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December 12, 2008
Retreat Refreshes Behavioral, Social Sciences
Dr. Christine Bachrach
Dr. Christine Bachrach, acting director of the Office of Behavioral and Social Sciences Research, wanted just one thing out of the first-ever day-long retreat for NIH’s widely dispersed community of behavioral and social scientists, held Nov. 12 at Natcher Bldg.
December 12, 2008
CBT4CBT
New Hope for Treatment of Addiction
Dr. Kathleen Carroll
Drug addiction is notoriously tough to treat, but now research is showing a fresh way to tackle the problem. It’s called computer-based training for cognitive-behavioral therapy (CBT4CBT)
OBSSR’s Mabry Wins with Systems Analysis Team
OBSSR’s Mabry Wins with Systems Analysis Team
More News >>
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January 28-29, 2009 Dissemination and Implementation Conference
February 9, 2009, 10:00 – 11:00 AM
Stigma: Lessons & New Directions from a Decade of Research on Mental Illness
July 12-24, 2009
OBSSR/NIH Summer Training Institute on Randomized Clinical Trials Involving Behavioral Interventions
May 3-8, 2009
Institute on Systems Science and Health
May 22-25, 2009
Gene-Environment Interplay in Stress and Health at the Association for Psychological Science 21st Annual Convention, San Francisco, CA
More Events >>
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Home > About OBSSR > Strategic Plan
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Strategic Plan |
 Strategic planning is a disciplined effort to produce fundamental decisions and actions that shape and guide what an organization is,
what it does, and why it does it. Strategic planning requires broad-scale information gathering, an exploration of alternatives, and
an emphasis on the future implications of present decisions. It can facilitate communication and participation, accommodate divergent
interests and values, and foster orderly decision-making and successful implementations.
The Office of Behavioral and Social Sciences Research (OBSSR) has twice undergone the process of determining its long-term goals and
best approaches for achieving those goals since its inception in 1995. The Office’s original strategic plan was implemented in 1997
and has since been updated with the 2007 version.
Defining OBSSR’s Vision
Strategic Plan 2007
Strategic Plan 1997
"Next Generation" Basic Science
Basic behavioral and social science research is critically important to NIH’s mission and is a core value of its scientific plan. Basic science spans the full range of scientific inquiry, from mechanisms and processes at the intra-individual level (“under the skin”) to mechanisms that explain inter-individual and systems behavior (“outside the skin”). Glass and McAtee (2006) provide a detailed argument for the need for a more integrative dynamic systems model, using concepts such as risk regulators and embodiment to reflect the intersection of biology with individual and population level exposures over time. Relatedly, Caspi et al. (2006) suggest that measured genetic variation and measured environmental and epigenetic exposures will play an increasingly important role, as will brain and behavior, in determining and refining the phenotypes, endophenotypes and intermediate phenotypes, for common disease and mental illness. Underlying this continuum is a need for basic inquiry into the complex interacting factors that affect health, health policy, and the delivery of health services. Basic research in the behavioral and social sciences provides the fundamental theoretical knowledge, methodology, and measures that are essential for understanding individual and collective systems of behavior and psychosocial functioning; for predicting, preventing, and controlling illness; for developing more personalized (tailored) interventions; for enhancing adherence to treatment and minimizing the collateral impact of disease; and for promoting optimal health and well-being across the lifespan and over generations. Basic science elucidates behavioral and social phenomena that are important in and of themselves, as well as in connection to health and disease.
Within this context there have been numerous exciting developments in basic behavioral and social sciences research (see sidebar):
- Research on learning theory and its application to psychopathology led to the development of empirically validated behavioral treatments for autism, anxiety, and depressive disorders now commonly used in clinical practice.
- Research on social networks and social relationships provided the basis for programs that enable families and groups to better assist individuals recovering from or coping with medical illness or addictions.
- Basic research on stereotypes, stereotyping, and cognitive processing has led to insights about how the medical care system delivers unequal treatment to women and ethnic or racial minorities.
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Memory: Where Learning, Behavior, and Biology Intersect
Nobel laureate Eric Kandel’s work identified the molecular changes that underlie learning and memory. His book, In Search of Memory: The Emergence of a New Science of Mind, relates the story of how four distinct disciplines— behavioral psychology, cognitive psychology, neuroscience, and molecular biology—converged into a powerful new science of the mind. Through his profound insights into thought, perception, action, recollection, and mental illness, this new science is revolutionizing the understanding of learning and memory while simultaneously showing great promise for more effective healing. Dr. Kandel suggests that 21st-century neuroscience increasingly will focus on the brain circuits and systems that regulate cognition. Two major systems problems that he would want to study are
- What factors regulate the unconscious processing of sensory information about our environment? How does conscious attention regulate the processes that then stabilize experiential memories? These are central issues in understanding consciousness and in the recall of memories from different places and times.
- What is the relationship between the activity of an individual brain and the corporate activity of a group of brains? In other words, what is the sociology of cognition?
Dr. Kandel’s work may shed light on one of the key problems in understanding addiction, namely how repeated exposure to drugs “teaches” the brain to become addicted.
Reference:
Kandel, E. (2006). In Search of Memory: The Emergence of a New Science of Mind.
New York: W.W. Norton & Company.
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At the same time, remarkable advances in biomedical research have greatly improved our understanding of the biological mechanisms underlying the effects of social and behavioral factors on health. For instance, animal studies have demonstrated that particular patterns of maternal care cause epigenetic changes in specific brain regions and permanently alter brain structure and the expression of behavioral and endocrine stress responses in adult offspring. Genome-wide association studies, in combination with improved measures of the physical, behavioral, and social environments, will allow researchers to elucidate the links among environmental factors, behavior, gene expression, and physiological function across the lifespan. Understanding the gene-gene, gene-behavior, and gene-environment-behavior interactions that ultimately influence health and disease will require increasingly sophisticated and precise behavioral and social methods, measures, and constructs (Caspi et al., 2006). With such advancements, behavioral and social scientists may be able to address exciting new questions.
In 2004, an advisory committee to the director of NIH was established to examine basic behavioral and social sciences research across NIH. This group reviewed the existing portfolio of basic behavioral and social sciences research to identify areas of opportunity, to examine barriers to the submission and review of applications in this area, and to make recommendations for improving NIH’s program in basic behavioral and social sciences research. In its report (OBSSR, 2004), the committee concluded that basic behavioral and social sciences research and training are critical to the NIH mission, and that greater support for this work is needed throughout NIH. Priority areas in basic behavioral and social sciences research identified in the advisory committee report and by stakeholders in OBSSR’s strategic planning process include:
- Gene-environment interactions: How are genetic traits and early life experiences linked to physical and emotional health later in life? What role does personality play in the expression of psychosocial risk factors under varying environmental conditions?
- Intergenerational transmission of behavior: How are epigenetics and gene expression related to inter- and trans-generational transmission of behavior and emotion? Conversely, what impact does the transmission of behavior patterns have on DNA?
- Biopsychosocial stress markers: What are the biological sequelae of stress, and how do they relate to long-term cognitive and affective reactions? How can these findings be used to understand group behavior in the context of trauma such as natural or man-made disasters and in phenomena such as premature chronic disease, neurodegeneration with aging, and how poverty and adverse living conditions interact with variation in DNA in disease etiology and progression?
- Technology, measurement and methodology, and cyberinfrastructure: How can we apply advances in computer sciences, communications, imaging, and biomarker data collection and other technologies to measure behavior in real time (e.g., ecological momentary assessment, personal sensors, geospatial coding methods) to decipher multilevel pathways linking biology, behavior, environment, and society? What informatics grids, networking, and database infrastructures are needed to support these activities?
- Spirituality and health: How do individual belief systems or social religious norms affect health?
- Work-related stresses: What are the effects of conflicts between work and family associated with women entering the workforce on social stress and health?
- Social integration and social capital: How have advances in technology and mobility affected neighborhood social networks and mechanisms such as resilience and connectedness? What is the impact of these advances on health behaviors and health outcomes?
- Inequality and health outcomes: How do large-scale societal structures (e.g., racial segregation, immigration and acculturation patterns, socioeconomic status) impact health?
- Complex adaptive systems: How can our growing understanding of complex adaptive systems be used to better understand the process of decisionmaking in health at the personal and systems levels?
- Social movements and policy change: How do social movements related to health take shape and permit things like tobacco taxes and school lunch program changes to occur? How and why must public opinion change before legislative, regulatory, or other legal action is possible? What science will enable researchers to coach legislators to frame messages in ways that maximize chances for motivating and sustaining positive health-related change?
Strategic Recommendations
OBSSR will help to build consensus and stronger partnerships within NIH regarding the most important research areas that will affect the Nation’s most pressing public health problems. OBSSR also will explore the potential to link behavioral and social scientists within NIH to leverage their knowledge and resources. OBSSR will facilitate a common research language and terminology among behavioral and social scientists and with the broader scientific community. It also will encourage the development of new theoretical models, methodologies, and tools necessary to answer the many questions facing our fields. Other recommendations from participants in the planning process include
- Work with partners and stakeholders to identify and reach consensus on priority research areas in basic behavioral and social sciences.
- Promote the value of basic behavioral and social sciences research throughout the NIH community.
- Encourage research that bridges basic and applied behavioral and social sciences.
- Develop better research infrastructure by encouraging the identification of human and animal populations, birth cohorts, and community populations for future longitudinal studies.
Interdisciplinary Research
We are not students of some subject
matter, but students of problems. And
problems may cut right across the
borders of any subject matter
or discipline.
~ Karl Popper, 1963
Solving our most pressing health problems will require a greater understanding of the full range of factors that determine health—biological, medical, behavioral, social, and environmental—and of their complex interrelationships. In many instances, a single research discipline is best suited to tackle specific health problems. However, increasingly it is recognized that the most urgent public health challenges facing our Nation cannot be adequately addressed within a single discipline, and instead require a more comprehensive approach. New discoveries and innovative solutions may become possible when researchers in different disciplines meet at the interfaces and frontiers of those disciplines to pool their diverse knowledge.
Various terms have been used to describe these collaborations (Rosenfield, 1992), including transdisciplinary, multidisciplinary, and interdisciplinary. For the purpose of this prospectus, we have chosen to use interdisciplinary research to refer to scientific endeavors in which a variety of disciplines work together closely from the outset to address a problem (Rosenfield, 1992). Interdisciplinary is the phase between unidisciplinary and multidisciplinary on the one hand, and full transdisciplinary synthesis on the other hand. Interdisciplinary research and education are inspired by the drive to solve complex questions and problems, whether generated by scientific curiosity or by pressing social need. Over time, collaboration among diverse scientists has the potential to produce new disciplines, as in bioinformatics, psychoneuroimmunology, behavioral genetics, and cognitive and social neuroscience.
Interdisciplinary approaches in the behavioral and social sciences have been discussed extensively (e.g., NRC, 2004; Kessel et al., 2003) and supported in several large-scale research programs. Two recent examples are the Research Teams of the Future theme of the NIH Director’s Roadmap for Medical Research (Zerhouni, 2003) and the NCI Transdisciplinary Tobacco Use Research Centers (TTURCs) established at several universities during the 1990s. An interdisciplinary framework can be used to understand major population health problems such as tobacco use through a conceptual synthesis across three major domains: (1) lifespan developmental factors that span the prenatal period through older adulthood; (2) individual variation in biobehavioral factors such as genes, hormones, cognitions, and behaviors; and (3) group variation in factors such as the peer group, family, community, and economy. Recently there has been increasing interest in applying interdisciplinary thinking to other areas such as the obesity and diabetes epidemics and health disparities (Abrams, 1999, 2006a,b; Abrams et al., 2003; Adler and Ostrove, 1999; McLeroy et al., 2003; Merzel and D’Afflitti, 2003). Such integrated approaches require more than collaboration across disciplines; moving from interdisciplinary to true transdisciplinary work requires a shared knowledge base, common terminology, and the ability to work synergistically to develop new conceptual models, measures, and interventions that change future health outcomes (Kahn and Prager, 1994).
Increasing numbers of researchers are calling for the use of more longitudinal and population-based approaches that integrate biomedical, behavioral, social, and public health sciences to address major health issues such as women’s health (Marts, 2002), child and adolescent mental health (Hoagwood and Olin, 2002), and alcoholism (Holder, 2001; Meyer, 2001). A 2003 IOM report, The Future of the Public’s Health in the 21st Century, points to the gap between health spending and health outcomes, and prescribes an interdisciplinary biobehavioral approach to evidence-based public health (IOM, 2003).
Despite the growing enthusiasm for interdisciplinary approaches and recent models of success (see sidebar on Page 14), broad acceptance of interdisciplinary research remains a goal for the future. In consultation with the scientific community, OBSSR will play a key role in defining relevant issues and facilitating an interdisciplinary, team-based approach to population health research by fostering collaborations among the broad base of stakeholders (e.g., policymakers, employers, practitioners, patients, the general public, and researchers) needed to ensure the implementation and adoption of scientific findings.
Understanding Tumor Growth in Cancer: An Interdisciplinary Approach
Cancer remains one of the most challenging human diseases. Recent interdisciplinary research suggests that its pathophysiology is strongly influenced by the mind. What we are learning about this link may inform the development of biological and behavioral interventions to prevent and treat cancer in the future.
A recent review in Nature summarized molecular, cellular, and clinical studies that have elucidated many of the mechanisms underlying the links between biology and behavior in cancer. Evidence regarding links between psychosocial and behavioral factors and tumor growth include the following:
- Stress, depression, and lack of social support play a role in the growth and development of cancer. For example, the breakup of a marriage has been associated with a twofold increase in the risk of breast cancer, and long-term chronic depression appears to increase general cancer risks.
- Psychosocial factors have an impact on cellular and molecular processes that, in turn, contribute to the incidence and progression of cancer.
- Treatment of animals with drugs that block sympathetic nervous system (SNS) activity, a key component of the physiological response to stress, has been shown to inhibit the effects of behavioral stress on cancer.
Early results of this research indicate a complex matrix of psychological, social, and biological factors in cancer, ranging from social isolation to viral infection, which in turn affect known physiological processes that lead to specific types of cancers in animal subjects. Further research in this area may yield targeted interventions—for the mind, the body, or both—that use this knowledge to reduce the burden of cancer.
Reference:
Antoni, M.H., Lutgendorf, S.K., Cole, S.W., Dhabhar, F.S., Sephton, S.E., McDonald,
P.G., Stefanek, M., and Sood, A.K. (2006). The influence of bio-behavioural factors
on tumour biology: pathways and mechanisms. Nature, 6, 240-8.
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Strategic Recommendations
- Engage the scientific community through symposia, working groups, and ad hoc committees to identify research areas that can be effectively investigated using interdisciplinary approaches.
- Encourage and support the development of funding opportunity announcements and Requests for Proposals to address the areas identified for interdisciplinary study.
- Provide education and training activities to facilitate interdisciplinary research among biomedical, behavioral, and social science researchers and practitioners. Strive for appropriate representation of scientific disciplines across the natural sciences (e.g., psychology, biology), mathematics and computer science, social sciences (e.g., anthropology, economics, communications, political science, public health), and applied sciences beyond traditional health-related fields (e.g., business, education, engineering).
- Identify, document, and share with key audiences studies that demonstrate the value of integrating social and behavioral sciences perspectives, constructs, and measures in health research.
- Develop metrics and methods needed to demonstrate the economic benefits and public health impacts of rigorous, integrated biopsychosocial health research.
- Collaborate in the development of curricula, modules, and materials to train behavioral, social, and biomedical scientists to design and conduct interdisciplinary research.
- Strengthen the behavioral and social sciences research methods and analyses to support interdisciplinary biopsychosocial health research. Increase the degree to which behavioral and social scientists have the capacity to help fulfill OBSSR’s mandate and the NIH mission.
Systems - Thinking Approaches to Health
The third component of OBSSR’s vision focuses on systems-thinking approaches to population health research. Systems integration and modeling have advanced dramatically since their inception in the 1950s due to advances in computer sciences, mathematics, and the development of cyberinfrastructure, the informatics superhighway, and global connectivity (Atkins et al., 2003). Systems thinking addresses the dynamic relationships among individual components and whole systems related to health and disease. The term “systems” in this context has multiple levels of meaning (see Trochim et al., 2006). It refers to the multilevel, complex interrelationships among the many determinants of health as well as the networks of stakeholders and organizations involved in addressing health issues. It is important to note that the term “systems” is used broadly here and is not meant to refer exclusively to the organization by which health care is provided, commonly referred to as the healthcare system (Trochim et al., 2006).
Systems-thinking approaches encompass both qualitative and quantitative methodologies. “Soft” systems approaches (Checkland, 1981) bring together multiple stakeholders to define and analyze population health problems within a structured group process. These approaches allow for diverse input in framing a problem, selecting analytic tools, and evaluating outcomes, and are believed to yield a richer conceptualization of a problem and more creative solutions. Central to the success of soft systems approaches is the availability of a technology infrastructure that links individuals in a network in which knowledge can be shared across research teams and disciplines. This knowledge includes both explicit knowledge (data) and tacit knowledge (experience and wisdom of individuals and organizations from diverse backgrounds). Cutting-edge innovations in health technologies by networks of stakeholders will likely yield dramatic improvements in disease surveillance, environmental monitoring, food safety, emergency planning, disaster management, and tracking of environmental hazards through geographic information systems (see below).
Information Technologies and the Behavioral and Social Sciences: The Promise of an Integrated Approach to Population Health
Recent advances in the computer sciences and information technology fields have spawned several methodological advances in the biological and molecular sciences (e.g., DNA chip technology and microarray analysis), enabled quantum leaps in molecular and submolecular medicine, and catalyzed the emergence of whole new fields of study such as proteomics, phenomics, nutrigenomics, and pharmacogenetics. Perhaps, in like manner, with the emergence of eHealth, the behavioral and population sciences may be on the verge of a similar information technology–based scientific revolution. New eHealth solutions may soon permit the real-time integrative utilization of vast amounts of behavioral-, biological-, and community-level information in ways not previously possible. Behavioral algorithms and decision support tools for scientists could facilitate the analysis and interpretation of population-level data to enable the development of “community (population) arrays” or community-wide risk profiles, which in turn could form the foundation of a new “populomics.” This population-level risk characterization could potentially go beyond the limitations of typical geographic analyses and yield insights distinctly different from risk stratification based on current methodologies. Generically, these emerging technologies have been termed population health technologies and are believed to offer significant promise.
~ Gibbons, 2005
Reference:
Gibbons, M.C. (2005). A historical overview of health disparities and the potential of
eHealth solutions. J Med Internet Res, 7(5), e50.
A second type of systems-thinking approach is quantitative in nature and focuses on the theories and methods to understand how numerous factors interact nonlinearly, over time in multiple feedback loops to determine health. Each of these tools enables systems approaches to address a broad range of factors within a single framework—from genetic to environmental, cellular to behavioral, and biological to social. For example, chaos and complexity theories have the potential to explain how small changes at the individual level that occur cumulatively in large populations can result in significant shifts in the absolute cases of disease (Rose, 1992; McKinlay and Marceau, 2000). System dynamics modeling and agent-based models are methods that can simulate complex and emergent behaviors, for example, the manner in which a pandemic bird flu might spread depending upon assumptions made about the behavior of individuals and clusters of individuals within different community, cultural, and national contexts.
Many of the components of systems-thinking approaches remain exploratory tools whose potential requires further study. However, successful application of these approaches in defense (Krygiel, 1999), business (Senge, 1994), and cellular biology (Weston and Hood, 2004; Grimm et al., 2005) have resulted in a growing interest in their application to population health research. An evidence base is growing for the impact of systems approaches in areas such as policy interventions for tobacco control (Levy et al.; 2004, Trochim et al., 2006), management of antibiotic resistance and the care of chronic disease (Homer et al., 2001), injury and violence prevention (SOPHE, 2006), and the synergistic interaction between infectious disease epidemics (CDC/NCCDPHP, 2005). Other examples include:
- The Initiative for the Study and Implementation of Systems (ISIS) Project: a proof-of-concept initiative for applying systems thinking to tobacco control.
- The Models of Infectious Disease Agent Study (MIDAS): a collaboration of seven multi-institutional research and informatics groups to develop computational models of the interactions between infectious agents and their hosts, disease spread, prediction systems, and response strategies (NIGMS, 2006).
- The NIH Roadmap for Medical Research: a large-scale initiative that promotes concepts from systems thinking such as stakeholder networks and systems modeling in its emphasis on new pathways to discovery and re-engineering the clinical research enterprise (NIH, 2006).
Systems-thinking approaches show promise for unlocking the secrets of complex, multidimensional health problems, and for transforming this knowledge into effective interventions that can fundamentally change population health (Trochim et al., 2006). OBSSR intends to harness systems-thinking approaches to support very clear and specific objectives: (1) to better understand the complex biobehavioral bases of current population health issues; (2) to create a research culture that works to find and implement solutions to these health problems by understanding how to organize networks of stakeholders at multiple levels; (3) to develop more efficient systems that maximize existing resources; and (4) to effectively disseminate emergent knowledge.
Strategic Recommendations
- Facilitate the development and application of conceptual frameworks and tools needed for the application of systems thinking to the study of human health and its determinants.
- Promote and support the development of biometrics, and the maintenance and widespread use of databases containing genomic information as well as biological, social, and behavioral data related to health.
- Contribute to the development of analytical frameworks, methods, and algorithms capable of integrating, analyzing, and interpreting highly diverse data with varying metrics from research on genomic sequences, molecules, behavior, and social systems.
- Collaborate in the development of curricula, modules, and materials required to train health scientists in the application of systems thinking and tools.
- Encourage the application of systems-organizing principles among stakeholder organizations in the behavioral and social sciences, and promote the development of systems-organizing expertise among leaders, policymakers, and researchers.
- Contribute to the science of dissemination to understand the factors promoting or impeding the adoption and implementation of research by health care providers, insurers, policymakers, and the public.
- Improve the dissemination of science by publicizing successful examples of collaborative research, fostering collaboration with health care delivery systems to translate research into practice, and encouraging a broad research dissemination mandate throughout NIH.
Population Impact: Problem–Focused Research
Behavioral and social sciences research has made enormous contributions toward understanding the relationships among psychosocial and biological factors in promoting health and in minimizing the burden of disease and disability At the same time, however, critical gaps remain in our understanding of well-being and disease. Urgent problems in need of innovative solutions include unintentional injuries and violence; health disparities across the disease continuum; major causes of death including heart disease, cancer, stroke, diabetes, and respiratory disease; and the social and behavioral risk factors that lead to these diseases and disparities (e.g., poverty, smoking, physical inactivity, social isolation, poor diet, stress). To address the complex and challenging population health problems facing our Nation, scientific inquiry must emphasize not only the pursuit of knowledge but also its application to solutions.
The three elements of OBSSR’s vision discussed so far—next-generation basic science, interdisciplinary research, and systems-thinking approaches—describe the types of research needed to achieve OBSSR’s vision. To maximize the population impact of scientific discovery in each of these areas, research products need to be translated into practical applications that are then implemented effectively and efficiently in real-world settings, disseminated broadly to all stakeholders, adopted by organizations and institutions, and maintained through policies. To realize this goal, health research must serve the needs of practitioners, decisionmakers, and the populations they represent, and must reach the audiences it is intended to help.
Making research relevant. Realizing the full potential of our Nation’s investment in health research requires that science inform both practice and policy. With strong leadership, inclusive participation, and appropriate vision, we can stimulate relevant and usable research that is informed by the needs of end users whether they are healthy individuals, patients, practitioners, community leaders, or policymakers. Successful use of each of these elements is described in the sidebar about the North Karelia Project, a multi-modal community-based initiative that serves as a precursor to today’s focus on public health as an integrated system.
To close the gap among research, practice, and policy, innovative models are needed for stakeholder participation throughout the research process. We need robust measures and consistent reporting of intervention and treatment costs that consider multiple perspectives such as those of the patient, payer, community, and employer. Research needs to provide relevant and timely information to practitioners, policymakers, and other decisionmakers. Subject participation in research trials needs to be maximized to understand the full spectrum of demographic, psychosocial, cultural, and religious factors related to health outcomes, and to ensure that research is culturally responsive and relevant to the context in which it will be implemented.
Improving Population Health: Lessons from North Karelia
The North Karelia Project underscores the value of a multi-modal approach to a major public health issue. In the 1960s, Finnish men had the world’s highest rate of heart disease mortality. The death rate was especially high in the province of North Karelia, a rural area in the eastern part of the country. In response to this public health crisis, in 1972 officials in North Karelia began a community-based initiative to reduce cardiovascular disease and mortality. Directed by Pekka Puska, M.D., Ph.D., the North Karelia project included:
- Cultural interventions addressing traditional Finnish dietary norms, successfully reducing fat intake and increasing consumption of fruits and vegetables more than twofold.
- Media outreach including health-related news features, educational content, and a national “quit and win” contest.
- Training health care providers to provide cardiovascular risk factor assessment and counseling for all patients.
- Engaging community leaders and workplaces to spearhead health promotional activities.
- Policy interventions including public smoking bans, the elimination of tobacco advertising, and taxes earmarked for tobacco control programs.
The results of this project are impressive. By the early 2000s, the number of deaths of working-age Finnish men from coronary heart disease had plummeted by 75%. In North Karelia, the reduction was even greater (82%) and life expectancy for men went up 7 years. Much of this reduction in mortality came from reductions in risk factors like high blood pressure, high cholesterol, and smoking through nutritional changes and smoking cessation. Today, this project continues to sustain itself with a modest level of public resources.
Reference:
Puska, P., Pirjo, P., & Ulla, U. (2002). Influencing publicnutrition for non-communicable
disease prevention: From community intervention to national programme—experiences
from Finland. Public Health Nutr, 5(1A), 245-51.
Implementation, adoption, and maintenance. It is not enough for behavioral and social scientists to do rigorous research and develop effective interventions; there must also be delivery channels and systems in place to disseminate these interventions to the public, policymakers, and other decisionmakers to ensure that they are implemented, adopted, and maintained. Research is needed to understand the processes involved in successfully transferring evidence-based interventions from the setting in which they were tested into local settings, which may differ somewhat. Fruitful and innovative business models and partnerships are needed to facilitate the dissemination and adoption of evidence-based interventions throughout the health care system. Implementation efforts must address the science of how discoveries are adopted. This involves considering such factors as capacity, organizational values, and the dynamics of practice networks. These efforts also must address the many contextual variables involved in the adoption and sustained maintenance of evidence-based practices. The systems-thinking approaches described earlier can be used to understand and improve organizational readiness and capacity to adopt and implement best practices.
Finally, behavioral and social scientists must consider factors that relate to the reward structure inherent in today’s health care delivery systems, including financial incentives, core business models, and alignment with organizational goals. The inherent rewards of putting what we know into widespread practice and policy are not built into existing social and economic systems (Kerner et al., 2005). This reality is in sharp contrast to other aspects of the health care industry, where new medications, devices, and technologies are rapidly being developed and deployed, secondary to financial incentives in the private sector pipeline of discovery, development, and delivery.
The past century has seen substantial improvement in overall mortality and morbidity. Life expectancy increased approximately 30 years (CDC, 2005), with adults now living well into their 70s. Despite this progress, the behavioral and social sciences still have enormous contributions to make in elucidating measured gene-environment interaction, and extending longevity, improving quality of life, and eliminating health disparities that have yet to be fully realized.
In some senses “population impact” requires scientists to “work backwards” from a complex but clearly defined problem to all possible causal pathways and their mechanisms of action and contributions to the problem. The “causes of causes” and the drivers of the large numbers of absolute cases of common and chronic disease burden and death may reside as much or more in macrosocioeconomic and lifestyle risk factors as they do in genetic variation or variation on DNA (McKinlay and Marceau, 2000; Rose, 1992).
Strategic Recommendations
- Collaborate in research on high-priority health issues that transcend the boundaries of individual NIH ICs, such as obesity, injury and violence, pain, parenting, and the management of chronic diseases.
- Develop and disseminate standards of evidence for the design, implementation, and reporting of biopsychosocial research of the highest quality and rigor.
- Facilitate a dialogue among researchers regarding the nature of evidence (e.g., randomized controlled trials versus qualitative methods) for behavioral and social science research.
- Help to define and establish consensus on terms such as dissemination, implementation, translation, and adoption.
- Encourage the appliUse problem-focused research to strengthen the science of dissemination and the dissemination of evidence-based behavioral and social science.
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