APA Book Notes
As backers of the Decade of Behavior point out, the modern causes of ill health are overwhelmingly linked to behavior. A new book from APA, Integrating Behavioral and Social Sciences with Public Health, discusses how changing those lifestyles and improving the nation's health will rely on assimilating behavioral and social science into the nation's medical and public health institutions.
"There has been increasing awareness that the solution to many public health problems probably will require the use of interdisciplinary strategies focused on multiple levels," notes the book, edited by University of Miami psychologist Neil Schneiderman, PhD; Marjorie Speers, PhD, of the Centers for Disease Control and Prevention; and Julia M. Silva, PhD; Henry Tomes, PhD, and Jacquelyn H. Gentry, PhD, of APA's Public Interest Directorate.
The volume grew out of a conference organized by APA and funded by the Centers for Disease Control and Prevention and other federal agencies. It gathers 16 separate analyses into two sections: The first has nine chapters discussing efforts to apply behavioral science to health problems; the second section offers analyses on methodological issues important to integrating the behavioral sciences and public health.
Research into practice
In the first section, a chapter by John Lynch, PhD, of the University of Michigan, looks at the association between income and cardiovascular disease. In a telling statistic, women who earn less than $10,000 a year are 3.4 times more likely to die of heart disease than women with incomes above $25,000.
Public health research indicates that poor people are also more likely to smoke, be overweight, be sedentary, have heavy use of alcohol and have other behavioral risk factors. A 1994 study in Alameda County, Calif., shows the same is true with psychological risk factors. Economically disadvantaged people were also likely to be cynical, to lack optimism and to be depressed, as well as be smokers, be sedentary and to have a high body-mass index.
"Failure to deal with fundamental socioeconomic health determinants will be a major barrier to improving public health in the coming century, as indeed it has been throughout history," Lynch contends.
Other chapters in the first section focus on behavioral-public health integration as related to violence, HIV infection, drug users, breast-cancer screening and unintentional injuries.
The book's second section illustrates how much work needs to be done to integrate behavioral and social science into medical care.
One chapter, for example, looks at one of the most visible social movements aimed at improving health: community health coalitions. These groups, notes author Abraham Wandersman, PhD, of the University of South Carolina department of psychology, have become popular methods for addressing substance abuse, AIDS, maternal and child health, cardiovascular disease, drunk driving and other issues.
But some coalitions have worked well and many others have shown only limited impact. It's crucial to know what makes the difference because, Wandersman asserts, "the public's health in the 21st century will be heavily influenced by the extent to which communities are able to mobilize their members and institute effective prevention programs."
Other chapters in the methodology section look at economic costs and benefits, psychosocially healthy work environments, evaluations of community-based health programs, efficacy and effectiveness trials, and programs improvement and capacity building.