Force Health Protection: the role of Military Environmental Health Practitioners

Environmental Health Practitioners (EHPs) and the wider profession play a vital role in protecting and maintaining public health, and as such work throughout society in a variety of roles and sectors. In this blog Major Glen Bullivant MBE RAMC sheds light on a lesser-known area that EHPs work tirelessly in, the Military.

Following a recent Military EHP graduation ceremony which our Director of Environmental Health and Chief Executive Officer attended, Major G Bullivant discusses how Military EHPs play a pivotal role in maintaining operational effectiveness when forces are deployed, how their training differs, and their overall contribution to managing health risks across the globe.

On 18 July 2023, the Defence Medical Academy, with guests from Leeds Beckett University (LBU) and CIEH, celebrated the latest cohort of Military EHPs graduating. One group of nine ‘Passed off’ after two years of training as Class 2 EHPs, and another group of nine graduated as Class 1 EHPs. A lot of military training is split into Class 3, 2 and 1. For the EHPs, the Class 3 and 2 covers initial trade training covering 10 out of the 19 modules. The Class 1 is the subsequent trade training and covers the final 9 modules and means they are then a fully employable Military EHP.

Becoming a Military EHP

Within the Military the Environmental Health Cadre is a relatively small trade group which isn’t advertised widely. We do, however have a powerful recruitment strategy – word of mouth! Almost all applicants year on year apply voluntarily to transfer or directly join the EH Cadre due to encountering an EHP during routine work, exercises or operations after seeing how good the job was. The Army’s applicants, in this highly sought-after military profession, go through a rigorous and competitive two-day selection event comprising of a literacy and numeracy test, essay, presentation, situational judgment task and an interview. Successful candidates will then embark on a four-year Military EHP BSc (Hons) programme; jointly delivered by the Defence Medical Academy (DMA) and Leeds Beckett University. This CIEH-accredited course is based around the core curriculum but has additional modules to capture the military training requirements, including modules such as military health stressors, operational and practical skills and professional development. The training also includes enhanced theoretical and practical entomology training at Lincoln University and Cyprus. DMA deliver 12 and LBU the other seven modules. Of the four-year training pathway, the first two years entails the majority of the academic learning and includes a nine month practical placement (Blocks 1-4) with a Military EH team, and the remaining two years is on the job training where the dissertation, a work based learning portfolio and a few final modules are completed (Block 5).

Why do we need Military EHPs?

A Military force needs to maintain its operational effectiveness when deployed. History has shown us time and time again how much manpower wastage there has been due to preventable illness (e.g. malaria, dysentery, typhus, cold injuries) compared to injuries sustained on the battlefield. We often deploy to historically familiar places, but also to new places with a range of unknown and emerging health threats that we have previously not seen or had to deal with. This is often in high risk (adversary) and demanding environments with limited resources.

As such, Force Health Protection is an essential component of healthcare and one that requires a lot of preparation before a deployment, and active engagement during the deployment. Environmental health is a key component of Force Health Protection and specialists like EHPs provide instrumental advice to the chain of command to assist in managing health risks all over the world. Force Health Protection aims to conserve the fighting potential of a force so that it is remains healthy and combat capable. There needs to be a sum of all efforts to reduce or eliminate the incidence of ill health. Rarely one control measure will reduce the risk enough, so by having a ‘suite’ of measures that can be integrated into a units health risk management plan is key, and ones they agree are realistic and take ownership of.

The importance of EHPs in practical implementation of health protection measures

Far too often the medical plan and health protection measures look comprehensive but in practice they are hard to achieve, which in turn puts people at risk. We have seen this recently in Belize with many cases of Leishmaniasis (spread from the sandfly). At times tactical requirements and tasks mean some measures are compromised or not even possible to apply; therefore, the chain of command needs to look at the mission objectives and assess what measures can be implemented in order to reduce the risk and achieve the objectives. There needs to be a balance to weigh the risk to health against the mission. Military deployments are inherently risky that is why a ‘sweet-spot’ between reducing the risk and accepting a level of risk to achieve the mission needs to be found. The challenge is to give the Commander the freedom of movement and ability to operate effectively whilst maintaining sufficient Force Health Protection measures that will reduce Disease and Non-Battle Injuries (DNBI) to an acceptable level. Thereby, we become an enabling not constraining asset.

EHPs deploy worldwide to many locations either as part of a reconnaissance team, deployed force asset or for audit and assurance purposes. These highly trained individuals, often at a junior level, have to operate with autonomy and minimal supervision in high-risk and austere environments in order to provide EH support. At the time of graduation, one of the students was serving in Belize for eight months – fortunately, she was able to dial in to receive her certificate virtually!