on behalf of the
prepared for the
April 11, 2000
Mr. Chairman and Members of the Subcommittee, the Coalition for the Advancement of Health Through Behavioral and Social Science Research (CAHT-BSSR) appreciates and welcomes the opportunity to comment on the Fiscal Year (FY) 2001 appropriations for health-related research supported by the agencies within the Department of Health and Human Services. CAHT-BSSR includes 16 professional associations, scientific societies, coalitions, and research institutions concerned with the promotion of and funding for research in the social and behavioral sciences. Collectively, we represent more than 120 professional associations, scientific societies, universities, and research institutions.
We would like to extend our sincere appreciation to Chairman Arlen Specter for his efforts, leadership and support on behalf of the scientific community. We would also like to thank the Subcommittee, as well, for its leadership and support. Congress, with the guidance of this Subcommittee, has invested in the promise of health-related research which transcends political and regional boundaries.
The National Institutes of Health - On behalf of the social and behavioral science research community, CAHT-BSSR thanks the Subcommittee for its increasing support of social and behavioral science research at the National Institutes of Health (NIH), especially that which falls under the rubric of "health and behavior" research. CAHT-BSSR is encouraged by the Subcommittee's recognition of the important implications of social and behavioral science factors for health and illness, including the impact of the stress of day-to-day living on the health of individuals. The Subcommittee's recognition that our nation's health problems have multiple determinants social, behavioral, demographic, and biomedical is essential for ensuring efficient, effective solutions to the complex health challenges we face now and in the future.
Mr. Chairman, we are standing at the threshold of an exciting new era of health-related progress, particularly in the social and behavioral sciences. Opportunities for creating sustainable interventions and prevention programs targeting the leading causes of death and disability in our society have never been greater. Furthermore, despite the significant funding increases provided to the NIH over the last five years, biomedical and behavioral research opportunities still outpace the available funding. Accordingly, CAHT-BSSR supports an appropriation of $20.5 billion for NIH in FY 2001, an increase of $2.7 billion (15 percent) and the third step toward the bipartisan goal of doubling the NIH budget by FY 2003.
Much of the chronic disease burden is preventable, Mr. Chairman. As reported by the Centers for Disease Control and Prevention's National Center for Health Statistics, this nation's critical health issues cardiovascular diseases, cancer, diabetes, AIDS, adolescent pregnancy, infant mortality, and substance abuse have significant social and behavioral factors that must be addressed to prevent and treat them. Chronic diseases heart disease, stroke, diabetes, cancer, and many others are among the most prevalent, costly, and preventable of all health problems. The prolonged course of illness and disability from these and other chronic diseases result in persistent pain and suffering as well as in decreased quality of life for millions of Americans. Medical care costs associated with these diseases account for more than 60 percent of the nation's total medical care costs.
Six of the ten leading causes of death in the United States are behaviorally based, including HIV/AIDS, smoking, violence, accidents, diet, and substance abuse. Other behavioral factors are now known to increase individuals' risk for disease, disability, and early death: obesity, physical inactivity, inadequate social support, environmental contaminates, anxiety, and traits of anger, hostility or depression. Individual behavior is important to health, though, it must not be the only focus to solving our complex problems. Social and economic factors racial/ethnic status, gender, age, income, education, cultural orientation, and community also have important effects on health. Social and behavioral science interventions are increasingly shown to be both effective and cost-effective for society. Social and behavioral science research is needed to undergird, shape, and evaluate such interventions.
Aging. The United States is on the threshold of a longevity revolution. Increased life span and the aging of the baby boom present unique challenges to health care over the next several decades. As more of the United States population ages the number of Americans ages 65 and older is expected to double by 2030 to nearly 68 million it becomes increasingly vital to the health of our entire society that we age well. Many of the problems that can accompany aging, especially chronic diseases, stem from behaviors that place individuals at risk of negative health outcomes. National Institute on Aging (NIA)-supported research has shown that lifestyle and other environmental influences can profoundly impact outcomes of aging, and that remaining healthy and emotionally vital until advanced ages is a realistic expectation. There continues to be a need for social and behavioral science research to develop, maintain, and/or enhance the health and well-being, including physical and cognitive functions, of older individuals throughout the life span.
Health Disparities. Among minority populations in the United States, health disparities have remained persistent and have, in some cases, increased. A Department of Health and Human Services' Task Force on Black and Minority Health task force from 1985 found that "there was a continuing disparity in the burden of death and illness experienced by Black and other minority Americans as compared with our nation's population as a whole." The task force examined the impact of a broad range of behavioral, societal, and health care issues. The task force's report further found that "advances in social and behavioral sciences research and methodology have elucidated relationships among biological, behavioral, and social factors that affect health and illness. The link among these factors [continues to be] critical to understanding the behavioral underpinnings of health, identifying effective strategies for disease prevention, maintaining treatment regimens, and suggesting ways to change behavior for more healthful living habits."
Expected demographic changes magnify the importance of addressing disparities in health status. Groups currently experiencing poorer health status are expected to increase within the total U.S. population, thereby adversely influencing the future health of America as a whole. Research has found a well-documented relationship between socioeconomic status, health, and longevity. People with higher incomes and greater wealth tend to be healthier and live longer. The causes of this relationship, however, are unknown. To aid in understanding causal links between health and wealth, more social and behavioral research is needed, including the support of more economics measures in future clinical trials to allow scientists to assess the impact of economic status on health, and vice versa.
Substance Abuse. The latest estimate of the economic burden for illegal drug use exceeds $110 billion. These costs are incurred through virtually every sector of American society. While the National Institute on Drug Abuse (NIDA) supports a comprehensive portfolio of research into all aspects of drug abuse and addiction, new research is needed to ensure that our current drug prevention efforts are responsive to all populations and to differences in the needs and responses of audiences that often vary in gender, ethnicity, and age. Prevention research is vitally important, given that the greatest risk for initiating drug use occurs during adolescence.
It is now estimated that alcohol use and abuse costs the nation $185 billion annually. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), about 14 million adult Americans have an alcohol-use disorder. Unfortunately, children also suffer from these disorders 23 percent of 14- to 18-year -olds interviewed in a state survey reported having had at least one clinically diagnosable symptom of alcohol abuse or dependence during their lifetime. Even worse, among college-age youth, alcohol abuse is epidemic. How to reduce drinking among young people is a complex and urgent issue, one that needs to be addressed by social and behavioral science research.
Adolescents. The transition from childhood to adolescence is typically a volatile period characterized by dramatic changes and rapid growth. CAHT-BSSR believes that it is important to understand how children adjust behaviorally, socially, emotionally, and academically during this period and how this adjustment affects the health behaviors, traits, and competencies with which they enter adolescence and adulthood. The National Institute of Child Health and Human Development (NICHD), through such studies as its Adolescent Health Survey (AddHealth), strives to better understand these factors. AddHealth is entering its next phase, and will provide important information about how adolescents make the transition into adulthood. CAHT-BSSR also believes it is critical that we understand the interrelationship between biology, behavior and the effect of a child's social environment in order to design effective treatments for children with a range of behavioral problems.
AIDS. The HIV/AIDS epidemic in the United States continues to evolve. While the incidence of new AIDS cases has declined, HIV infection rates are continuing to climb in a number of population groups such as women, racial and ethnic minorities, young homosexual men, people older than 50 years of age, and individuals with addictive disorders. African Americans and Hispanics accounted for 45 percent and 20 percent, respectively, of all newly diagnosed AIDS cases in 1998. Research has shown that behavioral change can successfully prevent or reduce the spread of HIV/AIDS. A better understanding, however, is needed of how to actually change behavior prior to HIV transmission, including how to maintain protective behaviors once they are adopted. We are far from realizing the full potential of prevention research on a global scale. A more refined understanding of social and cultural factors that contribute to HIV risk or protection is needed.
NIH's Office of Behavioral and Social Sciences Research (OBSSR). OBSSR , under the auspices of its first Director, Norman B. Anderson, has made significant progress in increasing the visibility and stature of social and behavioral science research at NIH. OBSSR, created by Congress in recognition of the substantial influence of behavior and social factors on health, is congressionally-mandated to foster the development of cross-disciplinary communication and research collaboration among behavioral and social sciences and between the behavioral and social sciences and biomedical sciences.
Unfortunately, since the inception of the Office in 1995, the OBSSR has been operating with a very small staff and budget. Despite its small budget, however, the OBSSR has been very effective serving as a point of coordination for cross-cutting NIH initiatives. CAHT-BSSR believes the OBSSR has the potential to accomplish much more with the continued support of the Congress and the necessary resources. OBSSR's FY 2000 contributions to the NIH mission are outlined below.
* Understanding and improving adherence to treatment is critical to all institutes of the NIH, and involves multiple levels of analysis from the patient, to the provider, to the context in which the adherence to a treatment must occur. Joining with 12 NIH Institutes, the OBSSR developed a request for application on testing interventions to improve adherence to pharmacological treatment regimens.
* Interpersonal violence has become endemic and constitutes a major public health problem for all Americans, with consequences that include severe psychological and social dysfunction as well as injury and death. Moreover, children and adolescents appear to be disproportionately at greater risk than others for violence perpetration and/or victimization. There continues to be a need for a richer understanding of the social, environmental, psychological, developmental, and biological factors involved in risk as well as a deeper understanding of how these factors interact. The OBSSR, along with NIAAA, NICHD, NIDA, and NIMH, collaborated to develop a request for applications to solicit research proposals that explore the translation of ideas from basic behavioral and social science research into novel interventions for children and youth demonstrating or at risk for violent behavior.
* Advancing our understanding of the role of the social environment in health requires a new commitment. Factors related to the social environment including socioeconomic status, race, gender and place have an impact on the distribution of disease and death. The OBSSR has organized a major conference (Toward Higher Levels of Analysis: Progress and Promise in Research on Social and Cultural Dimensions of Health) for June 27 -28, 2000, on sociocultural factors related to health. The conference will highlight the important contributions of social science to understanding health. The topics that will be addressed by the conference include: factors such as race, ethnicity, socioeconomic status and gender; the linkages between demographic factors and health; social/cultural factors in prevention, treatment, and health services; interpersonal, neighborhood, and community influences on health; health justice and ethical issues; and global perspectives on health. A research agenda will be developed.
The OBSSR's current budget is $19.86 million. The President's request for FY 2001 provides no increase for the Office's budget. CAHT-BSSR supports an appropriation of $21.84 million for OBSSR in FY 2001, an increase of 10 percent. A 10 percent increase would enhance the OBSSR's ability to continue coordinating research across the NIH institutes. Such an increase would allow the Office to augment its efforts in the following areas:
Behavioral Interventions. In 1997, the last year for which figures are available, the number of Americans suffering from health conditions which could be prevented or mitigated with behavioral interventions include: 58 million Americans who are obese, 47 million smokers, 18 million with depressive disorders, 16 million diabetics, 14 million who abuse alcohol, 13 million who use addictive drugs, five million with hepatitis, one million teens who become pregnant, and 600,000 individuals affected with HIV. An additional 10 percent for its budget would allow the OBSSR to support research toward the development of effective interventions for maintaining a healthy diet, getting an adequate amount of exercise, abstaining from tobacco and alcohol use, and other risky behaviors.
Behavioral and Social Science Research Priorities. The National Academy of Sciences panel examining priorities in the social and behavioral sciences will have completed its activities, including recommending several areas of science that would benefit from a targeted effort by OBSSR. A 10 percent increase would allow the OBSSR to move forward to develop initiatives and support several of these new research directions identified by the panel.
The Center for Disease Control and Prevention (CDC). CDC makes significant and critical contributions to the health of the American public, leading to longer, healthier lives. The agency's public health programs effectively promote health and quality of life by preventing disease, disability, and injury. CAHT-BSSR commends the CDC for acknowledging that as human behavior and demographics create new public health challenges, the expertise within the social and behavioral sciences will be critical in keeping the American public healthy. CAHT-BSSR supports the Centers for Disease Control and Prevention Coalition's recommendation of $4.1 billion for CDC, an increase of $1.2 billion over the FY 2000 funding level.
The Coalition's recommended budget for the CDC is essential to adequately support the agency's four priority areas: 1) strengthening science for public health action; 2) collaborating with health care partners for prevention; 3) promoting healthy living at every stage of life; and 4) working with partners to improve global health. The increase would allow the CDC to continue its core functions of detecting health problems, conducting applied research to enhance prevention, implementing prevention strategies, promoting health behaviors, fostering safe and healthful environments, and continuing to provide leadership and training. Tapping the potential of prevention requires adequate investment now.
In closing, Mr. Chairman, CAHT-BSSR would like to emphasize that we are in an era when Americans' health is increasingly damaged by preventable chronic diseases. Fortunately, we are also in a period of exceptional promise in the social and behavioral sciences. Modifying behaviors and our social environments hold the key to major health benefits. Social and psychological factors how we think, feel and behave, as well as the environment in which we live have profound influences on our health. Increasingly, our knowledge of the significance of social and behavioral factors is critical to improving the health of all Americans, as well as maintaining our economic growth. Your continued support for the social and behavioral science research programs at the NIH and CDC is vital to maintaining America's status as the world's premier biomedical and behavioral research leader.
We thank the Subcommittee for the opportunity to present our views.
American Anthropological Association
American Psychological Association
American Sociological Association
Consortium of Social Science Associations
Federation of Behavioral, Psychological and Cognitive Sciences
Gerontological Society of America
Latino Council on Alcohol and Tobacco
National Council on Family Relations
Sexuality Information and Education Council of the United States
Society for Research in Child Development
Society for the Psychological Study of Social Issues
The Alan Guttmacher Institute