Military health surveillance has seen dramatic changes and improvements since the Persian Gulf War ended in 1991.

"Over the past 30 years, military health surveillance has evolved from a focus on science for sake of knowledge, to a focus on medical readiness of the individual soldier, Marine, sailor and airman to ensure that if called upon, they are ready to fight and win the nations wars," said Army Col. Douglas Badzik, chief of the Defense Health Agency's Armed Forces Health Surveillance Division.

Those investigating the medical complaints of Gulf War veterans were hindered because relevant records were often inaccessible or nonexistent. The records that were found lacked uniformity and accuracy, and were generally not automated.

"The last 30 years have seen improvements in data collection, automation, and transmission. It has allowed for the creation of robust longitudinal health surveillance records on military populations," said Dr. Mark Rubertone, chief of AFHSD's Data Management & Technical Support section.

Badzik agrees, "This trend was accelerated in 2014 with the establishment of the Defense Health Agency and its role as a combat support agency and, the transition of AFHSD - known at that as the Armed Forces Health Surveillance Center - to the DHA public health directorate. The establishment of AFHSD also significantly increased the coordination of surveillance among the service public health entities."

Tools such as the Defense Medical Surveillance System (DMSS), a continuously expanding, fully integrated, relational public health surveillance system allowed for the conduct of powerful epidemiological assessments into the morbidity experiences of service members. Other "remote access" tools such as the Defense Medical Epidemiologic Database (DMED), the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE), and the Health Surveillance Explorer (HSE) provided users with unparalleled access to timely, relevant, and actionable information.

The most recent tool, the HSE, is a dynamic CAC-enabled mapping application that allows Geographic Combatant Commands to identify global health threats and disease outbreaks in near real-time.

Additionally, advances in biospecimen research utilizing repositories such as the DOD Serum Repository (DoDSR) with more than 70 million frozen serum specimens collected on service members during the past 30 years have contributed greatly to our knowledge of service members' health. With links to relevant demographic, occupational, and medical information within the DMSS database, the DoDSR provides a unique and powerful resource to support the conduct of military medical surveillance, clinical care, and seroepidemiologic investigations.

The potential values of comprehensive public health surveillance are numerous and well recognized. It remains essential that population-based demographic, exposure, and medical outcomes data are routinely and systematically collected from various sources and integrated into public health surveillance systems.

"If resourced properly and fully utilized in the DOD, future public health officials from all Services in the Defense Health Agency will be positioned to detect new and emerging hazards, track rates and trends of illnesses and injuries of concern, and prioritize and focus prevention programs," said Rubertone, an army retired colonel.

Badzik further explains, "The coordination among the Service public health entities has been invaluable in combating the COVID pandemic, which does not care what color uniform a Service Member is wearing. While health surveillance within DOD is still conducted to the highest scientific standards, it is now done through the lens of improving the medical readiness of the individual service member."