restricted access New Horizons in Health: An Integrative Approach (review)
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Journal of Health Politics, Policy and Law 27.3 (2002) 513-516

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Review Essay

New Horizons in Health:
An Integrative Approach

Burton H. Singer and Carol D. Ryff, eds. Committee on Future Directions for Behavioral and Social Sciences Research at NIH. New Horizons in Health: An Integrative Approach. Washington, DC: National Academy Press, 2001. 224 pp. $39.00 cloth.

What should priority research areas be for the National Institutes of Health (NIH)? Is NIH currently overlooking critical, promising research? Does the structure of NIH impede the charting of future directions that might pay large dividends?

The confluence of three factors make such questions as these particularly salient. First, choices about how research dollars are apportioned now may help determine the existence of future treatments as well as overall health care costs. These are significant matters at any time, but especially so in the present political climate with the growing concern over the soaring national health care bill. Second, the magnitude of the federal government research enterprise elevates its decision making regarding research priorities to the level of a critical issue. The federal government is the single largest sponsor of medical research, and the vast majority of its research money is appropriated to NIH. A bipartisan congressional drive, currently proceeding successfully, may double NIH's annual budget over five years, from $13 billion in 1998 to $26 billion [End Page 513] by 2003, and as NIH receives larger shares of the budgetary pie, the stakes regarding the spending of its money increase. Third, discontent with NIH's priority-setting criteria has exploded recently, with various constituencies pressuring NIH for explanations, justifications, and modifications (Johnson 1998; Marshall 1997). Disease-advocacy groups, for instance, increasingly have complained that their disease fails to get a fair share of funds. Congress, hearing these protests and with allocation concerns of its own, in 1997 requested the Institute of Medicine (IOM) to study NIH priority setting (U.S. Congress 1997).

In New Horizons in Health: An Integrative Approach, the Committee on Future Directions for Behavioral and Social Sciences Research at NIH presents recommendations and a research plan for NIH regarding behavioral and social sciences. The committee, created by the National Research Council (NRC) at the request of NIH's Office of Behavioral and Social Sciences Research (OBSSR), comprises fifteen scientists with records in multidisciplinary research from diverse backgrounds and fields of expertise. The committee's report is a commissioned study, intended
to guide NIH in supporting priority areas in the behavioral and social

Not surprisingly, considering the committee's origin, a major argument of New Horizons in Health is that behavioral and social sciences, which currently capture limited attention or are viewed as peripheral at some NIH institutes, merit a greater research investment. The Committee on Future Directions contends that this research is fundamental to developing a comprehensive understanding of disease etiology and holds broad significance for multiple disease outcomes and health promotion. To realize the potential, greater integration of biomedical sciences on the one hand and behavioral and social sciences on the other hand is critical; in other words, the suggestion is that NIH institutionalize a new approach, integrating biomedical and social behavioral fields of inquiry. More specifically, the study recommends ten priority areas for research investment to integrate these fields at NIH and furnishes a thorough discussion of each of these areas. The ten thematic priorities, satisfying "the complementary demands of high scientific payoff and response to pressing health concerns" (2), are predisease pathways, positive health, gene expression, personal ties, healthy communities, inequality, population health, interventions, methodology, and infrastructure.

The report by the Committee on Future Directions has obvious strengths. It offers an in-depth and serious exploration of the potential contributions of behavioral and social sciences research to the NIH mission and, as intended, should help to dispel the notion that this research [End Page 514] is in any way peripheral to NIH. The comprehensive examination of the ten recommended priorities also succeeds in reinforcing the reader's appreciation of the broad significance of behavioral and social sciences research for...