Report on the Department of Veterans Affairs and Alignment with Sustainable Development Goals

Introduction: Institutional Integrity and Veteran Well-being

An analysis of the current strategic direction of the Department of Veterans Affairs (VA) under Secretary Doug Collins indicates a significant divergence from key United Nations Sustainable Development Goals (SDGs). The administration’s policy of expanding healthcare outsourcing to private-sector providers raises critical questions regarding its commitment to SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions). This report examines four central narratives driving this policy shift and evaluates their impact on the VA’s capacity as a strong, sustainable public institution dedicated to veteran health.

Analysis of VA Policy Impact on SDG 3: Good Health and Well-being

Narrative 1: Health Care Provider Staffing Levels

The administration claims that healthcare provider positions are not being cut. However, official data contradicts this assertion, pointing to a degradation of the VA’s capacity to deliver care, in direct opposition to the principles of SDG 3.

• Systemic Contradiction: While assurances are made that clinical staff numbers will be maintained, the VA has recorded a net loss of thousands of healthcare positions since January, the only such loss in the past five years.
• Specific Staff Reductions: These losses include 688 physicians, 1,882 registered nurses, 365 licensed practical nurses, 511 social workers, and 201 psychologists.
• Operational Decline: Department-wide job announcements have fallen by 30%, applications by 44%, and new employee onboarding has decreased by 52% since last year.

This systematic reduction in personnel directly undermines the VA’s ability to provide accessible, quality healthcare, a foundational target of SDG 3.

Narrative 2 & 3: Quality and Efficacy of Private Sector Care

The assertion that private “community care is VA care” and is equally effective is not supported by evidence. This misrepresentation risks compromising the specialized care required to achieve good health outcomes for veterans.

1. Lack of Integrated, Specialized Care: The Veterans Community Care Program (VCCP) lacks critical features of the VA system, such as integrated care coordination, comprehensive health screenings, and rigorous public oversight, which are essential for fulfilling SDG 3.
2. Deficiencies in Training: A Government Accountability Office (GAO) report found that only 2% of VCCP mental health providers have completed any of the veteran-specific training required of all VA mental health providers.
3. Inferior Health Outcomes: A comprehensive summary of peer-reviewed studies confirms that the VA produces health outcomes equal or superior to the private sector. Furthermore, a survey by Iraq and Afghanistan Veterans of America (IAVA) found that only 31% of veterans using the VCCP felt their private providers understood their medical needs.

Narrative 4: Access to Community Care

The claim that the previous administration “stifled” access to community care is inaccurate. Data shows that during the first three years of the Biden administration, an additional 500,000 veterans gained access to the VCCP. The current policy of aggressive expansion, rather than strategic supplementation, is what poses a threat to the system’s stability.

Broader Implications for Sustainable Development

SDG 16: Peace, Justice and Strong Institutions

The VA is a cornerstone public institution responsible for the care of those who have served in military and conflict roles. The rapid expansion of private-sector referrals has been identified by independent experts as creating an “existential crisis” for VA health care. This policy threatens to destabilize and dismantle a strong public institution, contrary to the aims of SDG 16, which calls for effective, accountable, and transparent institutions.

SDG 10: Reduced Inequalities & SDG 8: Decent Work

The VA health system is a critical tool for reducing health inequalities for the veteran population, providing specialized care that is often unavailable in the private sector. Weakening this system risks increasing health disparities for this specific demographic, undermining the goals of SDG 10.

• Erosion of Decent Work: The planned elimination of 30,000 to 80,000 department positions represents a significant challenge to SDG 8 (Decent Work and Economic Growth), impacting the economic security of thousands of dedicated healthcare professionals.

Conclusion

The current policy direction of the VA, characterized by staff reductions and an accelerated shift to private-sector care, is inconsistent with the principles of multiple Sustainable Development Goals. The degradation of the VA’s internal capacity directly threatens SDG 3 by reducing access to high-quality, specialized care. This approach also weakens a vital public body, undermining SDG 16, and risks increasing health disparities, in opposition to SDG 10. To ensure the long-term sustainability of veteran healthcare, policy must realign with SDG principles by reinforcing the VA’s integrated system through full funding and staffing.

SDGs Addressed in the Article

• SDG 3: Good Health and Well-being – The article’s central theme is the provision of health care services to veterans, the quality of that care, and the accessibility of services, which directly aligns with ensuring healthy lives and promoting well-being.
• SDG 8: Decent Work and Economic Growth – The article discusses significant job cuts within the Department of Veterans Affairs (VA), impacting the employment of thousands of health care professionals and support staff.
• SDG 16: Peace, Justice, and Strong Institutions – The article critiques the governance, transparency, and accountability of the VA under its current leadership, highlighting the weakening of a major public institution.

Identified SDG Targets

1. SDG 3: Good Health and Well-being

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…
     
     The article directly addresses this target by debating the quality and effectiveness of health care provided to veterans. It contrasts the VA’s integrated system with the private sector’s Veterans Community Care Program (VCCP), questioning whether outsourcing provides “access to quality essential health-care services.” The article cites research showing the VA produces “health care outcomes equal or superior to the private sector” and notes that VCCP “lacks critical features” like integrated care coordination.
   • Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce…
     
     This target is relevant due to the article’s focus on the reduction of the VA’s health workforce. The text explicitly states that “the VA has recorded a net loss of thousands of health care positions” and that “countless clinical positions remain unfilled as replacement efforts have slowed to a crawl or stopped entirely.” This directly contradicts the goal of retaining and recruiting a health workforce.

2. SDG 8: Decent Work and Economic Growth

   • Target 8.5: By 2030, achieve full and productive employment and decent work for all…
     
     The article highlights a move away from this target by detailing plans to “eliminate between 30,000 and 80,000 department positions this year.” It provides specific data on job losses, such as “a net loss of thousands of health care positions,” which undermines the principle of full and productive employment within this public sector institution.

3. SDG 16: Peace, Justice, and Strong Institutions

   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
     
     The article critiques the VA’s leadership for a lack of transparency, citing the use of “misleading narratives” and not being “forthright about the adverse consequences” of privatization. It points out that the VCCP “lacks critical features that were pioneered at the VA, including… rigorous inspector general oversight, and public transparency,” indicating a weakening of institutional accountability.

Indicators for Measuring Progress

1. Target 3.8 (Access to Quality Health Care)

   • Indicator: Percentage of community care providers with veteran-specific training.
     
     The article provides a direct metric for this: “Only 2 percent of VCCP mental health providers have completed even one of the eight veteran-specific trainings required for all VA mental health providers.” This indicates a quality gap in care.
   • Indicator: Patient perception of care quality.
     
     The article implies this indicator through a survey finding that “only 31 percent of IAVA members with VCCP experience felt their community providers understand their medical needs.”

2. Target 3.c (Health Workforce)

   • Indicator: Net change in the number of health care staff.
     
     The article provides precise figures that can be used as indicators: “a net loss of thousands of health care positions,” including “688 physicians, 1,882 registered nurses, 365 licensed practical nurses, 316 nurse assistants, 511 social workers, 201 psychologists, and 766 medical support assistants.”
   • Indicator: Rate of new hiring and recruitment efforts.
     
     The article offers clear metrics: “Department-wide job announcements have plummeted by 30 percent and applications by 44 percent since last year, while new employee onboarding has sunk by 52 percent.”

3. Target 8.5 (Full and Productive Employment)

   • Indicator: Number of positions eliminated.
     
     The article states a clear plan to “eliminate between 30,000 and 80,000 department positions this year,” serving as a direct indicator of job loss.

4. Target 16.6 (Effective and Transparent Institutions)

   • Indicator: Presence of public oversight and transparency mechanisms.
     
     The article implies this by contrasting the two systems, noting the VCCP “lacks critical features that were pioneered at the VA, including integrated care coordination, comprehensive screenings, rigorous inspector general oversight, and public transparency.” The absence of these in the private program is an indicator of weaker institutional accountability.

Summary of Findings

Source: prospect.org