Department of Defense
INSTRUCTION
NUMBER 1010.10
April 28, 2014
Incorporating Change 3, Effective May 16, 2022
USD(P&R)
SUBJECT: Health Promotion and Disease Prevention
References: See Enclosure 1
1. PURPOSE. This instruction reissues DoD Directive (DoDD) 1010.10 (Reference (a)) as a DoD
instruction (DoDI) in accordance with the authority in DoDD 5124.02 (Reference (b)) to establish
policy and assign responsibilities for health promotion and disease prevention in accordance with
References (c) through (f).
2. APPLICABILITY. This instruction applies to OSD, the Military Departments, the Office of the
Chairman of the Joint Chiefs of Staff and the Joint Staff, the Combatant Commands, the Office of
Inspector General of the Department of Defense, the Defense Agencies, the DoD Field Activities,
and all other organizational entities within the DoD (referred to in this instruction collectively as
the “DoD Components”).
3. POLICY. It is DoD policy to:
a. Enhance mission readiness, unit performance, and the health and fitness of members of the
Military Services, medical beneficiaries, and civilian DoD employees through the creation of a
culture within the DoD that:
(1) Values health, fitness, and an injury-reduced environment.
(2) Encourages individuals and organizations to achieve optimal health by embracing those
values.
(3) Provides guidance regarding the procedures for implementing health promotion and
disease prevention programs to improve and sustain military readiness and the health, fitness, and
quality of life of Service members, medical beneficiaries, and civilian DoD employees, in
peacetime and conflict.
(4) Supports continuous cross-sectional analysis of Military Services’ disease and injury
occurrence for the purpose of conducting targeted interventions to improve health, and preserve
readiness.
(5) Views sleep patterns as a key indicator of readiness.
b. Identify the Total Force Fitness Framework as the DoD methodology for understanding,
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assessing, and optimizing Service members’ ability to meet mission requirements in accordance
with Chairman of the Joint Chiefs of Staff Instruction 3405.01 (Reference (o)).
c. Provide effective, integrated, and comprehensive health promotion and disease prevention
programs throughout the DoD that are based on scientific evidence.
d. Provide healthy environments for Service members, medical beneficiaries, civilian DoD
employees, and visitors on military installations.
e. Support the National Prevention Strategy (NPS) (Reference (c)), to shift from a focus on
treating sickness and disease to a focus based on promoting wellness and prevention.
f. Emphasize actions supporting the NPS priorities as defined in Reference (c) to reduce the
leading causes of preventable death and major illness.
g. Support the achievement of the Department of Health and Human Services’ vision for
improving the health of all Americans as outlined in Healthy People 2030 (Reference (d)).
h. Promote healthy sleep-wake cycles in operational and nonoperational environments and
develop sleep strategies against manning for operational units to maximize performance and
alertness throughout DoD that are based on scientific evidence.
4. RESPONSIBILITIES. See Enclosure 2.
5. RELEASABILITY. Cleared for public release. This instruction is available on the Directives
Division Website at https://www.esd.whs.mil/DD/.
6. SUMMARY OF CHANGE 3. The changes to this issuance:
a. Update policy by adding the Total Force Fitness Framework and healthy sleep-wake cycles
in accordance with the April 10, 2019 Deputy Secretary of Defense Memorandum (Reference (p))
and DoDI 6055.01 (Reference (q)).
b. Reassign responsibilities and updates organizational symbols to reflect the reorganization of
the Office of the Under Secretary of Defense for Acquisition, Technology, and Logistics, in
accordance with DoDD 5135.02 (Reference (r)).
c. Update references for accuracy.
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7. EFFECTIVE DATE. This instruction is effective April 28, 2014.
Enclosures
1. References
2. Responsibilities
Glossary
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ENCLOSURE 1
REFERENCES
(a) DoD Directive 1010.10, “Health Promotion and Disease/Injury Prevention,” August 22, 2003
(hereby cancelled)
(b) DoD Directive 5124.02, “Under Secretary of Defense for Personnel and Readiness
(USD(P&R)),” June 23, 2008
(c) National Prevention, Health Promotion and Public Health Council, “National Prevention
Strategy: America’s Plan for Better Health and Wellness,” June 16, 2011
(d) Healthy People 2030 website, https://health.gov/healthypeople
(e) U.S. Preventive Services Task Force website, “Recommendations,”
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics
(f) Public Law 111-148, “The Patient Protection and Affordable Care Act,” March 23, 2010
(g) Secretary of Defense Policy Memorandum 16-001, “Department of Defense Tobacco Policy,”
April 8, 2016
(h) Community Preventive Services Task Force website, “The Community Guide,”
https://www.thecommunityguide.org/
(i) DoD Instruction 1308.03, “DoD Physical Fitness/Body Fat Composition Program,”
March 10, 2022
(j) DoD Directive 3235.02E, “DoD Combat Feeding Research and Engineering Program,” April
6, 2021
(k) DoD Directive 6490.02E, “Comprehensive Health Surveillance,” February 8, 2012, as
amended
(l) DoD Instruction 6130.05, “DoD Nutrition Committee,” February 18, 2011, as amended
(m) DoD Instruction 5000.02, “Operation of the Adaptive Acquisition Framework,”
January 23, 2020
(n) DoD Directive 4715.1E, “Environment, Safety, and Occupational Health (ESOH),”
March 19, 2005, as amended
(o) Chairman of the Joint Chiefs of Staff Instruction 3405.01, “Chairman’s Total Force Fitness
Framework,” September 23, 2011
(p) Deputy Secretary of Defense Memorandum, “Safety and Occupational Health Policy and
Oversight Functions,” April 10, 2019
(q) DoD Instruction 6055.01, “DoD Safety and Occupational Health (SOH) Program,”
October 14, 2014, as amended
(r) DoD Directive 5135.02, “Under Secretary of Defense for Acquisition and Sustainment
(USD(A&S))” July 15, 2020
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ENCLOSURE 2
RESPONSIBILITIES
1. UNDER SECRETARY OF DEFENSE FOR PERSONNEL AND READINESS (USD(P&R)).
The USD(P&R):
a. Oversees the implementation of this instruction in accordance with Reference (b).
b. Provides:
(1) Strategic direction for health promotion, disease prevention, medical aspects of injury
prevention, and population health goals and objectives throughout the DoD.
(2) Strategic direction to any designated health promotion committees, task forces, and
work groups that:
(a) Advise DoD leadership.
(b) Review, coordinate, and integrate DoD health promotion and disease prevention
activities as appropriate.
(c) Align, integrate, and coordinate policies, initiatives, and business processes in
accordance with Secretary of Defense Policy Memorandum 16-001 (Reference (g)).
(3) Strategic direction and prioritization, in accordance with the DoD mission, of medical
and non-medical goals and objectives in accordance with References (c) and (d).
(4) Actionable information and direction to leadership on health promotion and disease
prevention programs and ensures continuing evaluation and makes recommendations for
improvement as necessary.
(5) Strategic direction oversight for DoD safety and occupational health in accordance with
References (p) and (q).
c. Oversees the integration of the strategic directives in Reference (c) in relevant policy,
guidance, and programs, and prioritizes the implementation of the non-medical recommendations
in References (c) and (d) in accordance with the DoD mission and as they relate to:
(1) Military personnel policy.
(2) Readiness and training.
(3) National Guard and Reserve Component affairs.
(4) Military community and family programs.
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(5) Civilian personnel policy.
(6) Medical aspects of injury prevention.
d. In coordination with the DoD Component heads, periodically reviews the status of non-
medical programs to measure management effectiveness and the costs, outcomes, and impacts of
these programs. The review should be aligned, where appropriate, with:
(1) NPS efforts to create prevention-oriented communities, support individuals in making
healthy choices, and enhance collaboration on implementing prevention and health promotion
activities to promote comprehensive wellness, in accordance with Reference (c).
(2) U.S. Department of Health and Human Services’ Healthy People Goals, Objectives, and
evidence-based resources, in accordance with Reference (d).
(3) U.S. Preventive Services Task Force recommendations (Reference (e)), supported by
evidence of effectiveness.
(4) Efforts to provide accessible, evidence-based preventive health services supported by
nationally recognized guidelines and recommendations, consistent with section 2713 of Public
Law 111-148 (Reference (f)).
(5) The Community Preventive Services Task Force evidence-based findings issued in the
Community Guide (Reference (h)) for the selection of interventions to improve health and prevent
disease and injury in Service members.
2. ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS (ASD(HA)). Under the
authority, direction, and control of the USD(P&R), the ASD(HA):
a. In cooperation with the DoD Component heads, coordinates and oversees the DoD health
promotion and disease prevention programs and practices in accordance with this instruction, and
related programs and practices as established in other DoD policies, including:
(1) Health promotion and disease prevention programs and practices established in
compliance with Reference (g).
(2) Health promotion program pertaining to physical fitness and body fat established in
accordance with DoDI 1308.03 (Reference (i)).
(3) Activities in the DoD Food Service Program that concern sanitation, nutrition
education, and nutrition standards in accordance with DoDD 3235.02E (Reference (j)).
(4) Effectiveness of medical and health surveillance programs and activities throughout the
DoD in accordance with DoDD 6490.02E (Reference (k)).
(5) Implementation of approved DoD Nutrition Committee recommendations in accordance
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with DoDI 6130.05 (Reference (l)).
b. In consultation with the Defense Health Agency and the Surgeons General of the Military
Departments:
(1) Periodically reviews the status of Service health promotion and disease prevention
programs and practices using the Military Services’ methodology to measure management
effectiveness and the costs, outcomes, and impacts of these programs. This review will include
those programs aligned, when appropriate, with:
(a) NPS efforts to create prevention-oriented communities, support individuals in
making healthy choices, and enhance collaboration on implementing prevention and health
promotion activities to promote comprehensive wellness in accordance with Reference (c).
(b) U.S. Department of Health and Human Services’ Healthy People Goals, Objectives,
and evidence-based resources as described in Reference (d).
(c) U.S. Preventive Services Task Force recommendations made in Reference (e),
supported by evidence of effectiveness.
(d) Efforts to provide accessible, evidence-based preventive health services supported
by nationally recognized guidelines and recommendations, consistent with section 2713 of
Reference (f).
(e) The Community Preventive Services Task Force evidence-based findings issued in
the Guide to Community Preventive Services for the selection of interventions to improve health
and prevent disease and injury in Service members.
(f) Promoting DoD tobacco policy to prevent initiation of tobacco use, help those who
want to quit using tobacco succeed, and decrease exposure to second-hand smoke in accordance
with Reference (g). This does not include tobacco product pricing policy.
(2) Recommends and prioritizes evidence-based health promotion and disease prevention
initiatives in accordance with the Military Health System (MHS) mission, strategies, and
objectives.
c. Facilitates the coordination of health promotion and disease prevention programs and
practices across the DoD Components and the MHS.
d. Utilizes available military health data systems for TRICARE Prime enrollees and other DoD
beneficiary groups, to acquire and manage information in a manner that:
(1) Supports DoD medical programs, including medical readiness requirements.
(2) Provides comparability with current national statistics.
e. Oversees the integration of the NPS strategic directives in relevant policy, guidance, and
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programs. Coordinates the prioritization of the achievement of the medical recommendations in
References (c) and (d) as they relate to the MHS.
f. Provides strategic guidance, prioritization, oversight, and any legally required exceptions for
the incorporation of clinical preventive services as recommended by References (e) and (f) in the
routine provision of health care.
g. Through the MHS decision-making process:
(1) Provides strategic direction to any designated health promotion committees, task forces,
and work groups that advise DoD leadership. Reviews, coordinates, and integrates DoD health
promotion and disease prevention activities as appropriate.
(2) In accordance with the DoD mission, provides strategic direction and prioritization of
the medical goals and objectives of References (c) and (d), through the USD(P&R), to the DoD
Components as appropriate.
3. UNDER SECRETARY OF DEFENSE FOR ACQUISITION AND SUSTAINMENT
(USD(A&S). The USD(A&S):
a. Oversees the integration of the NPS strategic directives in relevant policy, guidance, and
programs. Coordinates the prioritization of the achievement of the non-medical recommendations
in References (c) and (d) in accordance with the DoD mission, and as they relate to:
(1) Acquisition, technology, and procurement in accordance with DoDI 5000.02 (Reference
(m)).
(2) Installation and facility management in accordance with DoDD 5135.02 (Reference (r)).
(3) Environmental health in accordance with DoDD 4715.1E (Reference (n)).
b. Periodically reviews the status of non-medical programs initiated in response to References
(c) through (h). The review measures management effectiveness and the costs, outcomes, and
impacts of these programs.
c. Oversees the integration of the DoD tobacco policy in relevant policy, guidance, and
programs.
4. DoD COMPONENT HEADS. The DoD Component heads:
a. Implement, maintain, fund, monitor, and evaluate comprehensive and integrated health
promotion and disease prevention programs and practices in accordance with this instruction and
the total force fitness framework outlined in Reference (o).
b. Coordinate health promotion initiatives among and within all DoD Components to eliminate
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duplication of effort in achieving the strategies and priorities determined applicable to DoD.
c. Assess the gaps between the strategic directives in Reference (c) and DoD strategies and
priorities, and integrate the strategic directives in Reference (c), as applicable, into the
Component’s mission. The four strategic directives are:
(1) Healthy and safe community environments.
(2) Clinical and community preventive services.
(3) Empowered people.
(4) Elimination of health disparities.
d. Assess the gaps between the seven targeted priorities in Reference (c) and DoD strategies
and priorities. Integrate the targeted priorities, as applicable, into the Component’s mission. The
seven targeted priorities are:
(1) Tobacco-free living.
(2) Preventing drug abuse and excessive alcohol use.
(3) Healthy eating.
(4) Active living.
(5) Injury and violence free living.
(6) Reproductive and sexual health.
(7) Mental and emotional wellbeing.
e. Assess the gaps between DoD strategies and priorities and the leading health indicators
(LHI) in Reference (d). Integrate the prioritized LHI in DoD health promotion and disease
prevention programs and practices, as applicable, into the Component’s mission. The LHI are:
(1) Access to health services.
(2) Clinical preventive services.
(3) Environmental quality.
(4) Injury and violence.
(5) Maternal, infant, and child health.
(6) Mental health.
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(7) Nutrition, physical activity, and obesity.
(8) Oral health.
(9) Reproductive and sexual health.
(10) Social determinants.
(11) Substance abuse.
(12) Tobacco use.
f. Determine measures of effectiveness for the LHI in Reference (d) and distribute the results
of these measures to optimize health promotion and preventive programs.
g. Institute tobacco-free military housing areas and tobacco-free zones, where practicable, to
lessen the harmful effects of second-hand smoke and promote tobacco product cessation efforts, in
accordance with Reference (g). This includes:
(1) Multi-unit smoke-free military housing (government-owned or leased housing).
(2) Negotiated smoke-free options with the owners of privatized housing.
(3) Developing and implementing plans for increasing tobacco-free zones around areas
frequented by children.
h. Integrate the DoD tobacco policy in all DoD facilities to help tobacco cessation efforts, stop
people from becoming tobacco users, and help eliminate harmful health effects associated with
second-hand smoke, in accordance with Reference (g). Specifically:
(1) All DoD facilities will restrict use of tobacco products to explicitly designated outdoor
areas, which must be at least 50 feet from building entrances and air intake ducts.
(2) To the extent practicable, all areas within installations that are not designated as
‘tobacco use areas’ will be tobacco-free areas. Implementation shall be consistent with the
“Federal Service Labor-Management Relations Act.” The provisions of existing collective
bargaining agreements shall be honored and the DoD Components shall consult with employee
labor representatives about implementation of this instruction.
i. To the extent allowed by law, incorporate clinical preventive and cessation services
(including tobacco counseling and medications, where indicated) in the routine provision of health
care as recommended in References (d), (e), and (g).
j. Promote the use of evidence-based findings and recommendations to inform health
promotion and disease prevention programs (including comprehensive tobacco product control
programs) to improve the health and readiness of the force and improve public health through use
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of References (e) and (h) in accordance with References (c), (d), and (g).
k. Evaluate and recommend changes or improvements for the non-medical aspects of the health
promotion and disease prevention programs and practices to the USD(P&R), USD(A&S), and, for
the medical aspects of the health promotion and disease prevention programs, to the ASD(HA).
l. Conduct continuous review of all programs initiated in response to References (c) through
(h). The review measures management effectiveness and the costs, outcomes, and impacts of these
programs. The review should also assess the alignment of these programs, where appropriate, with:
(1) NPS efforts to create prevention-oriented communities, support individuals in making
healthy choices, and enhance collaboration on implementing prevention and health promotion
activities to promote comprehensive wellness in accordance with Reference (c).
(2) U.S. Department of Health and Human Services’ Healthy People Goals, Objectives, and
use of Healthy People evidence-based resources as found on Reference (d).
(3) U.S. Preventive Services Task Force recommendations provided on Reference (d),
supported by evidence of effectiveness.
(4) Efforts to provide accessible, evidence-based preventive health services supported by
nationally recognized guidelines and recommendations, consistent with section 2713 of
Reference (f).
(5) DoD’s Tobacco Policy efforts to prevent initiation of tobacco use, helping those who
want to quit using tobacco succeed, and decreasing exposure to second-hand smoke in accordance
with Reference (g).
(6) Community Preventive Services Task Force evidence-based findings issued on
Reference (h) for the selection of interventions to improve health and prevent disease and injury in
Service members.
m. Help prevent and mitigate the effects of sleep deprivation among Service members by
promoting and encouraging Service members to obtain adequate sleep by:
(1) Encouraging the use of behavioral strategies to improve sleep quantity and quality, such
as the use of mobile applications to help track sleep or shift work when allowed by operational
requirements.
(2) Promoting a sleep environment that facilitates healthy sleep, which considers complete
darkness, good ventilation, ambient temperatures, and low noise levels and, if appropriate,
encouraging use of eye masks and earplugs to counteract suboptimal sleep settings.
(3) Prioritizing time for optimized sleep hygiene, fatigue prevention measures, and as
mission requirements permit:
(a) Committing to at least 7 hours of uninterrupted sleep, incorporating adequate sleep
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recovery when mission requirements result in reduced or disrupted sleep, and planned or rotational
naps during unavoidable periods of sleep deprivation.
(b) Incorporating at least 7 hours of sleep per every 24-hour period into duty schedules,
training plans, and battle plans, with considerations to avoiding scheduling sleep during crew
briefings, meals, and other mandatory tasks.
(c) Planning recovery time of 2 to 3 consistent nights of sleep, if operational
requirements take precedence for any period of 7 or more calendar days, including consideration
for units to be placed “off cycle” for at least 3 nights following periods of significant sleep
deprivation, to ensure recovery to baseline performance.
(d) Allow additional sleep for Service members during the ramp-up preparation and
operations tempo period before a mission.
(e) Support sleep extension following periods of high operations tempo to allow
adequate sleep recovery time and restore baseline sleep.
(f) Allow at least 2 weeks of adaptation time to mitigate any physical and cognitive
effects of circadian rhythm disturbances for units deploying across six or more time zones with less
than a 72-hour transit period.
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GLOSSARY
PART I. ABBREVIATIONS AND ACRONYMS
ASD(HA) Assistant Secretary of Defense for Health Affairs
DoDD DoD directive
DoDI DoD instruction
LHI leading health indicators
MHS Military Health System
NPS National Prevention Strategy
USD(A&S) Under Secretary of Defense for Acquisition and Sustainment
USD(P&R) Under Secretary of Defense for Personnel and Readiness
PART II. DEFINITIONS
These terms and their definitions are for the purpose of this instruction.
disease prevention. Disease prevention is the deferral or elimination of specific illnesses and
conditions by one or more interventions of proven efficacy.
health promotion. The process of enabling people to increase control over and improve their
health. It moves beyond a focus on individual behavior toward a wide range of social and
environmental interventions.
sleep deprivation. Obtaining inadequate sleep to support adequate daytime alertness.
tobacco-free living. Adopting a lifestyle that avoids using all tobacco product types and
living free from second-hand smoke exposure.
tobacco products. Products made or derived from tobacco that are intended for human
consumption, including cigarettes, cigars, little cigars, pipe tobacco, roll-your-own tobacco,
smokeless and dissolvable tobacco, and products intended for use in hookahs/water pipes.
Electronic nicotine delivery systems, including but not limited to e-cigarettes, and vape
pens, will also be treated as tobacco products.
