Public Health as a Strategic Asset: The Capability and Impact of the 66B in Civil-Military Operations

(US, Angola conduct joint medical subject matter expert exchange on infection control, epidemiology. Photo by DVIDS)

LTC Morgan A. Torris-Hedlund, LTC Benjamin A. Roberts, LTC Laurence B. Webb, LTC Tracy T. Williams, CPT Kayla Thompson, MSG Fran Regan

Background: Evolving Civil Affairs and the Need for Health Governance Expertise

Since its formalization in the aftermath of World War II, the mission of Army Civil Affairs (CA) has centered on engaging and leveraging the civil component of the operational environment (OE) to support military objectives and fulfill obligations under international law. As outlined in early doctrine, CA responsibilities historically focused on establishing strategic access and placement to enable combat operations, maintaining public order in occupied territories, and advancing U.S. policy objectives following the cessation of hostilities.

By the early 1960s, the CA mission had expanded to encompass support for the commander’s broader politico-military objectives, reflecting an understanding that military success alone was insufficient to achieve strategic goals.¹ CA personnel played a central role in building the legitimacy of allied or host-nation governments, undermining insurgent influence, and establishing conditions for long-term U.S. access and influence. These efforts included supporting or restoring host-nation ministries, advising transitional governments, facilitating elections, and managing local governance functions. CA teams also contributed to restoring public order through law enforcement support. They helped stabilize fragile economies by advising on markets, currency, access to goods and services, and broader development planning, all aligned with the commander’s need to synchronize military actions with political, economic, and informational lines of effort.^{2, 3}

Contemporary doctrine has further evolved the role of CA. FM 3-57: Civil Affairs Operations and ATP 3-57.60: Civil Affairs Planning emphasize the critical contributions of CA to transitional governance, support to civil administration (SCA), and civil-military integration (CMI) across the competition continuum.^{2, 3} These mission sets often require sector-specific expertise in infrastructure, justice, education, and public health. Among the sector-specific capabilities required, public health stands out as both a stabilizing force and a strategic lever. Army Public Health Nurses (66Bs), embedded in CA formations, bring precisely the expertise needed to engage civil health systems, enhance governance outcomes, and support mission success across the competition continuum.

Army Public Health Nurses (66Bs) are assigned to CA units as embedded public health subject matter experts within Government Functional Specialty Teams (FxSPs). As highly trained, doctrinally aligned professionals, 66Bs bring systems-level expertise in health planning, epidemiological assessment, and population health. They support commanders by advising on health governance, conducting civil sector assessments, and engaging directly with host nation health ministries, NGOs, and interagency partners. Their integration enhances CA's mission planning and execution by enabling targeted, health-informed interventions that align with local needs and strategic objectives. In complex operating environments shaped by fragile infrastructure and public health vulnerabilities, 66Bs serve as force multipliers, reinforcing the Army’s ability to deliver sustainable, governance-focused outcomes through population-centered engagement.⁴

The Army Public Health Nurse (66B): Capabilities and Relevance

66Bs are uniquely trained to operate at the intersection of clinical care, public health systems, and operational readiness. As Registered Nurses with specialized education in epidemiology, community health assessment, health policy, and disaster risk reduction, 66Bs possess a systems-level perspective critical to understanding and addressing health threats across populations. Their core mission, force health protection and population resilience, is inherently aligned with the CA mandate to enhance governance, build host-nation capacity, and stabilize fragile systems within the civil component of the operational environment.⁴

Public health is a neutral and stabilizing engagement domain, especially in theaters such as U.S. Indo-Pacific Command (INDOPACOM), where environmental impacts, fragile infrastructure, and uneven health system capacity intersect with strategic competition. In these contexts, 66Bs have repeatedly demonstrated their operational relevance. For example, in response to the Red Hill fuel spill crisis in Hawai‘i, Army PHNs supported community engagement and environmental health monitoring. During Operation Allies Welcome, 66Bs coordinated population-level health screening and vaccination efforts for Afghan evacuees. As public health subject matter experts, 66Bs have also supported civil-military engagement efforts in Samoa, the Philippines, and French Polynesia, helping to strengthen joint health security and disaster risk reduction planning in partnership with host-nation allies and interagency stakeholders. In addition to INDOPACOM efforts, 66B’s have contributed to a broad spectrum of CA missions and activities. 66B’s have conducted local engagement efforts in Djibouti, operating from Camp Lemonnier as part of the AFRICOM HOA mission. 66B’s were instrumental in negotiating local efforts to establish medical services to the locals. Furthermore, 66B’s have gone on forward deployments from Camp Lemonier into areas such as Somalia and Kenya. 66B’s leverage their broad nursing experience and expertise in infectious disease, sanitation and disaster relief efforts to facilitate CA and other operational assets as they conduct their missions. This helps instill a “hearts and minds” mentality with the local population.

Aside from the AFRICOM mission, 66B’s have assisted in CA missions across EUCOM, including Poland and Moldova. 66B’s have been used to conduct local seminars on various topics, including Sexually Transmitted Diseases, Sexual Assault Nursing Examiner, and Human Trafficking. In one instance, the effort was so successful that the host nation invited the 66B to return for a second engagement, which significantly enhanced the capabilities of the deployed CA Team by raising its profile with the host nation's government.

When embedded with CA elements, 66Bs directly augment mission planning and execution through their ability to conduct civil reconnaissance (CR) focused on public health infrastructure, sanitation, disease burden, and access to care. This subject matter expertise informs Civil Information Management (CIM) data that feeds the Commander’s Common Operation Picture (COP).  Their expertise enables targeted civil engagements (CE) with community health leaders, local clinics, and health ministries, often serving as the initial point of access and trust-building with host-nation institutions. Additionally, 66Bs contribute to civil network development (CND) by identifying and connecting key health actors across governmental and non-governmental sectors, thereby helping to build durable public health coalitions that support U.S. objectives.⁴

Perhaps most importantly, 66Bs directly support transitional governance by advising on health system restoration, immunization planning, disease surveillance, and policy development during stabilization and recovery operations. Their presence in CA units addresses a persistent gap in health governance expertise, enhancing operational outcomes while reinforcing the legitimacy and capacity of host-nation systems.

Integration within Government Functional Specialty Teams

Within CA doctrine, Government Functional Specialty Teams (FxSPs), predominantly composed of Army Reservists, enable commanders to leverage extensive civilian-sector expertise across critical governance areas, including public health, infrastructure, education, and the rule of law. These multidisciplinary teams act as a planning and advisory resource, integrating functional knowledge into Civil Affairs Operations (CAO) throughout the competition continuum. The doctrinal framework established in FM 3-57: Civil Affairs Operations and ATP 3-57.60: Civil Affairs Planning designates FxSPs as vital for supporting transitional governance and strengthening the capacity of civil institutions.^{2, 3}

66Bs are ideally suited to function as force multipliers within these teams in the public health governance role. Their training and experience empower them to conduct thorough health sector analyses, evaluate health system vulnerabilities, and identify civil health priorities that affect military operations and civilian stability. They are prepared to advise host-nation health ministries and non-governmental organizations on outbreak containment, mass immunization efforts, and the restoration of health services during or after crises.⁴

While 66Bs may not be formally reflected in every CA unit's Table of Organization and Equipment (TO&E), their current presence within CA formations, often as attachments or through habitual support relationships, illustrates the functional adaptability of CA organizations. This flexibility enables 66Bs to contribute public health expertise without necessitating structural changes to CA force design.

Incorporating 66Bs into FxSPs directly enhances civil knowledge integration (CKI) and strengthens civil-military integration (CMI) by ensuring health considerations are embedded in mission planning and execution. This integration allows CA teams to operate more effectively in environments where health resilience is fundamental to governance and long-term stability.

Synergy with the Army 38G Military Government Officer Program

The Army’s 38G program, part of the broader CA Functional Specialty initiative, integrates civilian expertise into military operations by directly commissioning professionals with advanced credentials and experience in governance-related fields. Organized around six core functional areas, including Public Health, the 38G program aims to enhance CA units by providing sector-specific technical depth. Within this framework, 38G-P5 (Essential Services) personnel contribute knowledge acquired from their civilian careers in epidemiology, health systems administration, health policy, and global health security.^{2, 3}

66Bs are a natural point of synergy with 38G-P5 personnel. While 38Gs bring high-level subject matter expertise from civilian sectors, 66Bs provide doctrinal fluency, military medical experience, and sustained operational readiness, facilitating smoother integration into Joint and Army planning processes. This complementary relationship ensures that CA forces and the units they support benefit from strategic knowledge and field-tested public health practices, enhancing the planning and execution phases of operations.⁴ As with many CA functions, the impact of 66Bs is often realized through indirect or second-order effects, such as strengthened relationships with host-nation health ministries, improved legitimacy of health sector engagements, or enhanced interagency coordination. While these contributions may be difficult to quantify in traditional metrics, they align closely with CA’s doctrinal emphasis on shaping, influencing, and enabling through the civil environment.

Units can achieve more cohesive planning, mentorship, and interoperability by co-locating 66Bs with 38G-P5 officers in Functional Specialty Cells or Civil-Military Operations Centers (CMOCs). This collaboration enhances the Army’s ability to engage with host-nation health institutions, interagency stakeholders, and multinational partners. Additionally, it supports executing complex missions such as pandemic response, disaster risk mitigation, and public health system reconstruction, which are increasingly relevant in the INDOPACOM theater and across the global competition continuum.

Operational Integration and Strategic Alignment

66Bs are integrated into CA formations in a manner that reflects doctrinal relevance and operational necessity. 66Bs already support FxSPs in many settings, contribute to planning and mission execution alongside 38G-P5 officers, and serve within Civil-Military Operations Centers (CMOCs). These collaborations, some formal, others mission-tailored, underscore the growing recognition of public health as a key component of transitional governance, support to civil administration (SCA), and civil-military integration (CMI), all central pillars of CA operations as defined in foundational doctrine.^{2 - 4}

66Bs bring systems-level public health expertise to CA missions, enabling more nuanced assessments of population vulnerabilities, public health infrastructure, and risk factors that may impact operational success or long-term stability. In ongoing operations across INDOPACOM, 66Bs have supported humanitarian engagement, disease surveillance, civil engagement with health ministries, and interagency coordination. These efforts have often coordinated with 38G-P5 personnel, demonstrating a complementary relationship: 66Bs contribute doctrinal fluency and military planning experience, while 38Gs bring deep civilian sector expertise. Together, they improve both the scope and precision of health sector engagement.

The integration of 66Bs has also enhanced the Army’s ability to conduct health-focused civil reconnaissance (CR) and develop civil networks (CND) that include host-nation ministries of health, non-governmental organizations (NGOs), and multilateral partners. These relationships contribute to the legitimacy of CA engagements and reinforce partner nation governance. In environments where health systems are fragile or disrupted by crisis, 66Bs offer practical insight into epidemiological trends, resource gaps, and culturally appropriate interventions, making them critical to planning and executing effective, ethical engagement strategies.

In current practice, 66Bs are already contributing to CMOCs and joint planning cells, where their input helps shape course-of-action development, interagency synchronization, and real-time decision-making. For example, during recent missions in the Philippines, Samoa, and French Polynesia, 66Bs have operated as part of CA teams engaged in health system strengthening, environmental health monitoring, and disaster risk mitigation. These examples illustrate that, while not always formally codified, the integration of 66B is both feasible and impactful.

Field observations suggest that pairing 66Bs and 38G-P5 personnel in joint training environments and theater planning efforts fosters stronger interoperability and trust. As CA operations grow in complexity, particularly in regions marked by climate risk, fragile governance, and strategic competition, these relationships are likely to become more critical. Their joint contributions help bridge civil-military divides and position U.S. forces as credible, capable, and trusted actors in the public sector space. Doctrinal alignment is evident. The tasks performed by 66Bs mirror the public health governance functions outlined in FM 3-57 and ATP 3-57.60, even when those functions are not formally assigned to specific personnel.^{2 - 4} The continued presence of 66Bs in CA units reflects a growing operational consensus: public health professionals are valuable for medical readiness and their ability to operate across the health-governance interface, where access, legitimacy, and influence are built.

The integration of public health expertise, particularly in partnership with 38G Public Health officers, demonstrates how existing personnel are being effectively utilized to meet the demands of dynamic, health-affected environments. Instead of indicating a need for structural overhaul, these practices reflect the Army’s ability to adapt doctrine in action, optimize team-based mission execution, and apply specialized expertise to complex operational challenges. Some 66Bs supporting CA missions have gained civil-military experience through operational deployments, habitual support arrangements, or joint training events. Over time, a formalized skill identifier or structured training pathway could help identify and prepare 66Bs with the necessary knowledge for FxSP and CA missions, improving interoperability and reinforcing doctrinal alignment. Many Combatant Commands, particularly in INDOPACOM, utilize Global Health Engagement (GHE) as a key element of Theater Campaign Plans. The work of 66Bs supporting partner health systems, advising health ministries, and engaging in joint assessments aligns directly with these priorities. Increasingly, 66Bs are pursuing formal education in GHE, such as the U.S. Uniformed Services University (USU) GHE certificate, enhancing their capacity to support regional stability and align with national security objectives.

Conclusion

As CA operations evolve to meet the demands of complex, multidomain environments, integrating Army Public Health Nurses (66Bs) into Functional Specialty Teams offers a timely and necessary enhancement to the Army’s governance and stabilization capabilities. Operating at the intersection of health systems, governance, and civil-military engagement, 66Bs bring systems-level public health expertise, operational readiness, and a deep understanding of population health dynamics. These assets align directly with core CA competencies, including transitional governance, support to civil administration, and civil-military integration.

In partnership with 38G-P5, 66Bs contribute to field-level planning, civil reconnaissance, interagency coordination, and health sector engagement. Their presence has proven valuable across multiple operational contexts, particularly when disaster risk, fragile infrastructure, and strategic competition converge. These environments demand coordinated, population-centered solutions, and 66Bs are uniquely positioned to contribute to those efforts.

The integration of 66Bs into CA formations enhances the capabilities of FxSPs and reinforces the Army’s ability to engage effectively with host-nation health systems. Their presence ensures that public health considerations remain central to post-crisis recovery, stabilization, and long-term civil resilience. This ongoing collaboration reflects an adaptive, mission-oriented approach to CA operations that aligns with existing doctrine and advances U.S. strategic objectives through credible, population-centered engagement.

The views and opinions expressed in this article are those of the author(s) and do not reflect any official policy or position of the U.S. Army, the Department of Defense, of any other U.S. government agency.

About the Authors

LTC Morgan Torris-Hedlund is an Army Public Health Nurse with the 351st CACOM FxSP and Deputy Consultant to the Army Surgeon General. He has mobilized to Tripler Army Medical Center and Joint Task Force-Bravo and serves on the Tri-Service Nursing Research Program Advisory Council. In his civilian role, he is an Assistant Professor at Oregon Health & Science University, with scholarship focused on austere care, disaster preparedness, and Indigenous epistemologies.

CPT Kayla Thompson currently serves as the Chief of Public Health Nursing at Keller Army Community Hospital, West Point, NY. She earned her Bachelor of Science in Nursing from Truman State University in 2018 and commissioned into the U.S. Army Nurse Corps as a medical-surgical nurse that same year. She transitioned into public health nursing in 2021 and became a Certified Public Health (CPH) professional in 2022. She is pursuing a Global Health and Global Health Engagement certificate at the Uniformed Services University. 

LTC Ben Roberts has over 20 years of experience in cultural resources management and preservation. He serves as Heritage and Preservation Officer for the 351st Civil Affairs Command and, in his civilian role, is a Senior Architectural Historian and Cultural Resources

Planner with the Center for Environmental Management of Military Lands, supporting Navy Region Hawaii’s Environmental Program at Joint Base Pearl Harbor-Hickam. His expertise spans project management, cultural property protection, geospatial analysis, and safeguarding heritage during conflict and disasters. Recent military assignments in the Indo-Pacific include commanding Task Force RISEUP in Guam after Typhoon Mawar (2023), serving as interim commander and executive officer of the 411th Engineer Battalion (2022–2023), and leading a regional team for Task Force Oceania (2021–2022).

LTC Laurence Webb earned his BSN from Clemson University in 2007 and has clinical experience in emergency, intermediate care, and post-anesthesia nursing. Since completing Army Public Health Nurse training in 2016, he has served in APHN roles at Ft. Drum, Camp Casey, Ft. Belvoir, Ft. Bragg, and Ft. Eustis. From 2023–2025, he was Operational Public Health Nurse for the 95th Civil Affairs Brigade (SO)(A), and he now serves as Deputy Chief of Public Health and Chief of Public Health Nursing at McDonald Army Health Clinic, Fort Eustis.

LTC Tracey Williams was commissioned in 2009 and became a Public Health Nurse in 2012 after attending the 6A-F5 course in San Antonio, Texas. LTC Williams served as BDE Nurse and Deputy Surgeon at 95th CA BDE, Ft Bragg, NC, from 2017-2021. LTC Williams is currently the Department of Public Health Chief at Ft Stewart, GA.

MSG Fran Regan is a G9 Staff NCO in the U.S. Army I Corps Mission Command Post-Operational Detachment (MC-POD), with extensive experience in operational planning and Military Government Functional Specialty integration. In his civilian career, he is a Clinical

Practice Nurse with Kaiser Permanente, focused on database development in support of bariatric surgery patient navigation and data tracking.

References

1.      Department of the Army. 1962. Field Manual 41-10: Civil Affairs Operations. Washington, D.C.: Department of the Army, May 1962.

2.      Department of the Army. 2021. FM 3-57: Civil Affairs Operations. Washington, DC: Headquarters, Department of the Army.

3.      Department of the Army. 2024. ATP 3-57.60: Civil Affairs Planning. Washington, DC: Headquarters, Department of the Army.

Office of the Chief, Army Nurse Corps. 2023. "The Role of the Army Public Health Nurse with Civil Affairs." Unpublished internal briefing document.