[Presidential Directives and Executive Orders]

Extensive public review and analysis of Gulf War veterans' illnesses and risk factors have identified a number of opportunities for government action aimed at minimizing or preventing future post-conflict health concerns. Ameliorating, avoiding or, ideally, preventing such health effects can be approached through a variety of means. These include improving service personnel's understanding of health risk information; enhancing government collection of health and exposure data; coordinating agency research programs; and improving the delivery of health care services to veterans and their families, as could be accomplished by establishing effective linkages between health information systems.

The Presidential Advisory Committee on Gulf War Veterans' Illnesses recommended that the National Science and Technology Council (NSTC) "develop an interagency plan to address health preparedness for and readjustment of veterans and their families after future conflicts and peacekeeping missions." This Presidential Review Directive responds to the Committee's recommendation. The Department of Defense, the Department of Health and Human Services, the Department of Veterans Affairs, the Office of Management and Budget, the National Security Council, the Office of Science and Technology Policy, the Joint Chiefs of Staff, and others as appropriate, are asked to review policies and programs and identify relevant actions that may be taken by the Federal Government to better safeguard those individuals who risk their lives to defend our Nation's interests. In accordance with the Advisory Committee's proposal, agency recommendations will form the basis for an NSTC report, which will be submitted for outside expert review.

Agency recommendations should address the following:

• Health (e.g., stress prevention, treatment, research; medical surveillance adequacy, coordination; interventions for families);

• Outreach and risk communication;

• Record keeping (e.g., accountability, timeliness, cross-agency coordination, application of new technologies);

• Research (e.g., adequacy, quality, coordination, dissemination of results);

• Biological and chemical weapons preparedness and research;

• Application of emerging technologies (e.g., telemedicine, technology transfer); and

• International cooperation and coordination, especially on research and technology matters.

It is crucial that the lessons from the Gulf War experience be applied in improving protection of troops, responding to health concerns, and assisting veterans and their family members through difficult transitions. A comprehensive, coordinated set of interagency plans is necessary to build upon what we have learned and ensure that the burden borne by those who risk their lives and well-being to protect our country's interests is minimized.