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Increasing Concentration of Veterans in Rural Areas Poses Challenges for VA

by U.S. Medicine

January 11, 2013

Most Vets Now Settle in Only a Few States
BELLINGHAM, WA — Changing demographics for veterans in the United States, with most now settling in the South and the Southwest, often in rural areas, has potentially profound implications for how and where VA offers services. It also raises questions about the future of the broad base of political support that traditionally has existed for veterans’ healthcare.

Those concerns were underscored by a recent study which graphically illustrates the growing divide between veterans and civilians who have never served. Research by Jay Teachman, PhD, of Western Washington University indicates that, as the total number of veterans in the United States declined over the past three decades, the veteran population increasingly concentrated in rural counties.1

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According to the study published in Armed Forces & Society, veterans tended to gravitate to rural areas with large military installations in states such as Arizona, Florida, North Carolina and Texas.

Two factors primarily drive this migration, Teachman told U.S. Medicine.

“Oftentimes, these are the areas where veterans were recruited from initially. We know the largest number of recruits come from the Mountain West and South, and that’s where they tend to return,” he noted.

In addition, larger bases “offer settings veterans are more familiar and comfortable with — and where it is easier to obtain services and benefits,” Teachman said.

This might result in a continued shift of veterans’ services in tandem with military bases.

As former Defense Secretary Robert Gates noted in a 2010 speech at Duke University in Durham, NC, about the military-civilian divide, a significant percentage of Army personnel are now concentrated in Texas, Washington, Georgia, Kentucky and North Carolina.

“Studies have shown that one of the biggest factors in propensity to join the military is growing up near those who have or are serving,” Gates said. “In this country, that propensity to serve is most pronounced in the South and the Mountain West, and in rural areas and small towns nationwide — a propensity that well exceeds these communities’ portion of the population as a whole.”

Many military installations in the Northeast and West Coast have been shuttered, while other branches have seen similar consolidation, he added.

Most Counties Have Few Veterans
Jay Teachman, PhD,
Western Washington University

In the following decade, that number dropped by more than half. By 2010, only 26% of counties had veteran populations of 10% or greater. Outside the counties surrounding large bases, the counties with the highest proportion of veterans tended to be those that were very sparsely populated, such as in Alaska and Nevada.

Among larger counties with populations of 100,000 or more, the change in veteran populations is even more stark. In 1980, 20 large counties had veteran populations of 15% or more. By 2010, the number had dropped to nine, and those were located in only three states — Florida (5), Virginia (3), and Washington state (1) — all with major military installations.

Teachman cautioned that the smaller percentage of Americans serving in the armed forces and the reduced interaction between veterans and nonveterans could have serious consequences.

“After World War II, most of America had an understanding of military concerns,” he said. With the separation seen today, “there are more opportunities for misunderstanding and less empathy for the plight of veterans.”

According to the 2012 Blue Star Family survey, military families already acutely feel the consequences of poor communication and limited interaction with the broader civilian society. Ninety-five percent of respondents to the survey agreed that “the general public does not truly understand or appreciate the sacrifices made by service members and their families.”

Teachman said he fears that the potential for misunderstandings will increase, if current trends continue.

“On the broader political scale, the military is a very big institution that takes a good chunk of the federal budget. With a smaller number serving and greater geographic concentration of those that do, there’s a lack of exchange between the two groups that makes it harder for each group to understand what the other is going through,” he noted, suggesting that, in the competition for federal dollars, the concerns of veterans could be pushed aside.

1. Teachman J. A Note of Disappearing Veterans: 1980-2010. AFS. Article DOI: 10.1177/0095327X12468731. Article available through Sage.

Veterans Drop in Northeast, West

 

Teachman’s research shows a corresponding decline in veteran populations in those areas. “The drop in the percentage of veterans is particularly dramatic for the Northeast and the western third of the country” over the 30 years examined, he said.

This concentration in only a few counties in a handful of states will have significant impact on how and where the VA offers services, Teachman suggested.

“To serve veterans that are distributed very differently than in the past, the VA will have to make some changes. We’ll find that services are available in areas where there are not that many veterans and that services are not available in areas with increasing demand.”

A veteran in Temple, TX, boards a vehicle provided by the Veterans Transportation Service, one of the methods VA is using to improve access for rural beneficiaries. With veterans increasingly concentrated in rural areas away from VAMCs, VA also is trying to reach about 825,000 veterans through telehealth and mobile health by the end of 2013.

Since at least 2003, when it established the Capital Asset Realignment for Enhanced Services (CARES) Commission, the VA has wrestled with finding the best way to respond to changing veteran demographics and needs. Created to recommend the best ways to eliminate underutilized facilities, develop new facilities where demand had increased and redirect resources to better meet veterans’ needs, the commission and its recommendations have encountered significant community and political opposition. In a time of greater fiscal constraint, however, consolidations that reflect the dramatically altered distribution of veterans might be harder to avoid.

For the study, Teachman analyzed population data from 3131 counties from the 1980, 1990, 2000, and 2010 censuses. During the period studied, the number of veterans fell by 22%, from 28 million to 22 million. The decline occurred as the very large cohort of World War II veterans died and their numbers were not replaced by veterans from the much smaller all-volunteer active duty forces, which totaled only 2.0 million in 1980 and 1.4 million in 2010.

At the same time the number of veterans fell, the overall U.S. population grew by 80 million during the 30-year span. As a result of the confluence of these factors, the veteran proportion of the U.S. population dropped from slightly more than 12% in 1980 to about 7% in 2010.

“By itself, the decline in the number of active-duty service members and veterans means that the likelihood of civilian-military interaction has decreased,” Teachman wrote.

The biggest factor in reducing interaction between the two population groups has been the smaller proportion of people serving, Teachman said.

“In World War II, 70% of the birth cohorts served. During Vietnam, it was 25% of the birth cohort. Today, it’s just 7%. It’s a self-selected group. Before, with the draft, it was a more representative cross section of American men,” he said.

Geographic concentration in a relatively small number of counties has further increased separation of veterans from broader civilian society. On a county level, the results of the reduced number of veterans and increased geographic concentration are easy to see. In 1980, veterans accounted for more than 10% of the population of 80% of American counties. In 1990, that was true for 73% of counties and in 2000, for 55%.


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