The Army wants to keep soldiers and their families out of the doctor’s office, not by denying them care but by creating a healthier population needing less treatment.It is a balancing act, not like a circus act with someone juggling bayonets and hand grenades, but one of trying to make certain people get the care they need and provide preventive care by advocating healthy living and better decisionmaking to improve well-being.Called a System for Health, this is different from standard health programs because it concentrates on what Army Surgeon General Lt. Gen. Patricia D. Horoho refers to as “lifespace,” which is time spent outside the doctor’s office. It is during this time that sleep, activity and eating habits are crucial for soldiers’ overall health and performance, both of which influence Army readiness and resilience.Army medical officials believe this is a good time to advocate for lifestyle changes because the physical, emotional and mental health of soldiers has been negatively affected by 13 years of ongoing combat. Soldiers need to be ready to respond on short notice, and this requires that they maintain their own well-being.“Their mission is to be ready and to answer the call of duty as a volunteer servicemember,” said Lt. Col. Barbara Ryan, Health & Wellness, Office of the Army Surgeon General Training, Education and Communication Lead. Soldiers “take care of their equipment. They take care of each other. We’re [also] asking them to take care of themselves and their health.”According to Army officials, roughly one in four possible recruits is eligible to enlist, leaving approximately 75 percent who are ineligible due to weight or legal or medical issues. With a small pool of individuals to recruit from, the urgency for better health and lifestyle choices is no longer simply a national health issue; it is a matter of national security.The annual defense health care budget is about $37 billion, with $24 billion allocated to direct patient care. For years, Army officials have been concentrating on ways to cut health care costs with preventive care, but that could have an even greater budgetary impact.“We are aggressively moving from a health care system—a system that primarily focused on injuries and illness—to a System for Health that now incorporates and balances health, prevention and wellness as a part of the primary focus for readiness,” Horoho told a Senate committee in April. “Through early identification of injury and illness, surveillance, education and standardization of best practices, we are building and sustaining health and resiliency. This also moves our health activities outside of the brick-and-mortar facility, brings it outside of the doctor’s office visit and into the ‘lifespace’ where more than 99 percent of time is spent and decisions are made each day that truly impact health.”Speaking last year at the Association of the U.S. Army Annual Meeting and Exposition, Horoho said nine out of 10 people in the room where she was speaking “will die of a preventable illness. Most of us accept this as inevitable; not a matter of if, but when. But it’s not ‘when.’ It’s ‘if.’ The decisions we make every day determine if, not when, we will contract one of these life-threatening conditions.”None of what has been said so far, however, should be taken to mean that the Army health program discourages health care. It seeks ways to lower costs by making soldiers and families healthier and encourages them to make wiser lifestyle choices, such as seeking patient-centered medical care or utilizing Army Wellness Centers, according to Ryan.“The System for Health is looking at how we look at policies, initiatives, programs and … relationships that empower individuals to take health into their own hands and decide action with their health and wellness—and how we, as Army Medicine, plug into that,” Ryan said.By promoting wellness and educating people on the best ways to improve and maintain their health by changing behavior, the initiative hopes to create communities where wellness and healthy living are encouraged, allowing soldiers, civilians and families to make informed decisions with respect to their well-being and health, eventually leading to a decrease in preventable diseases and injuries.“This is a vision but also a systematic change that’s going to take the enterprise to have to change. [It will] also take the soldier and individual family members to change,” Ryan said.She also said such change requires the help and participation of leaders at every level. Rather than taking choices away from soldiers, offering additional options that provide healthy outlets for activity and healthy nutrition will allow room for change.“This is going to take a lot of energy and time and really a whole-government approach to really tackle the health of our nation. And the military being a subset of the nation, leaders are going to have to pay attention and continue to do the risk assessments and be held accountable as they are today for the readiness of their force,” Ryan said.Leaders can influence this change by encouraging their units to use the Performance Triad as a model for living. Horoho’s Performance Triad is an initiative within the System for Health that aims to improve readiness and resilience through the influence of three critical components—sleep, activity and nutrition—that play a major role in the overall health of soldiers and greatly influence cognitive abilities, energy levels, and physical performance (see “Eat, Sleep, Exercise: Seven Questions for the Army Surgeon General on the Performance Triad,” ARMY Magazine, June).The Senior Leader Guide for the System for Health encourages behaviors such as getting at least eight hours of sleep, taking approximately 10,000 steps per day, doing 150 minutes of aerobic activity per week, eating eight fruits and vegetables a day, and visiting Army Wellness Centers where various services and programs are available.“We don’t want this to be another training program. We want this to be in the DNA of the Army like the Army Values,” Ryan said about the Performance Triad. “Now that Army Values are ingrained in every soldier, we want healthy sleep, activity and nutrition habits to be ingrained in the soldiers of the Army. … If people can reside in a better state of well-being, people live healthier, happier lives while serving their country.”Since demanding work schedules and a 24-hour, on-the-go culture can make it difficult to turn adequate sleep and proper exercise into persistent habits, Army officials are taking steps to analyze the effectiveness of the Performance Triad.Three focus groups—located at Fort Bragg, North Carolina; Fort Bliss, Texas; and Joint Base Lewis-McChord, Washington—took part in Performance Triad trials. The aim of the study was to “assess the reach, effectiveness, implementation, adoption and programmatic achievements and gaps to inform and improve a broader implementation,” Horoho said. According to her testimony before a Senate committee, the pilot at those sites involved “equipping approximately 1,500 soldiers with activity monitors, performing periodic assessments and providing leaders with weekly activities to incorporate into training time.”Although the study wrapped up in May, Ryan said the results will not be available until July or August.“Medical readiness has improved over the years, and with this type of program and focus on transitioning to help people be healthy and make healthy choices, the goal is to have a more ready and a more resilient Army,” Ryan said. “We have a fit force; we’re just trying to get to a healthy and fit force.”