The Health Domain of 2040

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We (Paul and Nick) previously considered the Warfighting Health Effect in 2040 supported by Robotic and Autonomous Systems (RAS) in a deployed environment. We anticipated a new world of technology opportunity in the health domain. What we didn’t highlight are the ethical and technical challenges that lie ahead in order to maintain protection of the ADF’s most important asset in this technologically advanced battlespace; their people. We also didn’t explore the function of the health domain in the broader National Security Community of 2040, where RAS is king. What follows are thought-starters to a discussion around the role of Health as we move into this future.

Health of the force as a differentiator in the future battlespace

In 2040 the health of the force is no longer a mere enabler. It is a true force multiplier. In a war dominated by machines, the presence of humans is a superior differentiator.

Despite quantum assistants, the human mind continues to confound machines with ‘out of the box’ creativity and unorthodox innovation in warfighting. People are capability, and people capability is measured via metrics covering healthiness in mind, body, and purposeful resilience. 

Sleep, nutrition, and human security are now well understood to create a winning edge over those nations who rely on heavy metal and compute alone. But the humans aren’t mere mortals anymore; human-machine interfaces provide for augmented decision-making at the speed of thoughtthoughts that will last longer than their creators.

Is human performance, within the Future Force, more about a cognitive or physical edge? If we progress down the path of human augmentation to achieve advantages in the battlespace, what are the implications of this leap for re-integration and transition of service personnel back into wider civilian society? How could we use data and technology to give commanders the information they need to ensure the human element of the force is operating at its optimum?

Health implications of the changing character of war

By 2040, most actors are able to stand-up similar technological force structures in terms of machine versus machine measures and counter-measures, because technology is relatively low-cost to produce in a quantum-engineered age. A perennial challenge for less-wealthy or resourced nations is machine battle endurance; battery storage continues to be a constraint for those nations that have not yet achieved on-asset micro-power generation.

This means that the vision of ‘the operator’ has shifted to individuals in Tactical Operations Centres (TOCs) and remote tactical control rooms (VTCRs), potentially on a completely different land mass to the fight, controlling the battlespace remotely.

Unfortunately, this doesn’t ameliorate human casualties. Instead, ‘grey zone’ tactics of both state and non-state actors within battlespaces have started targeting civilians; the inevitable but tragic impacts of collateral casualties remain. 

What is the military responsibility to civilian casualties, and can the Future Force deliver this effect without human healthcare providers (HCPs) on the ground? If HCPs are deployed how are they protected? What is the impact, of this fundamental paradigm shift in the character of war, for mental health or moral injury, and are we prepared for this?

Population stability and the health of nations

Since the first engineered pandemics in the mid-2020s, along with the increasing scale and regularity of natural disasters, the militaries of the world have pivoted their operational model to national population stability as a means to ensuring the government of the day has the support of the people. This is a new battleground in 2040; best utilising technological and force capability to provide human security.

The most advanced nations are on the edge of self-healing nano-robotics. Equally, that which can be used for good can also be used for harm. In 2040 some nations are aware that should they need it, they could release a malignant and malicious nano-robotic wave that would not only harm a nation; it could literally wipe it from existence. The ethical consequences are profound. It is the new ‘nuclear’ weapon that cannot be un-invented.

If 2020 has shown us anything to date, it is that responding to natural disasters and pandemics requires a whole-of-government response where health and humanitarian support is pivotal. Bio-terrorism and the weaponisation of healthcare technology is a legitimate threat and potential flash point for conflict.

Health surveillance and health information cyber warfare

Aside from the kinetic-war, a continuous cyber-war rages for health information. Not only is health information the most lucrative of sensitive personal data, it is the means by which a Future Force can be undermined. In 2020, the F35 joint strike fighter was a technological marvel of hardware and software. Yet the ‘wetware’ in the cockpit became the determining factor as to the lethality of the platform. That fighter pilot who had relationship issues at home, or had a poor night of sleep, or was suffering a deterioration in mental health – here we found the greatest variable vulnerability to the warfighting platform. 

With our people remaining primal to capability, and this capability being engineered through their health, health information and infrastructure has become a targetable critical vulnerability. Offensive attempts to learn more about the health of our people has become a lever through which a battle or war is won. Undermining that capability has become a key component of our adversaries strategy. The weaponisation of health information has required Defence to grow a health cyber-warfare branch (HCWB), enhanced by AI enabled offensive and defensive vectors.

Is the weaponisation of health information and infrastructure one of the greatest risks to the people who constitute the ADF and more broadly the Nation’s security? Western ethical frameworks for the protection of sensitive health information and the provision of care, are already not aligned to potential adversaries of the 2040s. Continued focus on the active protection of health information and infrastructure is critical. How we do this remains a wicked and audacious problem.

The health domain of 2040

The health domain of 2040 is pivotal to protecting our nation and its strategic interests. Those choosing medical tradecraft in Defence are recognised for the capability they bring to the new concept of ‘defence’; more importantly they are held in the highest esteem by the civilian population for the undeniable humanitarian service that is visibly demonstrated in the news-coverage of the day.

RAS will bring with it huge opportunities for providing healthcare to the ADF. More broadly however, significant risks and ethical discussions will need to be had now, to ensure that Health is prepared to take a leading role in mitigating threats to the ADF’s people and the Nation’s security in this technologically advanced near-future.

Paul Grant (@paulgrant) is the interim Chief Health Information Officer for the Australian Defence Force (ADF), contracted through KPMG Australia to establish a sustainable health information office, as principal health analyst in support of the Surgeon General, ADF and to provide health domain data stewardship as the ADF implements its health strategy.

Nick Alexander is a current serving Combat Health Officer, member of the Military Writers Guild and Communications Director at Grounded Curiosity. You can follow him on Twitter @Nick_Alexander4.