Attendees at the 2013 Association of the U.S. Army Annual Meeting and Exposition’s Military Family Forum II received special health care, and it came with no deductible or copay.Small slips of white paper – prescriptions – were placed before the forum’s conference room in the Walter E. Washington Convention Center.They read: Activity:30 minutes this afternoon.30 minutes in the morning. Nutrition:Eat your calories, don’t drink them.No more caffeine until tomorrow a.m. Sleep:Remove electronics from the bedroom.Get seven uninterrupted hours. The prescriptions were signed by Lt. Gen. Patricia D. Horoho, U.S. Army surgeon general.The three elements of the prescription for health make up the Performance Triad, Army Medicine’s initiative on eating well, being active, and sleeping well.At the Family Forum, where she was lead speaker, Horoho highlighted the shift of Army Medicine’s focus from healthcare, the treatment of disease, to wellness, the preservation of health. She sees the transformation from a healthcare system to a system for health as vital to the Army and the nation."It would be tragic, if in the evening of our lives, as the shadows grow longer, we come to the realization that life could have been better, or that we didn’t live up to our potential," Horoho said.A healthy lifestyle, Horoho said, can lead to a better life with more engagement, energy and fulfillment.She said the three tenets of her prescription for health – activity, nutrition and sleep – are the keys to wellness and can avert what she called a crisis in America, where "nine out of ten of us in this room will die of a preventable illness. Most of us accept this as inevitable, not a matter of if, but when."Adding, "But it’s not ‘when’. It’s ‘if.’ The decisions we make every day determines if, not when we will contract one of these life-threatening conditions."Horoho noted that only one in four Americans aged 17-24 are eligible for military service today due to medical, weight or legal issues. "This is a clear and present danger to our national security," she said.The key to a healthy body is the mind, Horoho said, and that the three tenets of her prescription have a profound effect on the way the brain works, and, conversely, using the conscious mind to fight subconscious unhealthy impulses is essential.A lifestyle that has an adverse effect on health is, "a choice, not a sentence."She noted that lifestyle-induced disease is partly explained by our 24-hour culture influenced by spouses, children, coworkers, bosses and just about everyone around us."Lit by neon and fueled by caffeine, too many sweets, too many pills, not enough sleep and nowhere near enough activity," she said.The subconscious mind influences humans to avoid activity unless it’s necessary for survival as a way of storing more calories. This was necessary earliest eras of human development because food was scarce.Things have changed, and the average American now spends 21 hours each day either sitting or lying down.Horoho said we need to drive that number down."We weren’t built for this," Horoho said. "It’s toxic, and it’s a problem. I’m not knocking 30 minutes in the gym or PT, but that’s simply not going to offset the adverse health consequences of prolonged sitting."She recommends devices that monitor activity and sleep as a way of tracking your efforts to be healthier. Measuring activity can make it the transition to a more active lifestyle easier.When it comes to poor nutrition, the subconscious mind is again often the culprit."Your survival brain is primed for hunger, instilled long ago by evolutionary pressure," Horoho said. "And your emotional brain craves comfort foods – foods we associate with positive experiences."The average American eats 150 pounds of refined sugar every year, according to Horoho, but she does not expect us to eliminate it, only not to drink it in beverages and energy drinks.Adding, "A good reason to think twice before adding sugar to your morning coffee or tea is that with your first taste it sets off a reaction that makes you crave even more sugar throughout the day."Horoho called sleep "the game changer."She said sleep is when learning happens, because that is when the mind consolidates information and experience. Sleep is also critical, Horoho said, because sleepy people make poor decisions. Twenty four hours without sleep or one week of sleeping less than six hours per night is equivalent cognitively to a blood alcohol content of .10 percent, Horoho said."That’s not the person I want performing surgeries in our [operating rooms]. That’s not the person I want driving our children to school. Not the soldier I want at security checkpoints deciding friend or foe."Horoho said one way to get more and better sleep is to minimize environmental factors that work against your ability to sleep well. She said we should have no blinking lights in our bedrooms, including anything that emits light or makes a noise. "Right now, the typical bedroom resembles a modern-day science laboratory."Follow her prescription, Horoho said, and your performance will improve."Performance means being better spouses, better parents, better soldiers, better friends and better members of your community."Rachel O’Hern of Fort Belvoir, Va., the Army spouse of a severely wounded warrior who has transitioned back to active duty, said the elements of the Performance Triad are important."Especially for me, as a caregiver when my husband was injured," O'Hern said. "A lot of those things are easy to fall by the wayside. But you do see the results of that in your energy levels. Obviously, I was making some big decisions when my husband was an inpatient, so you want to be your best cognitive self."The Performance Triad initiative is nested under the Army’s Readiness and Resiliency Campaign, designed to improve the Army’s physical, mental and social well-being by strategically changing the culture."We’re nesting what we’re doing in the medical community within what is taking place across our Army [Ready and Resilient Campaign]. This is not a medical plan, it’s actually an Army plan," Horoho said. "We’re all focused on improving the readiness and resilience of our soldiers and their family members."Horoho listed the establishment of Patient Centered Medical Homes and Army Wellness Centers across the Army, alternative medicine and embedded behavioral health and physical therapy as parts of the readiness and resiliency campaign."It’s really looking at the capabilities of the programs we have out there, so that they are well synchronized on the ground, synchronized at the operational level, and then from a leadership level across all of our forums that we are synchronizing our policies, our programs and our resources so that we’re focused on improving readiness and resiliency," she said. Treating mental illnessDr. James S. Gordon, also on the forum’s panel with Horoho, proposed changing the military’s approach to medicine.Gordon, the founder and director of the Center for Mind-Body Medicine, urged bringing self-awareness, self-care and mutual support "into the center of all care," including the problems of traumatic stress, depression, and anxiety.He called for medicine that works with the body as well as the mind. "One of problems with mental health," he said, "is it’s too focused just on mind."He pointed to research showing there are two effective treatments for depression – one, talking with a sympathetic, compassionate and experienced listener and two, physical exercise, which, he said, changes brain physiology, chemistry and even anatomy.Gordon, a clinical professor of psychiatry and family medicine at Georgetown Medical School and chair of the White House Commission on Complementary and Alternative Medicine Policy, added that there is research showing an 80 to 90 percent decrease in Post-Traumatic Stress Disorder using self-care and mutual help among people exposed to mind-body groups in Gaza and Kosovo. His center has also worked in Macedonia, Israel, Haiti and southern Louisiana.Discussing self-care, Gordon said the biggest problem people have when traumatized, depressed or suffering chronic physical ills is feeling helpless and hopeless. Actually, he added, even the most traumatized person can be shown how he or she can help himself. He cited the simple acts of deep breathing or moving about."That becomes the beginning of that journey out of ill health," he said.He also expressed concern about conventional medicine’s focus on diagnosis, because it tends to make people feel a bit like outcasts and to isolate them. "It’s far more important," he said, "to make all these services – self-care, wellness, and mutual support" available to everyone. Everyone exposed to combat, he said, needs these skills.He acknowledged that at times people need individual therapy and very occasionally, medication. But, he maintained, "The skills of self-care should be fundamental and the first line for everyone."Adding, "Services have to be available to everyone. Why not like basic training? You learn how to deal with your weapon. Why not learn how to deal with your body, your mind?"He noted, "A group is the best way to work. I don’t know how many times I’ve had military men and women say to me: ‘I went into that shrink’s office and I felt like a bug under a microscope.’"By contrast, he said, "You create a group where people can come together as peers, as equals and share when they’re ready and what they’re ready to share, everything changes."He added, "If people are in a program where they’re respected, where they’re taught skills of self-care, then if they need something more, they’re much more amenable to receiving it."(Editor’s note: Craig Coleman, Northern Regional Medical Command, and Peter Slavin, AUSA NEWS, contributed to this story.)