New Horizons in Health An Integrative Approach (2001) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-16
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For example, the National Heart Institute, predecessor of the National Heart, Lung, and Blood Institute, was founded in 1948 and funded its first behavioral science research grant in 1955, focused on psychological factors related to high blood pressure and coronary heart disease. The National Cancer Institute, established by Congress in 1937, has an extensive behavioral research program emphasizing cancer prevention and control.
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An overarching theme is a focus on multiple pathways to diverse health outcomes. Pathway characterizations integrate information from the molecular and cellular level with psychosocial and community levels and thereby represent routes to deeper understanding of disease etiology as well as resilience in the face of adversity.
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Personal ties explicate the mechanisms by which proximal social interactions influence health and disease outcomes; 5. Healthy communities identify the collective properties of social and physical environments that influence health and disease outcomes; 6.
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Operationalization of culmulative risk across systems and across time is an important aspect of characterizing predisease pathways. Illustrating needed research in this direction are emerging studies of allostatic load, a preliminary formulation of cumulative physiological risk.
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that promote recovery and increased survival rates; · initiate new investigations that will advance knowledge of resilience in the face of life adversity, giving particular emphasis to longitudinal studies; · advance the science of primary prevention, giving particular attent~on to overcoming persistent maladaptive behaviors (e.g., drinking, smoking, sedentary lifestyles, poor stress management) ; · develop new population-based initiatives, implemented at local community levels, that promote health via the teaching of positive life practices and the provision of environmental supports to sustain them.
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NIH should support integrative research aimed at understanding the role of environmentally induced gene expression in disease etiology and promotion of health. This should include: · studies that combine environmental manipulations with physiological and molecular assessments to provide refined understanding of conditions leading to dysfunction and, concomitantly, the mechanisms that preserve allostasis; investigation of connections between personal ties, the physical environment, and gene expression are particularly important; · studies that explore in animal models the relationships between chronic stress, interactions among intervening systems (e.g., hypothalamicpituitary-adrenal axis, autonomic nervous system, immune system and overall central nervous system control of these systems)
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. and behaviors; · longitudinal studies that link cumulative social relational profiles with cumulative biological profiles; · increased emphasis on the collection of biomarkers in epidemiological studies of social relationships and health; · extensions of traditional laboratory studies to include experience sampling methodologies and corresponding ambulatory neurobiological ..
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Social processes in these collective sources of influence that require investigation include such phenomena as social cohesion, subcultures of violence, and informal social controls. Integrating collective properties into ongoing health research will also require attending to interactions between individual- and communityleve!
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The concept of cumulative physiological risk provides a useful framework for tracing pathways from environmental exposures to changes in health status. Moving beyond the current NIH initiatives on socioeconomic status and health, the committee recommencis the following foci of attention: · characterization of behavioral and environmental risks associated with educational, economic, and occupational disparities; · elaboration of the subjective experience of racism, discrimination, and stigmatization and their effects on behavior as well as their neurobiological substrates; .
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7. Population Health Previously listed priorities on predisease pathways, positive health, and environmentally induced gene expression place strong emphasis on preventing disease and promoting well-being at levels proximal to the individual.
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Interventions that have been widely implemented and emphasize behavioral and social factors include those designed to decrease behaviors associated with health risk (e.g., alcohol or substance abuse, smoking) or increase behaviors associated with health promotion (e.g., exercise, dietary practices)
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As such, longitudinal studies will increasingly require broad-based forms of data collection social, behavioral, and biomedical. Related to this general issue, the concept of cumulative physiological risk, illustrated with allostatic load, requires further refinement to better understand the cascade of internal events from optimal functioning of multiple systems to accumulating risk.
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10. Research Infrastructure and Training This report makes clear the need for sustained core support of human and animal populations that can be used to investigate integrated biopsychosocial pathways to diverse health outcomes (positive and negative)
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Both incentive structures and an institutional presence will greatly facilitate such collaborative strides. As a first step the committee recommends that NIH create internal mechanisms for developing consensus on the most promising research opportunities within and across the thematic priorities as well as a locus for strategic planning for future trans-institute initiatives.
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The ultimate payoff for the health of the public of the pathway focus emphasized throughout this report is prevention and health care strategies that are more effectively tailored and targeted to the set of circumstances confronting individuals, communities, and populations.
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