The primary goal of this project is to disentangle the long-term effects of war exposure upon health, social relations, and material wellbeing in Vietnamese survivors of the Vietnam War. A secondary goal is to assess the efficacy of older adults' self-reports of critical early life events, notably experienced during wartime. Vietnam is uniquely illustrative for this study, given its historically high levels of war mobilization, and survivors' entrance into many health and life course transitions typical of older adulthood. Twentieth century armed conflict has been most pervasive in developing countries like Vietnam, where we have virtually no knowledge of the long-term effects of war exposure on the burden of disease and older adult physical, psychological and social wellbeing, but where the population both moving into old age and having directly experienced war is growing rapidly. These early-life war exposures are intertwined with many acute and chronic stressors linked to social, economic and demographic change in the global south. This study directs attention toward war as it may contribute to or detract from healthy aging. To meet this goal, we will create a longitudinal dataset for cross-disciplinary study of exposure to war and its impact on health and other aspects of wellbeing amongst the aging Vietnamese population. We will use a stratified random sampling strategy to survey 4,900 older adults aged 60-80 living in four districts of northern Vietnam, stratified by their widely variable exposure to war (bombing intensity). Follow-up interviews with Wave 1 survivors and decedents' next-of-kin will be conducted three years later, allowing analysis of health, mortality, resilience and life course transitions as they relate to war exposure. We will place critical theoretical and conceptual emphasis upon multi-dimensional measures of war exposure, which encompass formal military service, militia participation, and traumatic events experienced by both men and women in military and civilian life. We will use survey and biomarker techniques to measure health across physical, functional and psychological domains. War-era records issued to service members permit an innovative measurement approach and a test of the validity of self-reported exposure. Purposive sampling and sibling data will illuminate cohort selective exposure and survival. The project team will utilize the assembled data to examine dynamic linkages between war exposure, stress environments, social relations, and older adult health. We will employ longitudinal analytical techniques to address questions about war exposure's enduring effects, including questions about the mechanisms through which war scars health or fosters resilience, and the variables, such as gender and material wellbeing, which mediate and moderate associations between war and health. Results will be disseminated widely across communities of scholars, policy-makers, and practitioners in public health, gerontology and allied fields, to tailor prevention, care and support in war-affected populations.
Addressing the heavy, yet widely unexamined, long-term toll of armed conflict on health in low- and middle income societies, this study will create and analyze a unique longitudinal dataset on diverse forms of war exposure in early life and older adult functional, physical and mental health in Vietnam. Diverse objective and subjective war exposure measures, based upon official military records and subjective self-reports, will be examined as they comingle with additional acute and chronic stressors over the life course in ways that scar health over the long term or lend resilience to buffer adults from later life declines in health. The project will improve understanding of the ways wars contribute to the global burden of disease; the role of military institutions in shaping the life course in developing settings, and approaches to modifying social and institutional contexts so as to minimize war?s long-term social, psychological, and physical tolls.
