In Brief

Efforts to improve public health should integrate traditional, one-to-one behavioral interventions with more broad-based initiatives that consider the full range of factors that affect health, including influences in families, schools, workplaces and communities, according to an Institute of Medicine (IOM) report released this summer.

The report, which drew on the expertise of psychologists, sociologists, medical doctors, epidemiologists and anthropologists, also urged that research and interventions to combat disease and injury emphasize fundamental social and behavioral determinants of health instead of examining diseases in isolation.

"Most prevention efforts mirror the approach of clinical medicine, addressing risks for specific diseases or illnesses in a categorical fashion, disease by disease," says Brian D. Smedley, PhD, an IOM senior program officer and study director for the report. "The IOM report points out that many of the same behavioral and social risks apply to several different diseases--for example, smoking is linked to lung disease, cancer and cardiovascular disease, to name a few."

Although health professionals and policy-makers have long recognized the importance of including behavioral interventions in disease prevention efforts, Smedley says, "there's been little consensus on how to tackle these problems."

The 11-member committee that wrote the report, "Promoting Health: Intervention Strategies from Social and Behavioral Research," was convened by the Robert W. Woodruff Foundation to identify promising areas of social science and behavioral research that could improve health.

The committee solicited a dozen papers addressing health issues during all stages of development, from preconception to old age. They also examined strategies for improving public health, including media and policy interventions and efforts to improve the quality of social networks in communities.

Recognizing that social and behavioral factors affect a wide range of conditions and disabilities, the IOM committee recommended that health and disease interventions should address generic social and behavioral determinants of health.

Noting the National Institutes of Health institutes and programs as an example of how funders tend to be organized by disease category, Smedley says, "We don't expect them to change their organizational structure, but it would be interesting to see if there are ways to create funding mechanisms that support efforts to address fundamental behavioral and social risks, as opposed to looking solely at reducing risk for specific disease categories."

The report's authors also observed that although health risks such as stress, poverty, insufficient social supports, poor diet and environmental exposures can be addressed at the individual level, "such efforts do little to address the broader social and economic forces that influence these risks."

They continued, "It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural and physical environment conspire against such change. If successful programs are to be developed to prevent disease and improve health, attention must be given not only to the behavior of individuals, but also to the environmental context within which people live."

Emory University psychologist Eugene Emory, PhD, one of four psychologists on the IOM committee, says the report examines the cost-benefits of behavioral and social science research.

"We have some basic, fundamental principles of behavioral science that we can use now and apply in broader ways to affect all areas of human activity," he says. "Behavioral science research...is nowhere near as expensive as some of the biomedical research that's been undertaken, yet the potential payoff is very great."

The IOM report, "Promoting Health: Intervention Strategies from Social and Behavioral Research," can be viewed on the Internet at www.nap.edu.

--S. CARPENTER