ger, childhood somatic disorders, and chronic pain.14 Moreover, cognitive–behavioral therapy is superior to antidepressants in the treatment of adult depression. Finally, while a combination of cognitive–behavioral therapy and fluoxetine has been shown to be equal to fluoxetine alone in alleviating moderate-to-severe de- pression in adolescents, adding cognitive–behavioral therapy improves the safety of the medication by reduc- ing suicidal ideation and events. 14 15
Another major public health success to which behav- ioral and social sciences research on decision making, drug abuse, and sexual behaviors has made a significant contribution is the mitigation of the spread of HIV/ AIDS.16,17 As people have reduced their frequency of risky behaviors and new medications have become available, new AIDS cases in the U.S. have been cut almost in half, from a peak in 1992 of over 78,000 to approximately 40,000/year since 1998.18 The contribu- tions from behavioral and social sciences research along with the development of effective pharmacother- apies have changed HIV from an imminent death sentence to a treatable, chronic disease. But for medi- cations to be successful, they must be taken on a regular basis, and behavioral and social sciences research has contributed to significant, albeit modest, improvements in adherence.19 An effective partnership between the behavioral and social sciences and the biomedical sciences is at the core of the progress being made in the fight against HIV/AIDS worldwide.
Given the powerful discoveries and successes of basic and applied behavioral and social sciences research— largely achieved within single disciplinary silos without the scientific breakthroughs of recent times—OBSSR’s vision is cautiously optimistic. It reflects a recognition that a new era is dawning in the 21st Century, an era for prevention and for re-engineering the lifestyles and environments that have been created previously. Life- style behaviors, social and physical environments, and policy and economic incentives can indeed be changed. Advances in biology, especially emergent work on epigenomics; dramatic successes in achieving population behavior changes; and improved rigor in behavioral, social, economic and population sciences are continuing apace, due in part to advances in mathematical modeling, informatics, imaging, sensor technology, spatial coding, cyber-infrastructure, and communication tools. These trends facilitate the under- standing of the causes of preventable chronic, common diseases and poor health outcomes, and enable the development of targeted solutions. Changes are in order in the behavioral, social, chemical, and physical environments that are much more user-friendly to the fixed-DNA sequences of human beings. The new tools and technologies and the potential for interdisciplinary and, ultimately, transdisciplinary vertical synthesis from cells to society (e.g., Glass and McAtee20) set the stage for OBSSR’s strategic vision for the future of both basic
and applied behavioral and social sciences research at NIH and elsewhere.
Overview of OBSSR’s Strategic Vision at NIH
The vision of OBSSR, as articulated in the strategic prospectus, is to mobilize the biomedical, behavioral, social, and population science research communities as partners to solve the most pressing health challenges faced by society.1 Such a transdisciplinary approach is called for because there is increasing awareness that the most daunting and intractable problems in public health are so because of their complexity, and that the failure to appreciate and adequately address this com- plexity is thwarting attempts to tackle these problems. Indeed, the health and well-being of the whole popu- lation may be best conceptualized as a “systems” prob- lem, occurring on a continuum over the human lifes- pan as well as across a variety of levels of analysis, ranging from the cellular and molecular to individual and interpersonal behaviors, to the community and society and to macro-socioeconomic and global levels (Figure 1). 21 22
The OBSSR at NIH has historically embraced a biopsychosocial perspective on the causes and corre- lates of health and illness.23,24 Extending the biopsy- chosocial model, Glass and McAtee20 provide an even stronger rationale for OBSSR’s taking an interdisic- plinary and systems science perspective to improve understanding of the forces that determine optimal health promotion and prevention, reduced disease burden, and improved chronic disease management across the human lifespan and across generations.
Consistent with the Glass and McAtee model of problem conceptualization,20 the OBSSR staff recog- nize that the health problems of the 21st Century are complex. Solving these problems not only demands a movement from interdisciplinarity to transdisciplinarity synthesis, but also dictates the methods needed for addressing them.25,26 OBSSR’s emphasis on systems science reflects this awareness.
Figure 1. Transdisciplinary integration: from cells to society over time and across lifespan developmental phases Reprinted with permission from Abrams 22
Am J Prev Med 2008;35(2S)