New Horizons in Health PDF
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New Horizons in Health An Integrative Approach Committee on Future Directions for Behavioral and Social Sciences Research at the National Institutes of Health Burton H. Singer and Carol D. Ryff, editors Board on Behavioral, Cognitive, and Sensory Sciences Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee respon- sible for the report were chosen for their special competences and with regard for appropriate balance. The study was supported by Grant No. N01-OD-4-2139, #56, between the Na- tional Academy of Sciences and the U.S. Department of Health and Human Ser- vices. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data National Research Council (U.S.). Committee on Future Directions for Behavioral and Social Sciences Research at the National Institutes of Health. New horizons in health : an integrative approach / Committee on Future Directions for Behavioral and Social Sciences Research at the National Institutes of Health, Board on Behavioral, Cognitive, and Sensory Sciences, Commission on Behavioral and Social Sciences and Education, National Research Council ; Burton H. Singer and Carol D. Ryff, editors. p. cm. Includes bibliographical references and index. ISBN 0-309-07296-4 (pbk.) 1. Health promotion—United States. 2. Medicine, Preventive—United States. 3. Health planning—United States. 4. Integrated delivery of health care—United States. I. Singer, Burton H. II. Ryff, Carol D. III. Title. RA394 .N365 2001 613'.0973—dc21 00-012474 Additional copies of this report are available from National Academy Press, 2101 Constitution Avenue, N.W., Lockbox 285, Washington, D.C. 20418. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area). This report is also available online at http://www.nap.edu. Copyright 2001 by the National Academy of Sciences. All rights reserved. Suggested citation: National Research Council. 2001. New Horizons in Health: An Integrative Approach. Committee on Future Directions for Behavioral and Social Sciences Research at the National Institutes of Health, Singer BH, Ryff CD, eds. (Washington, DC: National Academy Press). Printed in the United States of America National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engi- neers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respec- tively, of the National Research Council. COMMITTEE ON FUTURE DIRECTIONS FOR BEHAVIORAL AND SOCIAL SCIENCES RESEARCH AT THE NATIONAL INSTITUTES OF HEALTH Burton H. Singer (Chair), Woodrow Wilson School, Office of Population Research, Princeton University Lisa F. Berkman, Department of Health and Social Behavior, Harvard University Linda M. Burton, Center for Human Development and Family Research, Pennsylvania State University John T. Cacioppo, Department of Psychology, University of Chicago Margaret A. Chesney, Center for AIDS Prevention Studies, School of Medicine, University of California, San Francisco David Cutler, Department of Economics, Harvard University Baruch Fischhoff, Department of Social and Decision Sciences, Carnegie Mellon University Jerome Kagan, Department of Psychology, Harvard University Bruce S. McEwen, Laboratory of Neuroendocrinology, Rockefeller University Barbara J. McNeil, Department of Health Care Policy, Harvard Medical School Michael J. Meaney, Douglas Hospital Research Centre, McGill University, Montreal, Canada Carol D. Ryff, Department of Psychology, University of Wisconsin- Madison Robert J. Sampson, Department of Sociology, University of Chicago Shelley E. Taylor, Department of Psychology, University of California at Los Angeles David R. Williams, Survey Research Center, University of Michigan v BOARD ON BEHAVIORAL, COGNITIVE, AND SENSORY SCIENCES Anne Petersen (Chair), W.K. Kellogg Foundation Linda M. Burton, Center for Human Development and Family Research, Pennsylvania State University Stephen J. Ceci, Department of Human Development, Cornell University Eugene K. Emory, Department of Psychology, Emory University Rochel Gelman, Psychology and Cognitive Science, Rutgers University Anthony Jackson, Disney Learning Partnership, Burbank, California Peter Lennie, Center for Neural Science, New York University Marcia C. Linn, Graduate School of Education, University of California at Berkeley Elissa L. Newport, Department of Brain and Cognitive Sciences, University of Rochester Charles R. Plott, Division of Humanities and Social Sciences, California Institute of Technology Michael Rutter, Social, Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry, London Arnold Sameroff, Center for Human Growth and Development, University of Michigan Edward E. Smith, Department of Psychology, University of Michigan James W. Stigler, Department of Psychology, University of California at Los Angeles John A. Swets, BBN Technologies (Emeritus), Belmont, Massachusetts Esther Thelen, Department of Psychology, Indiana University Richard F. Thompson, Neuroscience Program, University of Southern California William A. Yost, Parmly Hearing Institute, Loyola University, Chicago vi Contents PREFACE xi EXECUTIVE SUMMARY 1 1 INTRODUCTION 17 The Context: Behavioral and Social Sciences at the National Institutes of Health, 18 The Charge to the Committee, 19 The Integrative Approach to Health, 21 Key Influences on Pathways to Health, 22 2 PREDISEASE PATHWAYS 25 Cumulative Physiological Risk, 26 Characterizing Predisease Pathways, 28 Connecting Predisease Pathways to Cumulative Physiological Risk, 39 Recommendations, 40 3 POSITIVE HEALTH: RESILIENCE, RECOVERY, PRIMARY PREVENTION, AND HEALTH PROMOTION 45 Resilience and Resistance to Disease: Who Stays Well and Why?, 47 Recovery and Differential Survival Processes, 49 Advancing the Science of Primary Prevention, 51 New Directions in Positive Health Promotion, 54 vii viii CONTENTS Positive Health and the Council of Public Representatives, 56 Recommendations, 57 4 ENVIRONMENTALLY INDUCED GENE EXPRESSION 63 Genes Expression and Prenatal Development, 64 Personal Ties and Gene Expression in Midlife, 65 Animal Models and the Consequences of Mother-Child Interactions, 66 Intergenerational Transmission of Behavior, 67 Plasticity of Genetic Trajectories, 68 Whole-Genome Analyses, 69 Recommendations, 70 5 PERSONAL TIES 73 The Centrality of Personal Ties, 73 Personal Ties and Gene Expression, 77 Personal Ties and Brain Function and Structure, 78 Personal Ties and Neuroimmunological Activity, 79 Personal Ties and Infectious Disease, 81 Social Relational Routes to Health, 82 Recommendations, 84 6 COLLECTIVE PROPERTIES AND HEALTHY COMMUNITIES 91 Community Contexts and Multilevel Research, 92 Experimental Evidence, 93 Mechanisms, 94 Methodological Challenges and Research Priorities, 95 Interactions of Individual and Collective Properties, 97 Other Social Contexts, 97 Recommendations, 98 7 THE INFLUENCE OF INEQUALITY ON HEALTH OUTCOMES 100 Socioeconomic Status and Health, 100 Racial and Ethnic Inequality and Discrimination, 106 Recommendations, 111 8 POPULATION PERSPECTIVES: UNDERSTANDING HEALTH TRENDS AND EVALUATING THE HEALTH CARE SYSTEM 118 Time Trends and Spatial Variation in Population Health, 118 Accounting for Macro-Level Health Patterns, 130 CONTENTS ix Health and the Macroeconomy, 135 The Health Care System, 137 Future Directions in Population Surveys, 142 Recommendations, 143 9 INTERVENTIONS 148 Experience with Interventions, 150 Key Trends, 155 Future Research Needs and Directions, 157 Recommendations, 159 10 METHODOLOGY PRIORITIES 164 Characterizing Pathways, 165 Advancing the Understanding of Biological Mechanisms, 170 Methods of Data Analysis, 175 Design and Evaluation of Intervention Programs, 178 Recommendations, 179 11 RESEARCH INFRASTRUCTURE 184 High Priority Human and Animal Populations, 184 Clinical Research Centers, 186 Communities and Interventions, 187 Training, 188 Recommendations, 188 BIOGRAPHICAL SKETCHES 190 INDEX 197
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