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New Horizons in Health: An Integrative Approach
institutes have longstanding and well-developed behavioral and social science programs. Trans-institute initiatives with linkages to basic biology are also appearing with increasing frequency, such as recent requests for proposals on socioeconomic status and health and the establishment of mind/body centers.
At the same time, the behavioral and social sciences have limited presence at some institutes or are seen as peripheral to primary agendas. Also when considered, behavioral, psychological, and social priorities are sometimes restricted to a narrow focus on their role as risk factors for particular disease outcomes. A central message of this report is that behavioral and psychosocial processes have broader significance and are fundamental to a comprehensive understanding of disease etiology as well as to promotion of health and well-being.
Building on recognition of these prior strengths and weaknesses, the Committee on Future Directions for Behavioral and Social Sciences Research at NIH embarked on its task. The committee was created under the Board on Behavioral, Cognitive, and Sensory Sciences of the National Research Council. It was established via a request by the Office of Behavioral and Social Sciences Research (OBSSR) to the NRC to evaluate the potential contributions of behavioral and social science research to the mission of NIH and to develop research priorities that support and complement the work of the institutes.
The committee's deliberations regarding investigations that would satisfy the complementary demands of high scientific payoff and response to pressing health concerns led to the identification of 10 thematic priorities. An overarching theme is a focus on multiple pathways to diverse health outcomes. Pathway characterizations integrate information from the molecular and cellular level with psychosocial and community levels and thereby represent routes to deeper understanding of disease etiology as well as resilience in the face of adversity. The mechanisms underlying racial, ethnic, and social inequalities in health also cannot be fully understood without integrated pathway characterizations. Pathway approaches also provide a comprehensive approach to health-promoting interventions. Early intervention and prevention have societal-level payoff in increasing active life expectancy and delaying the age of onset of disabilities. At the same time, the integrated pathway approach affords the knowledge base for more individualized forms of health care.
This report describes in detail the 10 thematic priorities highlighted below. Specific recommendations for research opportunities following from each of them are briefly outlined in this Executive Summary. These recommendations are elaborated at the conclusion of the individual chapters that follow. In addition to the thematic priorities, one overarching recommendation is put forth: the need to institutionalize the integrative approach at NIH.