Opportunities for Behavioral and Social Science Contributions to Population Health Improvement
Teresa M. Smith, PhD, Chair of the Population Health Science SIG
Lila J. Finney Rutten, PhD, Co-Chair of the Population Health Science SIG
Although the U.S. spends more on medical care than any other industrialized nation, and though its citizens are among the wealthiest in the world, they suffer poorer health and live shorter lives than people of many other countries.1 This health-wealth paradox has largely been attributed to failure to address important social and behavioral determinants of health,2 such as tobacco smoking, poor diet, obesity, physical inactivity, and alcohol use.3 Solutions to improve the U.S. population’s health require efforts to address complex interactions among environmental, social, and behavioral factors at the population level rather than through individual pursuits of clinical care for acute and chronic disease. At this time, however, the U.S. underinvests in social services that address and influence social and behavioral determinants of health.2
Behavioral medicine, broadly conceived as having a focus on behavioral, cognitive, social, and environmental factors that affect health and quality of life across the lifespan, can inform efforts to improve population health. A window of opportunity exists for behavioral and social scientists and practitioners to apply methodological and content expertise to inform and engage in the emerging population health improvement movement. There is growing recognition that solutions to pressing health problems require community-wide engagement around promotion of a culture of health, as communities are seeking to create environments and resources that support population health. Effective health promotion and disease prevention programs informed by behavioral medicine and the growing recognition of the social determinants of disease have contributed significantly to reductions in morbidity and mortality during the 20th century. Continuation of research to identify effective means to improve health behavior moving forward is crucial to inform efforts to improve population health and reduce health disparities. Drawing upon the evidence base for individual-level interventions to improve health behaviors and quality of life, behavioral medicine is positioned to inform population-level interventions.
Multilevel Opportunities for Behavioral Medicine Impact
The Centers for Disease Control and Prevention’s Health Impact Pyramid serves as a framework for identifying key areas of future scientific inquiry at the intersection of behavioral medicine and population science. The Health Impact Pyramid identifies a hierarchy of strategies for improving population health ranging from fundamental population-level socioeconomic factors that influence health outcomes to individual-level counseling and education. Behavioral medicine has historically focused its efforts at the top of this pyramid, emphasizing individual level counseling and education; however, there is a great opportunity for behavioral medicine to contribute to efforts across the various levels of the pyramid. At each level of the pyramid, behavioral research is needed to describe population trends, behavioral risk factors, mechanisms of behavioral change, and short- and long-term effects of interventions to improve population health. Comprehensive efforts that span multiple levels of the pyramid have the greatest opportunity for influencing sustainable health improvements, but require coordination outside of public health research and programs.4 The Society of Behavioral Medicine and members from all SIGs can draw upon its rich evidence base and methodological expertise to contribute to the following: evaluation of community-wide efforts to create health equity; addressing social determinants of health; and evaluating the impact of environmental factors behavior and related health outcomes.
1. Jaffe HW, Frieden TR. Improving health in the USA: progress and challenges. The Lancet. 2014;384(9937):3-5. doi:10.1016/S0140-6736(14)61032-1.
2. Adler NE, Prather AA. Determinants of Health and Longevity. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/population-health/adler.html. Published July 2015.
3. Bauer UE, Briss PA, Goodman RA, Bowman BA. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. The Lancet. 2014;384(9937):45-52. doi:10.1016/S0140-6736(14)60648-6.
4. Frieden TR. A Framework for Public Health Action: The Health Impact Pyramid. Am J Public Health. 2010;100(4):590-595. doi:10.2105/AJPH.2009.185652.