan, Haiti, and recently Libya. As a result of the consequences of high intensity training and operations associated with such missions, the health and well-being of these veterans can be seriously affected over their life course. The health implications range from battlefield injuries (mental and physical) and serious trauma to exposure to toxic chemicals, life-threatening diseases and viruses. Families of military members not only deal with the deployment of loved ones into “harm’s way,” but they become the primary care givers of injured veterans, and their own health is affected not only by this task but also the lack of continuity of care as they move about Canada. Canada must re-establish a national research program to guide veteran health care and services as part of our “social covenant” with those soldiers who have given so much of their lives so to ensure we have the peace and security that is integral to our quality of life.

In November 2010, Queen’s University and the Royal Military College of Canada initiated a major program to address this research gap by engaging and invigorating pan-Canadian support to establish a national academic research institute related to protecting the health of soldiers and examining the health impacts that occur throughout the life course of the soldier and their families. This initiative emerged from requirements identified by veteran groups, the Surgeon General of the Canadian Forces and liaison with senior government executives of Veterans Affairs Canada and National Defence. In the past, research has been re-active to major political crises caused by veteran concerns (e.g., Agent Orange and Gulf War Syndrome) rather than pro-active programs to protect, prevent and restore health consequences of military operations. Invariably the Government of Canada has been on the defensive against veteran claims. A review of best practices by our military allies and discussions with subject matter experts confirmed that the existing military and veteran health research priorities, programs and requirements could be substantially advanced through a pro-active program with participation from the Canadian academic community and leadership from an independent arm’s length focal point. The broad scope and complexity of health issues facing soldiers, veterans and their families calls for greater coordination of academic and government research efforts, as well as an expanded national capacity. Such a coordinated effort will make better use of existing resources, expedite return of veterans to productive citizens, reduce health care costs by keeping veterans out of expensive hospital beds, leverage Canadian research opportunities with our military allies and enhance Canadian industry opportunities to bring research outcomes to the market.

The first national conference on military and veteran health research in November 2010 in Kingston, Ontario, provided the catalyst for the research universities from across Canada to agree to work together with National Defence and Veterans Affairs Canada to establish a national research institute. Canada is alone amongst our major allies in not having an academic institute dedicated to research in military and veteran health. With the support of the universities, Queen’s University in partnership with the Royal Military College of Canada established the Canadian Institute for Military and Veteran Health Research, governed by a Board of Directors representing stakeholders and university partners. The Kingston headquarters for this pan-Canadian Institute benefits from its proximity to Ottawa and the largest military and veteran population in Canada.

Canadian Institute for Military and Veteran Health Research

The Beneficiaries. The serving military, veterans and their families will be the primary beneficiaries of the Institute programs. Research must consider the unique context of the military, including battlefield medicine, the imperative to maximize fitness for high performance duty and the unlimited liability to respond to Canadian government direction for operations around the world in aid of our nation’s security. Although research will be focused on military service, it will also benefit those with similar occupational exposures such as first responders (e.g., police, fire fighters, etc.), humanitarian workers and Canadians in general.

Research. The research will be innovative and responsive to the requirements of National Defence and Veterans Affairs Canada, but appropriately arm’s length in conduct from government and sponsors. In addition to focusing on prevention, treatment and rehabilitation, the research will have a robust technology development focus and industry spin-off to reflect the broader public health interests and S&T priorities of the federal and provincial governments. The Institute will ensure Canada’s best researchers are engaged in the research, which will be fully coordinated with national and international (e.g., United States) agencies to ensure Institute programs complement, not duplicate, existing research activities. Partnerships are being developed with organizations including the Rick Hansen Institute, Canadian Institutes of Health Research, Centre for Addiction and Mental Health, Amyotrophic Lateral Sclerosis Society and others. The Institute will facilitate Canadian participation in international research projects, such as the recent invitation to engage leading academic researchers in the NATO research on “Blast Injury,” a common and complex injury resulting from explosions (e.g., IED). In addition, Institute research programs will focus on mental health and musculoskeletal injuries, the most common life course impact on veterans’ health. Today’s professional Canadian soldiers deploy multiple times to dangerous war zones, exposing them and their families to numerous stressors. Outcomes of research will lead to evidence-based comprehensive treatment programs and services for both prevention and mitigation of the trauma associated with modern warfare, including PTSD. Programs will help build resilience in both the soldier and the military family. Research will improve rehabilitation and long-term management of such injuries with the objective of ensuring veterans regain their life as productive members of society. Veterans Affairs Canada reports that health consequences from previous wars did not peak until 30 years after service ended. Parliamentary committees have been advised to expect one in four veterans from Afghanistan to eventually suffer from mental health problems. The American Psychological Association reports that 50% of student veterans attending college state they have contemplated suicide. The evidence provided by the research will be mobilized through the Knowledge Exchange and Education programs of the Canadian Institute for Military and Veteran Health Research and ensure health care, protection and support programs are relevant to military members, veterans and their families. Additionally, building this research program will lead to economic development through the training and employment of highly qualified research personnel and the commercialization of technology, including technology that will be employed in areas outside of military and veteran health.

Funding Model. Queen’s University is providing the initial resources for the pan-Canadian Institute and research programs with a total commitment of over $2.5 million over the next five years. Other academic partners, including the Royal Military College of Canada, are also committing expertise and resources. However, the strategic plan for this initiative is based on public-private funding for an annual budget of over $10 million. Foundations and private donors (alumni, individual Canadians, the defence industry and corporate supporters) are being approached for support. In a short period of time, support has been received from Bell Canada, True Patriot Love Foundation, the Royal Canadian Legion, hospital foundations, university alumni, health care professional associations, university network partners and research institutes. The response and enthusiasm has been infectious, as Canadians are immensely proud of their military and they wish to re-assure those who serve Canada so well that they will meet the obligations inherent in the “social covenant” between the soldier and the nation.

Defence Industry Incentive. Encouraging dialogue with the defence industry has focused on leveraging the Industrial and Regional Benefits (IRB) program to support research in military and veteran health.The defence industry has seen exponential growth as part of military operations in Afghanistan and the policies of the Harper government. Defence companies have a similar “social obligation” to give back to veterans who have sacrificed so much. The government’s IRB Policy, managed by Industry Canada, requires companies that win Canadian defence and security contracts to place business activities in Canada equal to the value of the contract, either through direct sub-contract to suppliers for the procurement or indirect acquisition by the company of other products and services, including research. Currently, the defence industry has more than $20 billion in outstanding obligations and a further $20 billion in obligations will be incurred over the next few years. As part of the IRB Policy, defence companies are encouraged to invest in research at Canadian universities and currently can receive a 5X or even 10X multiplier credit toward their IRB obligations. Currently, defence industry does not consider Canada’s IRB policy on research as attractive as similar policies of our major military allies. An amendment to the IRB policy, that would provide at least a standard credit of a 15X multiplier for investment in military and veteran health research, will be an incentive for defence companies to partner with universities, contribute to sustainable funding for this pan-Canadian Institute and facilitate regional research and development economic activities across the country.

Conclusions - The Legacy

Canada has a strong research and development base that can produce outcomes that will improve the health and well-being of our veterans who sacrifice so much and bring honour to our nation. The Harper government has a proud record of unprecedented commitment to the Canadian Forces, particularly during recent combat operations in Afghanistan, and historically Canada has provided great support to our veterans. The Legacy of the government’s commitment and that of Canadians of living up to our nation’s “social covenant” with its soldiers should include a sustainable academic research program that will harness our national capacity and ensure our veterans receive world-class healthcare and support services.

We must re-invigorate and invest in our research related to protecting the health of soldiers and mitigating the health impacts that occur throughout the life course of the soldier and their families as a result of military service to Canada. In support of this objective, the members of the House of Commons Standing Committee on Finance are asked to consider the following:

Recommendation #1. As part of the 2012-13 federal budget, allocate $30 million over the next five years for a national academically led research program in military and veteran health, guided by the government’s priorities and coordinated by the Canadian Institute for Military and Veteran Health Research.

Recommendation #2. Provide a greater incentive for the defence industry to invest in research related to military and veteran health, through initiatives such as enhancing the Industry Canada policy on Industrial and Regional Benefits (IRB) that leverage Canada’s procurement of defence equipment, by expanding the current credit for research in this area to at least a 15X multiplier.

On behalf of the Canadian Institute for Military and Veteran Health Research, Queen’s University looks forward to having an opportunity to elaborate on our submission at an autumn meeting of the House of Commons Standing Committee on Finance.