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Advancing the Nation’s Health Needs
care and its delivery critically determines which diseases and problems are attacked, what research is carried out, and which treatments are given. The government has recognized these factors with multimillion dollar investments in surveys, such as the Health and Retirement Survey, the National Longitudinal Survey, and the National Survey of Families and Households. The behavioral and social sciences provide critical insights and knowledge. This knowledge covers a vast array of issues concerning our ability and willingness to deal with disability and our willingness to expend income and assets for health purposes, such as:
distributing health care geographically, sociologically, and economically;
using and misusing health care institutions;
monitoring health providers’ behavior;
studying the psychological and social effects of morbidity and mortality;
tracking the social and psychological effects on treatment and recovery;
transferring assets and beliefs across generations;
documenting social support mechanisms;
measuring the economics of alternative health care systems;
verifying the effects of approaches to care and bereavement; and
making health decisions.
Societal, behavioral, and economic factors work together to produce such problems as drug abuse, smoking, alcohol abuse, anorexia/bulimia, and obesity. Once-treatable diseases are making a comeback in more virulent forms because reliable methods cannot be found to ensure that curative drugs are taken as prescribed. Social and sexually transmitted diseases, such as HIV/AIDS, continue to be an increasing menace. Even crime and violence are rooted in elements that require the expertise of behavioral and social sciences research. It is now accepted that many diseases, historically considered mainly a matter for biomedical research, such as heart and lung disease, drug addiction, tuberculosis, and malaria, cannot be understood and treated without the benefit of behavioral and social research. When these far-reaching health implications of behavioral, social, and economic factors are added to the more direct implications of research for mental illnesses such as depression, schizophrenia, and various neurological illnesses, it is no surprise that the research demand in the behavioral and social sciences has grown rapidly in recent years.
Support for research in the behavioral and social sciences at NIH resides primarily in the NIMH, secondarily in the National Institute on Aging (NIA) and the National Institute of Child Health and Human Development (NICHHD), and is scattered in other institutes (with the present exception of the National Institute of General Medicine. It should be noted that the primary mission of NIMH is research into the prevention and treatment of mental disorders, and the mission of NIA and NICHHD is research into the health problems of young and aging populations. Consequently, neither institute directly supports research into key factors underlying societal health problems, such as smoking, alcohol and drug abuse, obesity, and the like. A case could be made that research in the behavioral and social sciences needs to be augmented significantly by other NIH institutes and centers. Most NIH institutes would benefit from scientists knowledgeable in the techniques, methods, and findings of the behavioral and social sciences. In particular, empirical design and quantitative and statistical methodology that have been so effectively refined in the social and behavioral sciences would be useful. Thus at institutes and centers that do not presently have a direct focus on research in the behavioral and social sciences, at least some training needs to be directed toward researchers with this focus. In addition, some of the training given to researchers with other primary foci needs to be informed by appropriate training in the social and behavioral sciences, a point that is taken up directly in Chapter 8.
BEHAVIORAL AND SOCIAL SCIENCES RESEARCH WORKFORCE
The behavioral and social sciences workforce is as difficult to identify as the biomedical workforce but for different reasons. In particular, it is difficult to identify scientists who are doing basic health-related research, as opposed to those who are involved in clinical practice. Past studies of research training needs in the behavioral sciences generally defined the target workforce as Ph.D.s trained in anthropology, sociology, speech and hearing sciences, and psychology, with the exception of clinical, family, and school psychology. However, since professional organizations in psychology indicate that nonresearch-oriented doctorates are now receiving doctor of psychology (Psy.D.) degrees, the category of clinical psychology is included but not the other practice-oriented fields. Appendix C lists the fields included in the behavioral and social sciences. This inclusion is also supported by an experiment in which NIH was asked to identify whether the research topics for the theses of a sample of the Ph.D. population in the above-listed fields, including clinical psychology, would be considered for NIH funding. The results of this analysis showed that about 90 percent of the thesis topics could be funded and therefore a large portion of the clinical psychology Ph.D.s could pursue research careers. This may be an overestimate of the workforce, but it might provide a more accurate assessment. Whenever possible, the identification of those who do not participate in research will be addressed in the following analysis of the workforce. In particular, attempts were made to identify institutions with professional programs in clinical psychology and to exclude their doctorates from the analysis.