Assessing Exposures in the United Kingdom’s Armed Forces - A Review of Systems that Collect Data Useful for Exposure Assessment

Abstract

The ability to assess the exposure of individuals or groups is a critical element in any effective health surveillance system, as it provides the opportunity to identify the causes of ill health, the levels of exposure resulting in ill health and, through controlling exposures, to protect the health of Service personnel. As part of a wider programme to enhance the health surveillance capabilities of the Defence Medical Services, a project was undertaken to assess the collection and retention of data for exposure assessment in the United Kingdom's Armed Forces. The systems investigated include those for health, safety and environment policy, personnel and pay, medical records, environmental and occupational monitoring and historical records. It was found that the use of many systems for exposure assessment would be hampered by inconsistencies in the data collected, poor accessibility and linkage, and variability in the retention of the data. This paper highlights some of the problems that limit the usefulness of the record systems for exposure assessment and summarizes the principal recommendations made for enhancing the systems to better facilitate health surveillance.

Lymphohaematopoietic malignancies in Scottish military veterans: Retrospective cohort study of 57,000 veterans and 173,000 non-veterans

“…Individual-level exposures may be recorded inconsistently, or not at all, (Cherry et al 2001) except where statutorily required. (Capleton et al 2001) Two earlier exposures of military personnel to potential haematopoietic/lymphopoietic harm raised widespread concerns; the exposure of many thousands of UK, US and other Service personnel to ionising radiation in the course of the nuclear tests which took place between 1952 and 1967, (Roff 2002, Muirhead et al 2003 and the exposure of a large number of US personnel and a smaller number of New Zealand and others to the dioxin-containing defoliant Agent Orange during the Vietnam War. (Frumkin 2003) As UK personnel were not involved in the latter exposure, Agent Orange will not be further considered in this paper.…”

The Deployment Health Surveillance Program: vision and challenges of health surveillance for Australian military cohorts

“…Exposure assessments a challenge in military health research, 21 and most studies still rely heavily on self‐reported exposure data, which is of course subject to recall bias. Ability to accurately and objectively assess the exposure(s) of individuals or groups is a critical element of health surveillance, as it provides the opportunity to assess the level of exposure that results in ill‐health 22 . Exposure data to environmental hazards and specific incidents are collected by the ADF and are available to the DHSP.…”

Considering Exposure Assessment in Epidemiological Studies of Chronic Health in Military Populations

“…Some forms of pay data provide the strength of a built-in feedback mechanism whereby both personnel and the employer are motivated to correct pay errors as soon as possible ( 47 ). However, differential retention of personnel data by rank and service has also been noted, with the potential to bias retrospective studies of exposure-effect relationships since exposures may differ across these factors ( 49 ).…”