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Dr. Christine A. Bachrach, Acting Director
For three decades, the U.S. Department of Health and Human Services (DHHS) has issued 10-year national objectives for promoting health and preventing disease. Healthy People 2020 (HP2020) will leverage scientific insights, innovations in health care, and lessons learned from public health experience to set goals for improving the nation’s health over the next decade. This undertaking is grounded in the idea that establishing objectives and benchmarks to monitor progress over time can help motivate and guide actions to improve health. On October 30, 2009, DHHS issued a call for public comment on the draft HP2020 objectives for the next decade. Comments will be accepted online through December 31, 2009.
Although the health objectives for the next decade will not be finalized until mid-2010, the Healthy People 2020 Framework has been released setting the stage by providing a vision, mission, and overarching goals for HP2020. The Framework provides the foundation and context for establishing and achieving the HP2020 objectives. The Framework is organized around a central vision: “A society in which all people live long, healthy lives. The mission presented in the Framework emphasizes the need for a strong foundation of scientific data and evidence to inform policies and practices to improve health, the importance of increasing public awareness of the social determinants of health and disease, as well as the need to engage multiple sectors of society to take actions to strengthen policies and practices that impact health.  To achieve the HP2020 mission, the Framework articulates four overarching goals.
The mission presented in the Framework emphasizes the need for a strong foundation of scientific data and evidence to inform policies and practices to improve health, the importance of increasing public awareness of the social determinants of health and disease, as well as the need to engage multiple sectors of society to take actions to strengthen policies and practices that impact health.
Over the next several months, the Office of Behavioral and Social Sciences Research and the Office of Disease Prevention will collaborate on a series of columns highlighting the four HP2020 goals. Bringing different perspectives and responsibilities, the two Offices will examine how behavioral and social sciences research supported by the National Institutes of Health (NIH) informs the HP2020 goals and how intervention science and community-based studies can guide strategies to address them. We will also explore promising research opportunities that have the potential to accelerate achievement of the Healthy People 2020 goals.
Behavioral and Social Sciences and the Healthy People 2020 Framework: Synergies and Opportunities
The HP2020 Framework is grounded in a “risk factors and health determinants” approach to understanding the causes of disease and disability. This approach emphasizes the mechanisms through which people’s characteristics, behaviors, and environments affect their health. Over the years, NIH-supported researchers have uncovered many of these important mechanisms – for example, the effects of tobacco use on lung cancer and cardiovascular disease(1); the importance of group level patterns of sexual contact for the spread of HIV(2); and the effects of public policy on parental investments in children’s health(3). NIH has also supported the development and testing of a wide range of intervention programs designed to improve health and prevent disease. Examples include the development of community-based programs to reduce risky behaviors among adolescents(4); lifestyle interventions to reduce the incidence of type 2 diabetes(5); and the development of brief screening and intervention protocols for tobacco(6) and alcohol(7) use for implementation in clinical settings.
Researchers in the behavioral and social sciences have long endorsed the multi-level, life course approach to understanding health. This approach recognizes that health and disease are products of a complex set of factors—biological, behavioral, medical, social, and environmental—as well as their extensive interrelationships and interactions over time.
Researchers in the behavioral and social sciences have long endorsed the multi-level, life course approach to understanding health. This approach recognizes that health and disease are products of a complex set of factors—biological, behavioral, medical, social, and environmental—as well as their extensive interrelationships and interactions over time. Preventing disease and improving health requires action at multiple levels, as illustrated in a classic article by John McKinlay and Lisa Marceau in 2000.
In addition, the level of influence of each determinant of health may change during the life course, so that optimal interventions to improve health may differ at different stages of life. This approach is inherently interdisciplinary, requiring not only the contributions of medical science and epidemiology but also developmental psychology, economics, urban planning, medical sociology, cognitive neuroscience, cultural anthropology, and a great many more specialties.
No one discipline or field of science can address the goals of Healthy People 2020 single-handedly.
Nevertheless, the behavioral and social sciences are uniquely suited to help advance the mission of HP2020.
Nevertheless, the behavioral and social sciences are uniquely suited to help advance the mission of HP2020. Just as the NIH’s investments in behavioral and social sciences research provide a solid foundation for HP2020, the Framework is a clarion call to researchers from these fields to apply their scientific expertise to develop new approaches to improve the nation’s health.
Addressing the Overarching Goals: Current Status and Future Challenges
The Healthy People 2020 Framework identifies four overarching goals. Each of these goals captures a fundamental component of the Healthy People 2020 vision and overall strategy for improving the nation’s health. In future columns we will address in turn these component areas of emphasis – preventing disease and disability, eliminating health disparities and improving health equity, creating healthier environments, and promoting health and quality of life across the life course.
We will seek to respond to the broad question of how can NIH-supported behavioral and social sciences research inform and support efforts to improve the nation’s health through these four key pathways. Our goal in these columns will be to highlight the knowledge and resources that NIH-supported behavioral and social sciences research can bring to bear on achieving the overarching goals of Healthy People 2020. Behavioral and social scientists and NIH-supported science can and must play a central role in leading the way towards creating a society in which all people live long, healthy lives.
- National Cancer Institute, “Tobacco Facts.” http://www.cancer.gov/cancertopics/tobacco. Accessed Nov. 17, 2009.
- Morris M and Kretzschmar M. Concurrent partnerships and the spread of HIV. AIDS 11:641, 1997.
- Gertler P. Do Conditional cash transfers improve child health? Evidence from PROGRESA’s control randomized experiment. Health, Health Care, and Economic Development 94:336.
- J. David Hawkins, PhD; Sabrina Oesterle, PhD; Eric C. Brown, PhD; Michael W. Arthur, PhD; Robert D. Abbott, PhD; Abigail A. Fagan, PhD; Richard F. Catalano, PhD Results of a Type 2 Translational Research Trial to Prevent Adolescent Drug Use and Delinquency: A Test of Communities That Care. Arch Pediatr Adolesc Med. 2009;163(9):789-798.
- Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. Diabetes Prevention Program Research Group. N Engl J Med 2002;346:393-403.
- Solberg LI, Maciosek MV, Edwards EM, Khanchandani HS,Goodman M J. Repeated Tobacco-Use Screening and Intervention in Clinical Practice: Health Impact and Cost Effectiveness. Am J Prev Med 2006;31(1):62–71.
- Curry, S., Ludman, E., Grothaus, Donovan, D., & Kim, E. (2003). A Randomized Trial of a Brief Primary-Care-Based Intervention for Reducing At-Risk Drinking Practices. Health Psychology, 156-165.
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