To help overcome multiple barriers to the incorporation of the behavioral and social sciences into medical school curricula, the committee recommends that the National Institutes of Health or private foundations establish behavioral and social sciences career development and curriculum development awards. Moreover, concerned that the U.S. Medical Licensing Examination currently places insufficient emphasis on test items related to the behavioral and social sciences, the committee recommends that the National Board of Medical Examiners ensure that the exam adequately covers the behavioral and social science subject matter recommended in this report.

ROLE OF BEHAVIORAL AND SOCIAL FACTORS IN HEALTH AND DISEASE

For more than a decade it has been well established that approximately half of all causes of morbidity and mortality in the United States are linked to behavioral and social factors (McGinnis and Foege, 1993; NCHS, 2003a). In fact, the leading cause of preventable death and disease in the United States—smoking—significantly increases the risk of lung cancer and chronic lung disease, as well as the risk of heart disease and stroke (CDC, 1999; Mokdad et al., 2004; NCHS, 2003a). A sedentary lifestyle, along with poor dietary habits, has also been associated with increased risk of heart disease, as well as a myriad of other adverse health conditions, and may soon overtake tobacco as the leading cause of preventable death (Graves and Miller, 2003; Mokdad et al., 2004; Morsiani et al., 1985; U.S. DHHS, 2001). Alcohol consumption is the third leading cause of preventable death in the United States (Mokdad et al., 2004). And although moderate alcohol intake may have some protective effects against heart disease, excessive consumption has been linked to a variety of potentially preventable conditions (Maekawa et al., 2003; Nanchahal et al., 2000; Pessione et al., 2003).

Illnesses related to behavioral factors include, among others, cancer, heart disease, poor pregnancy outcome, chronic obstructive pulmonary disease, type II diabetes, and unintentional injury (Hoyert, 1996; NCHS, 2003a; NHLBI, 2003a,b; U.S. DHHS, 1996). In addition to these adverse health effects of harmful behaviors, psychological and social factors have been shown to influence chronic disease risk and recovery. Psychological factors, such as personality, developmental history, spiritual beliefs, expectations, fears, hopes, and past experiences, shape people’s emotional reactions and behaviors regarding health and illness. Social factors, including support of family and friends, institutions, communities, culture, politics, and economics, can have profound effects as well. Indeed, scientific evidence is increasing on the effects of psychological and social factors on biology, and recent studies have demonstrated that psychosocial stress may be a significant risk factor for a variety of diseases (Barefoot et al., 2000; Carroll et al.,



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