Antifragility, Asymmetry, and All-Hazards Capability Development
By Commander Michael Hallett, U.S. Navy Reserve
The U.S. government, led by the Office of Foreign Disaster Assistance, occasionally provides support to countries that request assistance after major natural disasters. A small percentage of these situations—for example, the November 2013 response to the massive Typhoon Haiyan in the Philippines—requires unique U.S. military capabilities. As Naval Doctrine Publication 1 suggests, providing foreign humanitarian assistance is a core military capability. To reduce the costs of these activities and the disruption to other operations, the U.S. military must support partner-nation efforts to enhance their disaster-management capabilities. An asymmetric approach based on increasing the antifragility of local disaster-management systems can help U.S. military planners achieve this goal.
Responding to Disasters in the Global Village
Globalization has tightened the linkages, both obvious and subtle, between geographically dispersed events and activities, ensuring that an increase in tension anywhere is felt everywhere. Flooding in Southeast Asia, for example, generates disruptive waves through the global information-technology industry by interrupting disk-drive supply chains. Mobile computing and the widespread availability of the Internet have accentuated and intensified life within what author Marshall McLuhan refers to as the “global village.”1 By extending the reach of our senses to instantly access information from across the globe, unmediated by news organizations or governments, information technology has brought additional pressures on political leaders to act quickly in response to emotionally compelling disasters. The requirement for rapid response can create dilemmas for U.S. military planners when these requirements conflict with existing commitments.
The U.S. military is dealing with these tensions in part by engaging in disaster-management capability-enhancement activities with partners. For example, the U.S. Pacific Command (PACOM) bundles its disaster assistance in response to natural and man-made events and supporting partner risk-reduction activities under the “All Hazards” heading of its official strategy, which states:
Natural and man-made disasters regularly impact the stability of the Asia-Pacific as a consequence of unstable geological fault lines, annual tropical depressions, and over-burdened coastal environments. Four of the six nations most susceptible to vectoring pandemic influenza are in the Asia-Pacific. When called upon, USPACOM will extend assistance in support of other U.S. government agencies and international organizations, to victims of natural or man-made disasters and support efforts to reduce risk to vulnerable populations.2
Engaging in the All-Hazards disaster-management cycle of preparation, mitigation, response, and recovery can help stabilize a situation and support U.S. allies and friends at local, national, and regional levels. For planners, the prioritization of response assistance in support of other U.S. government agencies and nations is relatively straightforward, as the requirements are provided and validated by the U.S. Office of Foreign Humanitarian Assistance. Supporting efforts to reduce risk prior to a disaster are less clear. Planners’ application of two conceptual lenses—asymmetry and antifragility—to the course of the action-development component of the risk-reduction activity planning process can help them prioritize and therefore increase the effectiveness of U.S. military engagement in partner nations’ All-Hazards management-capability enhancement.
All-Hazards Prioritization
U.S. military engagement in All-Hazards risk reduction is rooted in the concept of security, which applies to the creation, maintenance, and use of capabilities to counter disruptions emanating from both the man-made and natural environments. In addition to encompassing capabilities that reduce the ability of potential adversaries to degrade the United States’ and partner nations’ freedom of action, security is enhanced by the creation of capabilities that are “antifragile” in the face of extreme events affecting the natural and artificial environments. In Antifragile: Things That Gain from Disorder, author Nassim Nicholas Taleb defines antifragility as “Beyond resilience of robustness. The resilient resists shocks and stays the same; the antifragile gets better.”3 This concept applies directly to All-Hazards capability development, which requires people and organizations to adjust how they learn from catastrophic events. Taleb says:
After the occurrence of an event, we need to switch the blame from the inability to see an event coming (say a tsunami, an Arabo-Semitic spring or similar riots, an earthquake, a war, or a financial crisis) to the failure to understand (anti)fragility, namely, “Why did we build something so fragile to these types of events?” Not seeing a tsunami or an economic event coming is excusable; building something fragile to them is not.4
In addition to robust response capabilities and a willingness to rebuild whatever the cost, effective security therefore requires the development and maintenance of antifragile systems. These enable military forces to preserve their autonomy and ability to perform assigned missions despite challenges ranging from traditional military kinetic opposition to industrial accidents, terrorist attacks, and extreme weather events. The concept of antifragility thus provides a lens through which to prioritize partner All-Hazards–related capability-enhancement activities in ways that build on unique military capabilities and skills. Planners can use the concept of antifragility during the capability-development planning process to rank activities in light of the degree to which the engagement increases, decreases, or has no effect on the antifragility of local All-Hazards–related systems.
An Asymmetric Approach
U.S. military activities designed to support partner All-Hazards management-capability development requires an asymmetric approach; the U.S. military is relatively light in All-Hazards capability-enhancement tools. Not only do other organizations, like the United Nations Office for Disaster Risk Reduction and the U.S. Agency for International Development have stronger capabilities in this area—the opportunity cost of directing a large component of U.S. military resources to All-Hazards capability-development efforts is too high. The military has other responsibilities.
The asymmetric approach can be operationalized through focusing on high leverage points particularly suited to the military’s strengths by operating on two main lines of effort to enhance partner nations’ disaster-preparation and -response capabilities: training partner military personnel on All-Hazards applications of military capabilities (such as logistics) and formulating engagements that bring together U.S. and local military forces as well as local governmental and non-governmental organizations.
Training partner security organizations to use capabilities designed for specifically military purposes (such as heavy lift, helicopter resupply, and airfield operations) in response situations requires little additional expertise on the part of U.S. military subject matter experts, yet can generate a high return on the training investment. This, combined with specialized training from, for example, logisticians from international organizations with expertise in disaster response, narrowly focuses the contribution of the U.S. military capability-enhancement efforts. It does not provide a complete solution, but supports locals as they build the components of that solution.
The second line of effort, bringing together local militaries with non-military organizations engaged in All-Hazards response, emerges from the challenges caused by the geographically distributed scope of the challenge and thin spread of management expertise. External first responders such as the U.S. military cannot carry the load alone; they can only bring specific capabilities to support the efforts of those immediately affected. All-Hazards risk reduction is of necessity an “all-hands” activity requiring active involvement by government agencies, businesses, civil society, and individuals who have the local knowledge necessary for effective response. While the U.S. military’s preponderance of effort will be with military organizations, integrating All-Hazards activities with governmental and civil society organizations offers significant benefits to all engaged partners by helping produce a “layered defense” of multiple interoperable, mutually supportive nodes on the preparation, response, and recovery network or system of systems.
An asymmetric approach focused on enhancing partner-nation All-Hazards antifragility can help planners design risk-reduction engagement activities that permit effective and resource-efficient responses to events. However, the U.S. military cannot (and should not) address the full range of the All-Hazards capability-development challenge. Within the disaster-response portion of the disaster-management cycle, the role of the U.S. Department of Defense is clear. The DOD responds to disasters only on direction from the U.S. Department of State Office of Foreign Disaster Assistance, the lead U.S. agency in these situations, based on a formal request from the affected nation.
The U.S. military can, however, proactively assist in the All-Hazards capability-development effort through supporting the expansion of partner-military capabilities. The concepts of antifragility and asymmetry can help U.S. military planners prioritize the related risk-reduction activities, both increasing the effectiveness of U.S. military engagement when required and reducing the need for such involvement due to increases in the antifragility of partner capabilities to manage challenges independently.
1. Marshall McLuhan, The Gutenberg Galaxy: The Making of Typographic Man (Toronto: University of Toronto Press, 1962).
2. PACOM strategy, www.pacom.mil/AboutUSPACOM/USPACOMStrategy.aspx.
3. Nassim Taleb, Antifragile: Things that Gain from Disorder (New York: Random House, 2012), 3.
4. Ibid., 136.
Commander Hallett is the U.S. Pacific Fleet Maritime Operations Center Detachment 301 operations officer and was a planner at the Pacific Command Center for Excellence in Disaster Management and Humanitarian Assistance. He is currently a contractor with Netsimco at the U.S. Naval War College.
Exposure Risk Management for Naval Forces Deployed Ashore
By Captain Jim Need, U.S. Navy (Retired)
In the past 75 years, military medicine has made tremendous advances in force health protection (FHP), specifically in the areas of combat casualty care and operational preventive medicine. Combat injury fatality rates for Operations Iraqi Freedom and Enduring Freedom (2001–05) were half that of Vietnam and one-third that of World War II.1 Similarly, morbidity rates from diseases such as malaria, leishmaniasis, pneumonia, and wounds infected with multi-resistant Acinetobacter bacteria have decreased significantly; modern mortality rates are extremely low for such threats.2
While these advances will continue, there is one area in which an immediate improvement in FHP can be made—that related to the prevention, avoidance, and mitigation of exposures during overseas deployment to dangerous occupational and environmental health (OEH) hazards such as contaminated soil and burn pit smoke; toxic industrial chemicals and materials; and chemical, biological, radiological, and nuclear (CBRN) agents. Such exposures may not have immediate detrimental effects on combat effectiveness, but history shows they can cause severe chronic health problems and carry a tremendous healthcare-cost burden in ensuing years. The recent disclosure of “thousands of abandoned and highly dangerous chemical weapons” in Iraq to which American and Iraqi troops were exposed between 2004 and 2011 remind us that the United States “has an obligation to ensure [our deployed personnel] are aware of potential threats and prepared to defend themselves.”3 We must formally and systematically apply the operational risk-management (ORM) philosophy/process to risk assessment, risk decision making, and implementation of risk controls (to accept, mitigate, or avoid OEH exposure) for deployed forces ashore.
Background
Current Department of Defense policy requires operational commanders to consider both immediate and long-term health effects in all aspects of operational planning for the full spectrum of military operations—including combat.4 But the implementation of that policy today is not timely, systematic, or consistent in any of the armed services. For example, the Institute of Medicine was asked to review the “special controversy” surrounding the open burn pit used to dispose of solid waste at Joint Base Balad (JBB), near Baghdad. Its comprehensive 2011 report noted numerous significant “limitations of and uncertainties in burn pit information.”5 This clearly indicated the lack of a systematic approach to OEH exposure mitigation, prevention, avoidance, and documentation at JBB, which is one of many deployment sites with such concerns during the past 11-plus years of war. Further, those “gaps” made it impossible to effectively prove or disprove the potential acute and chronic health effects. Meanwhile, the concern for burn pit exposures at JBB and elsewhere has led to the recent establishment of a Department of Veterans Affairs (VA) registry to allow veterans of the past 20 years to document their exposures and concerns.6
Why are the prevention, avoidance, and mitigation of potential OEH threats important?
• In 2010, almost $2 billion of the nearly $15 billion in annual VA disability payments were for Agent Orange exposure-related ailments.7
• At least 25 percent of Gulf War vets were affected by various exposures now termed “Gulf War illness” (between 175,000 and 210,000 veterans).8 Annual costs are not yet available, but could range into the billions of dollars per year for the next 30 to 40 years of VA care.
• Potential exposures may cause chronic health concerns for current combat veterans. Some subset of the more than 2.5 million Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn combat veterans may have been exposed to a wide variety of environmental hazards during their service that could cause chronic health concerns. Potential hazardous exposures include CBRN agents, dust, burn pit smoke, cold and heat injuries, indiscriminate releases from nearby (host-nation operated) refineries and industrial facilities, and to a lesser degree, chemical agent-resistant coating paint, chromium, and toxic embedded fragments. Annual costs are not yet available, but may range into the billions of dollars per year for the next 40 to 50 years of VA care.
• Marines and sailors have self-reported exposure concerns. A February 2014 Armed Forces Health Surveillance Center report indicates that 17 percent and 21 percent of all Navy and Marine Corps active duty personnel (N=33,915), respectively, and 31 percent and 25 percent of all Navy and Marine Corps Reserve personnel (N=5,297), respectively, deployed in the previous 12 months self-reported “exposure concerns” on their post-deployment reassessment health forms.9
• Most important, taking care of deployed Marines and sailors is a core Navy and Marine Corps value. A new approach will leverage recent advances in doctrine and technology to significantly enhance FHP for deployed Marines and sailors ashore.
Solution
We need a “common,” comprehensive, ORM-based deployment health program and standard operating procedure that improves, synergizes, standardizes, and institutionalizes two important but presently unconnected programs: pre-deployment medical intelligence (PDMI) and the recently introduced OEH Site Assessment (OEHSA) program.10 Next-generation OEH FHP should use information-visualization software in combination with geographic information systems to expand the focus of PDMI to include an assessment of probable geocoordinate-specific OEH exposure concerns in combination with more traditional infectious disease threats.
Traditional PDMI must evolve into medical-intelligence preparation of the operational environment.11 This new assessment should be produced via a simple request to a single designated “one-stop shop” staffed with the appropriate experts to provide courses of action (COAs) to operational planners early in the pre-deployment stage. Then, combat and/or contingency conditions permitting, dedicated assets (trained personnel and equipment) must be systematically deployed to carry out the OEHSA process for each deployment site. Within weeks of site establishment, a conceptual site model and systematic sampling analysis plan must be developed, sampling conducted, and analysis completed. That analysis will provide updated COAs for operational leader ORM decision making.
Naval forces ashore must develop a next-generation solution that expands and improves the existing PDMI program, then systematically merges it with a refined OEHSA program to provide operational commanders with a prioritized assessment of site-specific exposure-related FHP issues prior to deployment that is continually updated and refined as onsite OEH exposure validation occurs. Such an approach will greatly improve deployment FHP and permit operational commanders to balance the early detection and potential mitigation of a variety of defined health threats with the other demands related to mission success.
SECNAVINST 6200.1, “Deployment Occupational and Environmental Health Program,” was signed in August, marking a pivotal first step in the development of Navy and Marine Corps–specific guidance.12 This will lead to the codification through OPNAV and CMC instructions/orders of a formal and “required” ORM-based deployment-site assessment process, standard operating procedure, platform, and training for occupational health exposure prevention, mitigation, avoidance, and documentation.
Imagine: An OEH ORM FHP program that makes real-time assessments of deployment site conditions; provides prevention, mitigation, and avoidance COA recommendations to operational leaders; and properly documents all unpreventable OEH exposures.
Benefit to the Warfighter
Next-generation OEH FHP would provide the operational commander with an awareness and understanding of concerns with recommended action plans unlike anything ever available in the past. It would:
• Be centralized, systematic, timely, and accurate
• Greatly expand quality and content of the current PDMI and OEHSA programs
• Provide actionable ORM-based OEH FHP COAs for warfighter consideration
• Save substantial DOD healthcare and VA disability dollars
• Support the Marine Corps’ Expeditionary Force 21 Concept by ensuring expeditionary advance base operations sites are well integrated and planned, and assisting the Strategic Health Assessment process by identifying a “critical delta between capabilities of our current force and those required to achieve Expeditionary Force 21.”13
Most important, it would provide the most advanced FHP possible to deployed Marines and sailors by eliminating unintended exposure risks and protecting their health.
1. John Holcomb, Lynn Stansbury, Howard Champion, Charles Wade, and Ronald Bellamy; “Understanding Combat Casualty Care Statistics,” Journal of Trauma, Infection, and Critical Care, vol. 60, no. 2 (February 2006), 397–401.
2. Naomi Aronson, John Sanders, and Kimberly Moran, “In Harm’s Way: Infections in Deployed American Military Forces,” Clinical Infectious Disease, vol. 43, 14 September 2006, http://cid.oxfordjournals.org/content/43/8/1045.full.pdf.
3. C. J. Chivers, “The Secret Casualties of Iraq’s Abandoned Chemical Weapons,” The New York Times, 15 October 2014.
4. Memorandum for the Joint Chiefs of Staff, MCM 0028-07, Procedures for Deployment Health Surveillance, 11 February 2007. Department of Defense Instruction (DODI) 6490.3, Deployment Health, 30 September 2011.
5. Institute of Medicine, Long Term Consequences of Exposure to Burn Pits in Iraq and Afghanistan (Washington, DC: National Academies Press, 2011), www.iom.edu/Reports/2011/Long-Term-Health-Consequences-of-Exposure-to-Burn-Pits-in-Iraq-and-Afghanistan.aspx.
6. Kelly Kennedy, “Vets may sign up for registry after dust, smoke exposure,” USA Today, 23 June 2014.
7. Jason Grotto and Tim Jones, “Senator challenged VA’s coverage of 3 new illnesses linked to Agent Orange,” Chicago Tribune, 8 June 2010.
8. Research Advisory Committee on Gulf War Veteran’s Illnesses, Gulf War Illness and the Health of Gulf War Veterans: Scientific Findings and Recommendations (Washington, DC: U.S. Government Printing Office), November 2008.
9. Deployment Health Assessments, U.S. Armed Forces, Armed Forces Health Surveillance Center, 8 April 2013.
10. Navy Tactical Reference Publication 4-02.9, Occupational and Environmental Health Site Assessment, October 2012. (Also ATP 4-02.82 and AFTTP 3-2.82_IP).
11. Force Health Protection Concept of Operations, Office of the Assistant Secretary of Defense (Health Affairs), 17 November 2011.
12. SECNAV INSTRUCTION 6200.1; Deployment Occupational and Environmental Health Program, 22 August 2014.
13. GEN James E. Amos, USMC, 4 Expeditionary Force 21, “Forward and Ready: Now and in the Future” (Washington, DC: Department of the Navy), March 2014.
Strengthening the Force through Community Service
By Lieutenant Commander Edward H. Erwin, CHC, U.S. Navy
For sailors and Marines, a heightened emphasis on community involvement can restore broken morale and infuse hope, ultimately strengthening the force—and the Navy’s mission. Metrics, research data, and anecdotal evidence show how community service leverages the resources of esprit de corps, why community-relations programs play a critical role in theater security cooperation plans, and in what ways volunteerism facilitates force retention.
Shaping Moral Development
Headlines detailing a commanding officer’s resignation over embezzlement, a noncommissioned officer’s DUI, or a Marine’s hazing conviction reflect the moral malaise and shortfall of resilience in contemporary society. More than ever, a fresh initiative on ethics is essential to mission accomplishment, high morale, and healthy homes. An innovative approach to moral formation might very well include a renewed commitment to volunteer service. In even a cursory survey of ethical theories, it is evident that a basic agreement exists that acts of altruism have intrinsic value for both the provider and the recipient. Whether it’s Thomas Aquinas’ virtue ethics, Immanuel Kant’s categorical imperative, or John Stuart Mill’s utilitarianism, all would agree that volunteer service is of profound moral importance.
The Navy Community Service Program is not simply a humanitarian means to a military end, but a moral imperative to implement what is good in society through five flagship programs: personal excellence partnerships; health, safety, and fitness; environmental stewardship; Campaign Drug Free; and Project Good Neighbor. OPNAV 5350.6C4 reaffirms the Navy’s commitment to community service: “It is Navy’s policy to promote a joint Navy and community effort to assist in the education and enrichment of America’s youth and communities and in revitalizing citizenry.”1 Project Good Neighbor, which is sponsored by the Navy chief of chaplains, maintains that a community service program offers hope and helps those in times of hardship experience personal recovery. Activities such as food drives and home repairs for the less fortunate are not about perpetuating self-defeating cycles of dependency through a handout, but inspiring efforts of self-improvement through a “hand up.”
Chaplains often function as coordinators of community service in the Navy and Marine Corps and fulfill the moral mandate explicit in the Department of the Navy’s Strategic Plan for Religious Ministry 2014–2019, which correlates with the Chief of Naval Operation’s navigation plan. In goal 1, “Serve Our People,” the Strategic Plan calls for chaplains and religious program specialists (RPs) to “strengthen the moral and ethical foundations” of sailors, Marines, Coast Guardsmen, and families. In goal 2, “Engage With Leadership,” chaplains and RPs are to “assist in creating and maintaining a moral and ethical command climate.”2 Ethics is not simply something they do; it’s part of their identity and spiritual calling. Throughout the naval services—not just the religious ministry team—volunteerism exemplifies ethics in the development of character and the application of the Navy’s core values.
Supporting Community Relations
In 2010, Center for Information Dominance (CID) Corry Station was the winner of the U.S. Congressional Record Citation, which honors excellence in community service and as such is added into the official record of Congress, with 9,481 volunteers who donated 87,801 hours of community service to positively impact 107,807 citizens of Northwest Florida. As CO Captain Gary Edwards told CID sailors preparing for a community service project:
What you are doing today is just as important as our mission and in some ways it is more important because winning the hearts and minds of the people around the world is our mission. Serving the community is who we are as a global force for good in the Navy.
Serving the community is consistent with the Navy’s overall mission to help the people it defends and is especially important during counterinsurgency in asymmetric warfare. The good that the U.S. military renders to the community will be reflected back in saved lives. Earning goodwill and trust, whether at home or abroad, stems from the Navy’s credibility as “a global force for good.” To that end, the “people skills” sailors practice during service projects in the States are crucial for establishing successful partnerships in theater with local nationals. As Staff Sargent Justin Cameron of 2d Battalion, 9th Marines (2/9) told me in regards to service events during Operation Enduring Freedom, “[Community relations] helped in combat and saved lives. The local populace we helped gave us valuable information about IEDs.”
Effective community-relations efforts presuppose the collaboration and commitment of the local population to sustain a project’s lasting imprint. The results of community service (sharpened people skills, project completion, unit cohesion, camaraderie, saved lives, revitalized neighborhoods, etc.) forge moral character and reinforce Navy core values. Volunteer service shapes the moral development of sailors and Marines. Without their moral development, we cannot readily preserve the force necessary to achieve strategic, operational, and tactical military objectives in keeping with global peace.
Empowering Operational Resilience
Moral development through community service also empowers operational resilience. Volunteering can establish improved physical and mental health by furnishing life purpose, a sense of accomplishment, and the contentment of having made a dramatic difference in the lives of the disadvantaged. Community service can boost individual resilience and unit morale in ways that behoove the helped and the helper, enhancing the reputation of the military while supporting positive gains in local neighborhoods.
Medical studies demonstrate the correlation between altruism and health benefits. Acts of service release endorphins and oxytocin within the brain, alleviating depression, lowering the mortality rate, and creating the aura of well-being known as the “helper’s high.”3 Research at the London School of Economics advances the claim that volunteering culminates in the “happiness effect.”4 The more people serve, the happier they are. The everyday experiences are overwhelming in supporting the thesis that the happiness effect emanates from community service. In restoring a struggling zoo near Pensacola, Florida, stricken by Hurricanes Ivan and Dennis, 161 sailors from CID (the winner of the Project Good Neighbor Award in 2009) served a total of 953 volunteer hours to enrich the lives of more than 4,000 visitors who enjoyed the restored zoo in the Florida Panhandle. An information technology seaman from CID told me, “When I joined the Navy, I knew that I would proudly serve my country. But I never knew that I would also fulfill my heart’s desire to one day help out at the zoo. This is a dream come true.”
She experienced the irony that in benefiting others we benefit ourselves in a way that perhaps only volunteer service can afford. In giving to others, we always receive back more in return than we could ever give away. In serving our community, we also serve our country by preserving our forces in robust volunteer service projects that define the very core values of the naval services. In 2010 at CID and 2013 at Camp Lejeune, 10,104 service members from Corry Station and 2/9 donated 91,818 hours of volunteer work to help improve the quality of life for 127,527 members of the Florida Panhandle and coastal North Carolina. Furthermore, they dispersed an amazing 116,016 pounds of food to members of the community at risk of hunger. With organizational discipline, synergy, and unity of effort, sailors and Marines optimized their performance to achieve stunning results in humanitarian assistance within a relatively short period of time. Through courageous action on the battlefields (cyber and kinetic) and in at-risk neighborhoods, they are heroes abroad and at home.
Second Battalion, 9th Marines and CID are just the proverbial tip of the iceberg for volunteers who make a significant difference in the world every day by serving their country and local community. Their collective story champions the call to national service. Respected scholarship and countless stories corroborate the indisputable point that community service helps shape moral development and empower operational resilience. As showcased at 2/9 and CID, volunteerism is one among many useful programs instrumental in contributing to the fundamental goals of serving the community, strengthening the force, and supporting the mission. Acts of altruism add to the health and happiness of servicemembers, and by doing so they fortify the cause of freedom locally and internationally. In fostering more vibrant neighborhoods through volunteer service, we build stronger sailors and Marines who in turn make for a safer world.
1. OPNAV INSTRUCTION 5350.6C4, 26 March 2007, http://doni.daps.dla.mil/Directives/05000%20General%20Management%20Security%20and%20Safety%20Services/05-300%20Manpower%20Personnel%20Support/5350.6C.pdf, 2.
2. Department of the Navy, Strategic Plan for Religious Ministry 2014–2019, www.navy.mil/docs/2014-2019-stratplan-religiousministry.pdf, 4.
3. Christine Carter, “What We Get When We Give,” Psychology Today, 18 February 2010, www.psychologytoday.com/blog/raising-happiness/201002/what-we-get-when-we-give. See also Robert Grimm, Kimberly Spring, and Nathan Dietz, “The Health Benefits of Volunteering: A Review of Recent Research,” April 2007, www.nationalservice.gov/serve-your-community/benefits-volunteering.
4. Joanna Saisan, Melinda Smith, and Gina Kemp, “Volunteering and its Surprising Benefits,” September 2013, www.helpguide.org/life/volunteer_opportunities_benefits_volunteering.htm.