DEPARTMENT OF THE NAVY by DYAtEM

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									                                    DRAFT as of May 2, 2006



                               DEPARTMENT OF THE NAVY
                            BUREAU OF MEDICINE AND SURGERY
                               WASHINGTON D C 20372-5120
                                                                                IN REPLY REFER TO
                                                                               BUMEDINST 6110.13A
                                                                                            date

BUMED INSTRUCTION 6110.13B.

From: Chief, Bureau of Medicine and Surgery

To:

Subj: NAVAL MEDICAL DEPARTMENT HEALTH PROMOTION

Ref:     (a) 32 CFR 85 Health Promotion
         (b) DoD DIRECTIVE 1010.10 (Health Promotion and Disease/Injury Prevention)
         (c) DoD Directive 6200.4 (Force Health Protection)
         (d) OPNAVINST 6100.2 (Health Promotion Program)
         (e) MARINE CORPS ORDER P1700.29 (Marine Corps Semper Fit Program)
         (f) DON Civilian Human Resources Manual subchapter 792.4
         (g) Healthy People 2010, U.S. Department of Health and Human Services, January 2000.

1. Purpose. To provide policy and guidelines for the Naval Medical Department’s roles and
responsibilities in U.S. Navy’s Health Promotion Program.

2. Cancellation. BUMED INSTRUCTION 6110.13

3. Applicability and Scope.

      a. This instruction applies to all Navy Medical Department activities.

   b. References (a through e) establish an effective, integrated, and comprehensive health
promotion program throughout the Department of Defense (DoD) and Department of Navy
(DoN). Navy Medicine is one of several vital components in support of the DoN Health
Promotion Program. Reference (f) establishes health promotion requirements for civilian
employees. Reference (g) establishes U.S. Department of Health and Human Services Healthy
People 2010 Goals and Objectives for the Nation.

    c. The Bureau of Medicine and Surgery (BUMED), through the Surgeon General, is the
principal advisor to the CNO on the provision of centralized, coordinated policy development,
and professional advice on health service programs for the DoN, and thus provides expert
consultation in support of the DoN’s Health Promotion Program. Navy Medicine will serves as a
resource to support the DoN’s health promotion programs.
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    d. A high level of health among service members supports force readiness (reference c).
Per reference (d) health promotion is a command responsibility. Each commanding officer,
officer in charge, and senior enlisted leader will promote health within their commands by active
support of health promotion programs and through personal example and active participation.

4. Background.

    a. Unhealthy lifestyle is a major health and economic burden in the United States.
Individuals who make unhealthy lifestyle choices such as tobacco use, poor diet, sedentary
lifestyle, misuse of alcohol and drugs have substantially higher medical costs. It is estimated that
lifestyle-related chronic diseases account for at least 70% of the nation’s annual medical care
costs. Additionally, limited research suggests that the cost of lost productivity due to poor
employee health may be as much as three times the cost of direct medical and disability
expenses. The Navy and Marine Corps family, active duty, reserves, civilians, retirees, and their
families, is a cross section of American society and reflects the unhealthy lifestyle trends of our
Nation.

    b. Health promotion is an integral and distinct component of Population Health
Improvement and Force Health Protection. Health promotion is the science and art of helping
individuals and groups engage in healthy lifestyle choices and to avoid health risk behavior, to
move toward a state of optimal health. Optimal health is defined as a balance of physical,
emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a
broad range of health promotion activities that enhance awareness, change behavior and create
environments that support healthy practices to avoid preventable morbidity and mortality and the
associated costs of curative care.

    c. Health promotion activities are provided to both individuals and groups, in a variety of
settings to include medical treatment facilities (MTFs), wellness centers, worksites, and
community locations.

    d. Health promotion activities are based on the result of a periodic community assessment to
determine the needs and interest of the targeted audience. The assessment can include data from
a variety of local and higher level DoN and DoD sources. Results of the assessment will guide
program activities, goals and development of measurable objectives. All measurable process and
outcome program objectives should be stated prior to program implementation and should be
included in the program evaluation plan. All program objectives should be minimally assessed
annually to determine progress toward the attainment of each.

   e. The range of health promotion program activities covers three levels of programming:

       (1) Awareness, Education/Motivation, and Intervention, to account for individuals and
groups in the various stages of readiness to make behavior change. Awareness activities are
intended to increase knowledge and interest in a particular health behavior or topic, and increase
motivation to change attitude and behavior. Examples may include conducting public awareness
campaigns, health fairs, or providing information through Plan of the Day (POD) Notes,
brochures, booklets, posters or newsletter articles.



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        (2) Education/motivation level activities are designed to further increase knowledge and
interest in a particular health behavior or topic, but usually include providing individualized
feedback regarding health status. Examples may include the completion of a Health Risk
Appraisal (HRA), health screening, challenges, videos, one-session seminars, motivational
interviewing and counseling, or making environmental changes.

       (3) Intervention level activities are more intensive, providing long-term support of
behavior change through the practice of skill building activities, intended to promote the self
management of health. Examples may include individual counseling or weekly on-going group
programs or courses of extended duration with long-term follow up.

5. Policy

   a. Navy Medicine serves as an aggressive advocate and primary consultant for all health
promotion programs in the U.S. Navy and Marine Corps in support of references (a) through (f).

    b. Navy Medicine supports the achievement of the Department of Health and Human
Services’ Healthy People 2010 Goals and Objectives (reference b), placing special emphasis on
the Leading Health Indicators (reference g). Health promotion programs will also emphasize
mission readiness through a fit and healthy force (reference c).

   c. Priority areas for Navy health promotion will include alcohol, tobacco, physical activity
and injury prevention, nutrition, obesity, suicide, stress management, and sexual health.

    d. Navy medical activities shall provide health promotion activities and interventions
targeting health care beneficiaries, provide worksite health promotion in accordance with
references (a-b) and (d-f), and provide health promotion support to non-medical, line commands
within their area of responsibility (AOR) to coordinate and integrate a community approach to
health promotion as specified below.

6. Responsibilities

   a. Chief, BUMED

     (1) Provide policy guidance and assure funding and resources necessary to execute the
requirements of this Instruction.

     b. Commanders, Navy Medicine Regional Commands

   (1) Ensure distribution and execution of this Instruction to the medical activities under their
command.

     (2) Require that the medical activities under their command annually prepare a plan for
execution of approved health promotion programs and activities and submit a budget to support
the plan.



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     (3) Ensure that metrics that monitor efficacy of required health promotion programs are
reported and analyzed.

     c. Commanding Officer, Navy Environmental Health Center

     (1) Designated lead agency to oversee implementation of all aspects of this Instruction.

     (2) Coordinate and provide centralized health promotion support and services to medical
activities, afloat and ashore.

      (3) Provide professional expertise, technical assistance, and capability building through
training opportunities, in health promotion to medical department and ashore/afloat non-medical
commands. These may include SECNAV, Manpower, Personnel, Training and Education
Command, Naval Installations Command, Fleet Forces Command, and Navy Reserve Force, in
support of the medical and scientific aspects of health and wellness and health promotion
programming.

    (4) Define best practices for individuals, worksites, and communities that are evidence-
based and an appropriate use of resources. Identify effective incentives for use as tools to
enhance healthy lifestyle behaviors.

      (5) Establish, collect, analyze and distribute metrics and lessons learned through web
based and other dissemination pathways. Publish metrics for use by medical activities. Collect
and aggregates metrics that measure efficacy of health promotion programs, publish
improvements made in health promotion methods instituted by Navy MTFs. Improve
methodologies that are established by NEHC for Navy-wide programs. Analyze data to target
DoN-wide goals and prioritize problem areas. Data sources include morbidity, mortality, health
risk assessments, PRIMS, AHLTA and other available data sources.

     (6) Develop health promotion programs and products for implementation by Navy
Medicine and for distribution throughout the DoN. Such programming includes, but is not
limited to, health promotion calendar of events, supporting tools and resources for field
implementation, and supporting health promotion excellence through award recognition.

     (7) Support Navy Environmental Preventive Medicine Units to conduct health promotion
activities in support of Operational and Fleet TYCOMS, in coordination with MTF Health
Promotion Coordinators.

   d. Commanding Officers, Naval Hospitals

     (1) Plan, budget for and execute health promotion programs focusing on workplace
health promotion activities, population based activities and clinical preventive services.

    (2) Commanders and Commanding Officers shall appoint a Health Promotion
Coordinator and staff necessary to carry out applicable requirements of this instruction.



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     (3) Collect required metrics to monitor health promotion program effectiveness. Submit
metric report to NEHC and respective Regional Commander as required by NEHC.

   e. Health Promotion Coordinators shall

   (1) Define the supported population, assess the health status and health gaps within the
population served, prioritize health promotion programs, and establish specific measurable
program objectives. Ensure delivery of targeted interventions based upon identified needs.

   (2) Organize the health promotion program assessment, planning, implementation, and
evaluation efforts by the MTF, coordinate meetings, liaison and coordinate with other
commands, communicate with MTF staff, delegate responsibilities, monitor the overall program,
and serve as the commanding officer’s representative for health promotion.

   (3) Identify and execute necessary program budget, identify and procure program resources,
and select strategies for intervention based on identified program priorities. Optimize staff roles
and responsibilities and ensure support staff receives all necessary training.

    (4) Plan and conduct program evaluation methodologies for each intervention. Collect and
analyze metrics and apply lessons learned at the local level to improve programs. Provide
lessons learned and program method improvements to NEHC for distribution throughout Navy
Medicine.

   (5) Review the status of programs for efficiency, efficacy and progress at least annually.

   (6) Implement health promotion best practices and programs as recommended by the Task
Force on Community Preventive Services and/or supported by NEHC.

   (7) Implement health promotion program guidance provided by NEHC.

    (8) In support of Reference (a) coordinate with non-medical, shored based commands/bases
within AOR to support an integrated and coordinated approach for regional health promotion
activities. Provide health promotion expertise to MTF departments, and both line and shore
based commands as requested. Where responsibilities cross command lines, maximize
cooperation and shared resources for ensuring efficiency, cost-effectiveness, and
comprehensiveness of programs.

6. Action. Commanders, Commanding Officers, and Officers in Charge of Naval Medical
Department activities shall ensure that the policy and guidelines provided in the Instruction are
implemented.




                                              DC Arthur



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