In 1982, the Institute of Medicine published a landmark study titled Health and Behavior: Frontiers of Biobehavioral Research. That study drew on the findings of six invitational conferences to provide a perspective on the frontiers of the biobehavioral sciences, their relevance to public health—particularly to decreasing the burden of illness—and their implications for science policy. The report stimulated research and training in the biobehavioral sciences, and although the report is now 18 years old, much of it is still current.
The Board on Neuroscience and Behavioral Health and the Board on Health Promotion and Disease Prevention of the Institute of Medicine were interested in updating the 1982 report because of the broad range of research and intervention activity it stimulated, and the growing recognition of the importance of behavior to health during the years since the original report. The Robert Wood Johnson Foundation, the Office of Behavioral and Social Science Research of the National Institutes of Health, and other Department of Health and Human Services sponsors, including the National Institute of Mental Health and the Centers for Disease Control, provided funding for a new study that would differ in several ways from the original report. First, the new study was not to be merely an update of the areas covered in the original report or diseases in which the contribution of behavior is recognized (such as HIV and AIDS), but instead was to identify factors involved in health and disease for which research is incomplete. Second, this study was to go beyond biobehavioral research to consider applications and cost-effectiveness.
The Institute of Medicine convened the Committee on Health and Behavior: Research, Practice and Policy in September 1998. The Committee comprised 12 members with experience in basic, clinical, and public health research; practice in settings ranging from public health to private practice and managed care; and experience with federal, local, and private policy. Committee members had specific expertise in internal, family, adolescent, and pediatric medicine; health policy; epidemiology and social epidemiology; family therapy; clinical and social psychology; law and ethics; health education; neuroendocrinology; and immunology and psychiatry.
The Committee refined its statement of task at the first meeting. The Committee decided that the health and behavior field had become much too large to study comprehensively in the time allotted. The Committee therefore agreed to focus primarily on new and promising developments in the field since 1982, based on the best available research, or, occasionally, on the Committee's assessment of where the field is heading. Committee members agreed that health and behavior should be broadly defined to include both behavioral and psychosocial factors as in the 1982 report, rather than limiting consideration to “health behaviors” such as eating, smoking and other substance use and abuse, and physical activity. This decision also reflected the sense of the Committee that since 1982 the social sciences have made new and exciting contributions to understanding health and behavior and that these have implications for interventions and policy. Psychosocial factors are the individual interpretations or understandings of social relationships, events, or status that reflect a combination of psychological and social variables and are internalized and affect biological factors.
The Committee also decided at the first meeting to consider “applications” of behavioral and psychosocial interventions rather than “practice.” The significance of this change was to enable the Committee to think beyond traditional medical or other clinical practice to include programmatic and public health interventions.
The resulting charge to the Committee was to (1) update scientific findings about the links between biological, psychosocial and behavioral factors, and health; (2) identify factors involved in health and disease but for which research on these factors and effective behavioral and psychosocial interventions is incomplete; (3) identify and review effective applications of behavioral and psychosocial interventions in a variety of settings; (4) examine implementation of behavioral and psychosocial interventions, including guidelines and changes in provider behaviors; (5) review evidence of cost-effectiveness; and (6) make recommendations concerning further research, applications, and financing.
The Committee prepared papers on a variety of topics and deliberated in a series of five meetings, several of which were open to the public. Several experts in health and behavior were invited to address the Committee at meetings, and several more were invited to a workshop on health, communications, and behavior (see agenda in Appendix A). Additional information was obtained through six commissioned papers; a contribution by the Working Group on Family-Based Interventions in Chronic Disease; active participation in meetings by consultants in public health, health psychology and law; and comments on draft papers by a number of additional expert consultants prior to formal review (see Appendix B). The Committee noted great enthusiasm in the health and behavior field, and many busy experts were willing to give generously of their time and effort for little or no compensation. The Committee is grateful to all who provided assistance; those who served as consultants are acknowledged by name in Appendix B.
National Academies Press (US), Washington (DC)
Institute of Medicine (US) Committee on Health and Behavior: Research, Practice, and Policy. Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington (DC): National Academies Press (US); 2001. Preface.