In the dust and heat of Afghanistan, an idea that will change the face of Army medicine took root in the heart and mind of Lt. Gen. Patricia D. Horoho, the Army surgeon general.
It was transplanted to home soil and cultivated at a workshop held Sept. 18--21 at Aberdeen Proving Ground, Md. As it matures, the idea will shift the focus of U.S. Army Medical Command from "a healthcare system to a system for health."
Horoho's idea is called the "Performance Triad." It summarizes a simple truth about human performance and well-being: that all of us--no matter who we are, how old we are, or what we do--need a balance of three things to build and sustain health. The three are sleep, activity and nutrition.
While deployed to Afghanistan in 2011, Horoho noted that many Soldiers suffered from sleep deprivation. It was hard to get more than four hours of uninterrupted sleep. For many, the inability to sleep well for the recommended seven to nine hours carries over after redeployment. Healthy activity--physical, mental and spiritual--was disrupted by a host of factors including operations, the threat of attack, available recreation options and individual motivation. While food in the dining halls at fixed bases was plentiful, many high-fat and high-calorie choices were offered alongside more healthy options.
Horoho realized that many of the issues deployment raised about the Triad weren't exclusive to the Army.
"People are grappling with these questions around the globe, and [the idea of the Triad) resonates with everybody I've talked to," she said at the September workshop. "What we come up with here has got to be something that an individual can grasp, and a leader can grasp. … It should be a framework for a unit, a command, a Soldier and a family, and it should be something they can incorporate into their lives."
She also realized that both mindsets and behaviors needed to change.
Attendees at the workshop were charged with using the Performance Triad of sleep, activity and nutrition to build a framework for change. They approached the question by looking at what blocks Soldiers, leaders, units and families from achieving healthy sleep, activity and nutrition. From the list of these blockers, they prioritized the ones that are most important to address--no more than five or so. Then they outlined plans to fix the blockers, which will be presented to the medical and Army leaders for approval.
In addition to guidance, Horoho and other medical leaders provided inspiration.
"This is something I am absolutely passionate about; I believe we are going to make great changes in health care and in health," Horoho asserted. "We're creating something different than anything we have in the past. We (Army medicine) do heath care better than anyone else in the world; now we are going to be the model for delivering health. That's what you are creating."
Horoho is convinced that people need support, information and education well beyond what can be provided in a clinical setting, in what she calls "the life space."
"We know that on average our beneficiaries see a healthcare provider five times a year, for 20 minutes a time--a hundred minutes," Horoho explained. "We impact the individual's life with care, but not their health."
Where health happens, Horoho said, is in the other 525,500 minutes per year. What Army healthcare beneficiaries are doing in those other 525,500 minutes is working, thinking, training, spending time with family and friends (activity). They're also food-shopping, cooking, eating and drinking (nutrition). When they're not engaged in activity or taking in nutrition, they're sleeping.
"We need to get people to think about what they are doing," she said. "We all mean well, but we all want instant results. It (improving and maintaining health) isn't that easy--it really takes how we, individually, look at activity, nutrition and sleep."
Some of the broad initiatives that workshop attendees thought would help change mindsets and behaviors in each area of the Triad included:
• Education and training--Some examples include validated tools to assess health information, health product marketing and study results; training in scientifically proven fitness and performance methods.
• Reliable, Army-provided or --sanctioned sources of information, preferably easy to access and use, in formats that leverage current technologies.
• Top leader support and example.
• Clear, consistent messages about what to do, when and how often to do it, and the whys behind good health practices.
• Practice and policy based in sound ("evidence-based") science.
The workshop brought together more than 80 medical and scientific experts from fields as diverse as sports medicine, exercise physiology, physical therapy, psychology, public health, clinical medicine, medical research, health promotion, dietetics, molecular biology, marketing and management. They were from DOD, the Department of Veterans Affairs, the American College of Sports Medicine and other non-profit and private sector organizations, and from academia. Some of their names appear on the covers of books, in scientific journals and in the popular press.
Maj. Gen. Jimmie O. Keenan, whose Aberdeen Proving Ground-based staff provided public health expertise and planned the workshop, seconded Horoho's vision of influencing the health of the Army and the nation.
"We are here because we are concerned about the state of the health of America's Sons and Daughters," Keenan said. "Innovative ideas from the Army medicine plan for a healthy force can influence the nation."