Raynard S. Kington, M.D., Ph.D., Director, Office of Behavioral and Social Sciences, OD, NIH
In 1999 the National Research Council was asked to develop a research plan to guide NIH in supporting areas of high priority behavioral and social sciences. It sought and received input and advice from ICs throughout NIH. The NRC released its report, New Horizons in Health: an Integrative Approach, in February 2001. The report focuses on areas of common interest to ICs, likelihood of greatest scientific merit, and greatest importance to public health.
The report identified the following ten areas of importance:
- pre-disease pathways.
- environment and gene expression.
- personal ties.
- healthy communities.
- population health.
- positive health or health promotion.
- inequalities.
- interventions.
- methodology and training.
- research infrastructure.
The NRC recommended that NIH expand its support for research on key indicators of biologic influences and related behavioral, social, and psychological influences that precede morbidity and mortality. The report suggested a need to understand complex and dynamic interactions between genetic factors, environmental causal factors, behavioral, and social factors that affect health outcomes.
Three recommendations were broadly related to the notion of untangling the connection between social factors and health outcomes. We need to better understand the cumulative impact of social ties on biologic processes and clinical outcomes. Another area of research is the relationship between characteristics of communities and health outcomes independent of individual characteristics. Similarly research is needed on large trends in population health and health care over time.
The report notes that far too little attention has focused on the study of positive health outcomes. One of the most illuminating questions scientists can ask today is why some people seem to have good health outcomes in spite of the worst social, environmental, and individual risk factors. Community-based research, particularly in the most vulnerable populations, might be a fruitful area of research. Few recognize that poor communities also have the widest variance in health outcomes.
For the next steps, Dr. Kington said his office was interested in collaborating on health disparities research and the role that behavioral and social factors play in explaining the differences. His office hopes to work on the correlation between educational attainment and a wide range of health outcomes. This report is an important research planning document that identifies areas to be addressed to advance public health research over the next decade.
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