Service Transformed: Lessons in U.S. Veteran Centered Care. This is unit one, and we're going to focus on the Veterans Health Administration's contribution to medical education. We have several objectives around this idea about the demographic information and knowledge related to veterans. Today's veterans is quite a diverse landscape, they represent more than 25% of the veterans today or from minority populations. We have currently 21 million people in the United States who have been active in the military. And one of the most interesting things over the course of the last decade is the increasing number of female veterans in the U.S. population. But we have to get to our veteran status first and we have to understand that people are actively serving in the military and this gives you a nice, demographic background of the five branches of the military. Those include the Army, Navy, Air Force, Marines, and Coast Guard. The interesting thing about the Coast Guard, one has to remember is that that's Homeland Security sponsored organizations, where the others are part of the Department of Defense. The other interesting thing to know is that those who are active duty are split between those who are active full time, and those who are active part time. The difference between active duty and those in the Guard, or the Reserves, would be the same concept around, do you have a full time military job or do you have a part time military job? Those in the National Guard and the Reserves have other jobs, other activities that fill their days, and take some time out to serve our country, they typically seek care in the community at civilian facilities, and then we have active duty servicemen, who will engage in daily activities of the military and seek healthcare to a variety of different installments across the world. We need to understand those of us who did not participate in the military, that there is a culture. One of the most important ones to understand from the get go is that there's an idea of rank and structure that's very clear. There's officers that are approximately 17 to 20% of the active forces, they're often the leaders. They're responsible for the activities of their units, and if you want to think about other social demographics, they almost always have a 4-year college degree. The remaining are enlisted active duty military folks who trained, who often entered the military after high school or a few years afterwards, and actually trained in a special area under the direction of an officer. Those of us who need to refresh our US history, there have been active conflicts since World War II and it's interesting and important to know that since World War II, there have been several periods where we've been in active military conflicts. Those include the Korean War, the Vietnam War, Persian Gulf or Desert Storm, and Afghanistan and Iraq, where we're currently sending down troops in those active areas of conflict. As we think about veteran status, we have to get out of the military and some of us don't really understand that process. There is an average length of service for those in the military that's often between two and six years, depending on the branch, depending on what individuals had signed up for. There's multiple discharge categories, the most common being an honorable discharge, which is general. And as you can see, there is other ones. And one of the things that we'll talk about quite a bit is people start to engage and need to have evidence of their eligibility for the Veterans Health Administration is the DD Form 214, and that's just their discharge papers that say very clearly that they have a discharge from military service. We've just covered what today's veterans look like, in terms of percent of population, and what processes they undergo, as they're active duty military. We're going to spend some time looking more closely, at what the representation of veterans are in today's U.S. population, as we go forward. As we think about the U.S. population, in general, about 9 to 10% of the current U.S. population are veterans. And one of the things we talked about earlier is, in fact, it's a quite well represented group of individuals, it's quite diverse. As we go forward in these slides, the dark color slides represent veterans, the lighter color slides represent non-veterans or the general population. And as you can see, there's approximately 25% of U.S. veterans who define themselves as Non-White, Hispanic. An interesting note, over the course of the last ten years, more females have actively engaged in our volunteer armed services, and thus, they are becoming a bigger part of the female veteran population, and represent about 7% of the current veterans today. Here's a slide just looking at the veteran age distribution across the age categories. As you can see, we're losing more and more World War II veterans, veterans in their 80's. However, we're having a bulge in the mid-40s and 50s, later 60s and 70s, and this represents the most common veterans have participated in some sort of Vietnam conflict. And again, here, you can see where Vietnam Era veterans represent approximately 35% of male veterans, and as you can see over the course of time, that there are more and more female veterans who participate in active combat. One of the most important note on this slide is the last columns, where approximately only 25 to 30% of veterans have only participated in Peacetime duty. The rest of the veterans, another 70%, have been in conflict situations, or during the time of conflict in the United States. Again, just to remind you, the dark colored slides are Veterans, the lighter colored slides are the general U.S. population. As you can see, we're going to talk about under served populations, populations that are vulnerable, but when we think about veterans overall, the military is this great gateway to educational and income attainment. It allows people in the United States an opportunity that other parts of service don't necessarily reflect, and so here, you can see that, in fact, most veterans have some post high school education. And that's really attributed to the types of opportunities that are available, either in the military or post-military, in terms of their educational attainment. Again, you can see managerial, professional types occupations are overrepresented by veterans, when you compare that to the U.S. general population. And you might hear on the radio or TV ads where people are particularly interested in hiring those with military experience. If you want to think about it, if you run a business that's team-oriented, where you want go-getters, the military's a great place, or the veterans are a great potential hire, because you know the background, and the experience of those individuals. Again, we're going to focus on those veterans who are at the margins, in terms of income and healthcare opportunities. However, we have to remember, overall, veterans have high median earning incomes, when you think about total earnings or in terms of personal income. Remember, income is different than earnings. Income does entail things like create benefits, disability benefit, et cetera. The green on this slide is the U.S. general population. And if you want to think about, we have this idea that there is multiple veterans with service connected illnesses. And we'll talk about that later in the course, however, in fact, veterans have less disability than that in the general population and again, those who represented in poverty is less than the general population, as well. Types of healthcare insurance. We're going to focus through this course on the Veterans Health Administration and those who receive their care through the VA. But veterans have all types of health insurance just like the general population, and here, you can see the distribution around private, public, or no coverage at all, again, having the VA as an option for many veterans who have a honorable discharge. And finally, the most important point is only 25 to 30% of all veterans seek healthcare in the Veterans Health Administration System. The rest, the 70% of other veterans, seek care at our civilian hospitals, and that's why it's so important for everybody to understand the concepts related to veteran centered care, how to ask questions about military history, how they might impact ones health care, and we hoped to focus on that for the rest of this course, to ensure that not only the healthcare professionals who work within the VA system, but also those who work in civilian hospitals and healthcare systems have the skill set to care for today's veterans.
