Backed by an explosion of scientific data underscoring the importance of behavioral and social factors in health, an interdisciplinary group of scientists is arguing that the sheer weight of that evidence demands a restructuring of how social and behavioral research and interventions are conducted.
At a May 23 symposium organized by the National Research Council (NRC) and the Institute of Medicine (IOM), "Through a kaleidoscope: viewing the contributions of the behavioral and social sciences to health," experts drew on six recent NRC and IOM reports (see box). Each concludes that the nation's health can be significantly improved if the scientific and medical communities--as well as policy-makers--heed the wealth of data that show how behavior and social environments shape health.
"We are truly at a crossroads," said Lisa F. Berkman, PhD, of the Harvard University School of Public Health, speaking at the symposium. "Traditional notions of health, deeply configured in a biomedical model of disease causation, have often precluded construction of successful interventions. Developing effective interventions is a critical next step--it requires us to build on everything we've learned, but to integrate it in a fundamentally new way."
Specifically, speakers at the symposium called for more:
Interdisciplinary research on the ways biological, psychological, behavioral, social and institutional factors together influence health and disease.
Longitudinal studies to track how behavior shapes long-term health outcomes.
Research on the biological mechanisms through which behavior affects health.
Training of young scientists to conduct interdisciplinary, multilevel and longitudinal research.
Effective translations of promising interventions into large-scale practice.
These changes are critical, said social epidemiologist Berkman, because even though the United States spends more on health care than any nation in the world, that spending "doesn't buy us health."
To have more impact on public health, Berkman and other speakers at the conference stressed, health-promotion efforts must target not only individual, biological and behavioral processes that lead to ill health, but also the broader social contexts in which people live.
"Even as high-risk people change their behaviors and lower their disease risk, new people enter the population to take their place--forever," said S. Leonard Syme, PhD, professor emeritus of epidemiology at the University of California, Berkeley. "This is because we rarely identify and take action against those forces in the population that cause risk for disease."
For example, he said, public health experts in California have addressed the musculoskeletal problems, respiratory complaints, gastrointestinal difficulties and other ailments that bus drivers often experience--and such studies have yielded recommendations for treating each of these complaints. But by studying one disease at a time, "we tend to ignore the major problem: the design of the job itself," Syme said. To make a real difference at a broader level, he argued, intervention efforts need to consider the constellation of influences that can lead to health problems with the job.
One of the most compelling justifications for boosting investment in social and behavioral research in health is the changing composition of the U.S. population, said Raynard S. Kington, MD, PhD, associate director for behavioral and social sciences research at the National Institutes of Health.
"The behavioral and social sciences have the potential to address some of the most pressing health problems that the country is facing--and particularly those problems related to differences in health status across racial groups, ethnic groups and groups stratified by socioeconomic status," he argued.
Psychologist John T. Cacioppo, PhD, and sociologist Robert J. Sampson, PhD, both of the University of Chicago, described examples of research that highlights links among social environment, behavior and health. Cacioppo discussed research showing that social isolation and loneliness are associated with increased risk for illness and earlier mortality. As the population of the United States ages, he said, "This is something that it's important to get a handle on--how is it that social isolation is getting under the skin? Understanding the mechanisms by which such behavioral and social factors exert their influence requires greater investment in multidisciplinary, multilevel research."
Sampson emphasized that just as individual psychological factors can impinge on health, so can broader social contexts, such as neighborhoods.
"We need to treat neighborhood and community contexts as important units of analysis in their own right," he urged, calling for greater investment in research and interventions that address structural features of neighborhoods and communities such as community trust, social networks and people's sense of social control within their neighborhoods.
Although much progress has been made in developing behavioral interventions to combat disease, challenges remain for both scientists and practitioners, said Margaret Chesney, PhD, a professor of medicine, epidemiology and biostatistics at the University of California, San Francisco. In particular, she said, these involve extending health improvements to all ethnic, racial, social class and gender groups.
Further, Chesney urged, "We've got to move from thinking of behavior as something that is like an infection that can be cured. Changing behavior is more like diabetes--it needs monitoring and care over time."
National Research Council and Institute of Medicine reports featured at the symposium were:
The Aging Mind: Opportunities in Cognitive Research.
Bridging Disciplines in the Brain, Behavioral and Clinical Sciences.
Health and Behavior: The Interplay of Biological, Behavioral and Societal Influences.
From Neurons to Neighborhoods: The Science of Early Childhood Development.
New Horizons in Health: An Integrative Approach.
Promoting Health: Intervention Strategies from Social and Behavioral Research.
The reports can be viewed at www.nap.edu.