Military Global Health Engagement and Low-Dose Ionizing Radiation

• Published in: Military medicine 2017-09, Vol.182 (9), p.1677-1679
• Main Authors: Miller, Alexandra C, Gilstad, John, Brenner, David J
• Format: Article
• Language: English
• Subjects: Armed forces; Cancer; Collaboration; Defense; Diplomacy; Disaster relief; Displaced persons; Emergency preparedness; Environmental Exposure - adverse effects; Evacuations & rescues; Gamma rays; Gene expression; Global Health - trends; Humans; Military Medicine - methods; Military Medicine - trends; Military strategy; Nuclear accidents & safety; Population; Public health; Radiation, Ionizing
• ISSN: 0026-4075; 1930-613X
• DOI: 10.7205/MILMED-D-17-00142

U.S. Military Global Health Engagement is evolving toward more specifically military strategic objectives, as well as better coordination with U.S. diplomacy and international development.1 The Department of Defense (DoD) issued policy guidance on global health engagement codifying these priorities for the first time in 2013, and is now developing the corresponding implementing instructions and a Joint Concept of Operations.2 As concepts gel, the time is ripe for new ideas that can help round out military global health engagement's emerging triple aim of force health protection, partnership building, and threat reduction, and situate these activities effectively within Whole of Government global health efforts. Radiation avoidance measures necessary to meet this target included mission-impacting constraints such as deferred maintenance to reduce crew exposures and increased ship standoff distances.3 After-action analyses identified lack of consistent guidelines to translate detectable radionuclide levels to protective actions, and widespread lack of preparation to implement ALARA decision-making within an evolving emergency.4 U.S. authorities set the evacuation zone in Japan at 80 km for U.S. nationals, conflicting with the Japanese government's 20 to 30 km zones despite the challenges for public trust and risk communication that this discrepancy created. Progressively higher statistical power is needed for epidemiologic study of lower exposures. [...]it has been estimated that measuring the increased risk due to a 20 mGy exposure would require lifetime follow-up of roughly a million people.6 However, within a defined population with a specific overall dose response rate, there are subpopulations and individuals with higher and lower risks.7 Methodological advances such as genetic sequencing, gene expression profiling, bioinformatics, and single-cell irradiation are enabling new experimental and epidemiologic strategies that promise better ways of individualizing risk assessment and follow-up, as well as potentially leading to risk-modifying countermeasures. The current GHSA countries include 5 of the 6 low-resource countries worldwide, which have no current nuclear power capability, but do have reactors in the planning or proposal stage: [...]recently, the U.S. Department of Energy's (DOE) Office of Science had taken the lead in low-dose radiation research.