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Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Many service members and veterans face serious challenges in readjusting to normal life after returning home. This initial book presents findings on the most critical challenges, and lays out the blueprint for the second phase of the study to determine how best to meet the needs of returning troops and their families.
Chronic multisymptom illness (CMI) is a serious condition that imposes an enormous burden of suffering on our nation's veterans. Veterans who have CMI often have physical symptoms (such as fatigue, joint and muscle pain, and gastrointestinal symptoms) and cognitive symptoms (such as memory difficulties). For the purposes of this report, the committee defined CMI as the presence of a spectrum of chronic symptoms experienced for 6 months or longer in at least two of six categories-fatigue, mood, and cognition, musculoskeletal, gastrointestinal, respiratory, and neurologic-that may overlap with but are not fully captured by known syndromes (such as CFS, fibromyalgia, and IBS) or other diagnoses. Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified. Many thousands of Gulf War veterans1 who have CMI live with sometimes debilitating symptoms and seek an effective way to manage their symptoms. Estimates of the numbers of 1991 Gulf War veterans who have CMI range from 175,000 to 250,000 (about 25-35% of the 1991 Gulf War veteran population), and there is evidence that CMI in 1991 Gulf War veterans may not resolve over time. Preliminary data suggest that CMI is occurring in veterans of the Iraq and Afghanistan wars as well. In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness recommends how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans, recommends additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty and recommends such legislative or administrative action as the IOM deems appropriate in light of the results of its review.
In December 2016, the CCA was asked by then Minister of Health Jane Philpott and Minister of Justice and Attorney General of Canada Jody Wilson-Raybould to undertake independent reviews related to medical assistance in dying (MAID). Specifically, the CCA was tasked with examining three particularly complex types of requests for MAID that were identified for further review and study in the legislation passed by Parliament in 2016: requests by mature minors, advance requests, and requests where a mental disorder is the sole underlying medical condition. On December 12, 2018 the CCA released the three final reports of the Expert Panel, one on each type of request: The State of Knowledge on Medical Assistance in Dying for Mature Minors; The State of Knowledge on Advance Requests for Medical Assistance in Dying; and The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder is the Sole Underlying Medical Condition.
Social factors, signals, and biases shape the health of our nation. Racism and poverty manifest in unequal social, environmental, and economic conditions, resulting in deep-rooted health disparities that carry over from generation to generation. In Perspectives on Health Equity and Social Determinants of Health, authors call for collective action across sectors to reverse the debilitating and often lethal consequences of health inequity. This edited volume of discussion papers provides recommendations to advance the agenda to promote health equity for all. Organized by research approaches and policy implications, systems that perpetuate or ameliorate health disparities, and specific examples of ways in which health disparities manifest in communities of color, this Special Publication provides a stark look at how health and well-being are nurtured, protected, and preserved where people live, learn, work, and play. All of our nation's institutions have important roles to play even if they do not think of their purpose as fundamentally linked to health and well-being. The rich discussions found throughout Perspectives on Health Equity and Social Determinants of Health make way for the translation of policies and actions to improve health and health equity for all citizens of our society. The major health problems of our time cannot be solved by health care alone. They cannot be solved by public health alone. Collective action is needed, and it is needed now.