induced gene expression, overload of physiological systems) through which behavioral and psychosocial factors contribute to illness and disease. In counterpoint to such maladaptive biobehavioral interactions, people's positive daily practices (e.g., getting proper nutrition, engaging in physical activity, avoiding cigarettes, alcohol, and drugs), along with the quality of their social relationships, psychological outlooks, and community supports are emerging as key ingredients to health and well-being over the life course. In short, the behavioral and social sciences are unavoidably implicated in making sense of both illness and good health, although much as yet is unknown about how these effects occur, particularly in terms of what can be done to avoid their deleterious impacts as well as promote their salubrious benefits for ever larger segments of the population.

This chapter sets the stage for the proposed new era of integrative health research. We first briefly review the history of the behavioral and social sciences at NIH and then describe the specific charge to the committee and our interpretation of this charge.

The integrative approach to health is the overarching theme of this report. In support of it, we revisit the distinguished intellectual history of those who have called for such bringing together of multiple levels of analysis. In numerous corners of science, the need to embark on new inquiries that put the disciplines together is a growing refrain. This synthesis—the move toward “consilience” (Wilson, 1998)—is particularly essential if we are to achieve comprehensive understanding of how good health at the level of the individual and of society is realized or lost. Much has been learned, and will continue to be gained, by focusing on single diseases and single mechanistic processes, but we bring into high relief the reality that many illnesses co-occur, as do many risk factors (behavioral and biological). What is needed, thus, are new studies that delineate the biopsychosocial pathways through which converging processes contribute to diverse health outcomes.

Each of the following chapters is broad and integrative in scope. Collectively, the chapters comprise key elements required for integration, from molecular, cellular, and genetic levels through behavioral, psychological, social, and environmental levels to multiple health outcomes. Stated otherwise, the chapters embody what the committee deemed critical influences that are essential to understanding the pathways to health.

THE CONTEXT: BEHAVIORAL AND SOCIAL SCIENCES AT THE NATIONAL INSTITUTES OF HEALTH

The behavioral and social sciences are increasingly recognized as vital contributors to understanding and improving the nation's health. In this regard, it is important to note the long history of behavioral and social



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