Scott, 1999; Evans and Stoddart, 1990). The term “biopsychosocial,” however, appears to imply three separate spheres while omitting other key disciplines, such as the behavioral sciences and economics. A unified approach that is more inclusive than both the biomedical and biopsychosocial models is needed as a curricular framework for medical education (see Figure 1-1 for an example of such a model).

A number of demographic factors in the United States also underscore the need for more attention to the behavioral and social components of health. First, the proportion of the population aged 65 and over is expected to grow by 57 percent by 2030 (U.S. Bureau of the Census, 1996), and with Americans now having an average life expectancy of 77 years (NCHS, 2003b), physicians need the knowledge and skills to care for this aging population. To this end, they must understand the interplay of social and behavioral factors (e.g., diet, exercise, and familial and social support) and the role these factors play in delaying or preventing the onset of disease and slowing its progression. Physicians also need to have been trained in pain management and means of improving quality-of-life measures that are essential to providing patient-centered care. Knowledge and skills in both of these areas are especially critical for the treatment of chronic conditions, common in this population, that require palliative care.

A second demographic change is the rising percentage of minorities in the overall U.S. population. According to U.S. census data, 26 percent of the current

FIGURE 1-1 Model of the determinants of health. This model is a theoretical delineation of the interacting forces that contribute to the health, functional status, and well-being of an individual (or a population). Reproduced with permission from Elsevier Science Ltd.

SOURCE: Evans and Stoddart (1990).