Health and Behavior, the Interplay of Biological, Behavioral and Societal Influences.

Health and Behavior, the Interplay of Biological, Behavioral and Societal Influences. Committee on Health and Behavior, Institute of Medicine Research Practice and Policy Board on Neuroscience and Behavioral Health. Washington, DC, National Academy Press, 2001, hardcover, 377 pp, 43. 00. The Institute of Medicine (IOM) was established by the National Academy of Sciences to utilize “the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. ” Each year teams of scholars study issues that are deemed crucial to the fields of medicine, research, and education; collect and analyze available evidence; and make recommendations for change. The results of these investigations are published in text format and made available to the public for a fee. In 2001, the Board on Neuroscience and Behavioral Health collaborated with the Board on Health Promotion and Disease Prevention of the IOM to update the 1982 IOM report, Health and Behavior: Frontiers of Research in the Biobehavioral Sciences. The scholars who were gathered to develop this document come from the fields of medicine, public health, epidemiology, family therapy, psychiatry, clinical and social psychology, law and ethics, and health education. The text begins with an executive summary that defines concepts of health and behavior, and provides a brief overview and summary of findings and recommendations. The remainder of the report is divided into 3 parts that provide a comprehensive evidence-based report that describes the connections between health, biological risk factors, social risk factors, and social contexts. Part One evaluates “Biological, Behavioral, and Social Factors Affecting Health. ” Part Two identifies “Health-Related Interventions, ” and Part Three summarizes their “Findings and Recommendations. ” Chapter Two, “Biobehavioral Factors in Health and Disease, ” begins Part One with extensive evidence to support the effects of stress on all body systems, including negative health outcomes, particularly in the immune and cardiovascular systems. Chapter Three focuses on “Behavioral Risk Factors” and their negative health outcomes, particularly related to the areas most likely to be targeted by health promotion programs: tobacco use, obesity, physical activity, diet, alcohol consumption, sexual practices, and health screenings. The chapter also describes the positive benefits of discontinuing risk behavior. Chapter Four extends the examination of health risk factors to social risk factors including stresses in the community that cause stress in an individual. Socioeconomic factors, social networks, jobrelated factors, social inequalities, and religious beliefs are the topics covered as social risks. Part Two explores “Health Related Interventions. ” Chapter Five, “Individuals and Families: Models and Interventions, ” provides an excellent description of the most commonly used behavior change strategies for individual or population-based interventions, and a review of evidence for the efficacy of behavioral change on disease outcomes for specific conditions. Knowledge of behavior change interventions would be an extremely valuable addition to the interventions provided by physical therapists in all practice settings. Chapter Seven examines “Organizations, Communities, and Society: Models and Interventions. ” The effects of the greater community on the choices individuals make, the availability of resources, and work site factors are investigated. This chapter will be particularly useful for physical therapists who are not familiar with these public policy interventions. If physical therapists are to be truly engaged in health promotion, it is important to work on multi-level interventions that affect health outcomes. Chapter Eight, “Evaluating and Disseminating Intervention Research, ” states that “efforts to change health behavior should be guided by clear criteria of efficacy and effectiveness of the intervention, ” and begins with an explanation of the outcome measures used to evaluate health interventions. The chapter provides an excellent explanation of evidence-based medicine and its importance to clinical decision making. While some may not see a good “fit” with the traditional role of the physical therapist, the concept is well suited to the mission of the American Physical Therapy Association. The authors encourage advancing a “profession's role in the prevention, diagnosis and treatment of movement dysfunction and the enhancement of health and functional abilities of members of the public. ” Part Three contains the committee's findings and recommendations that are a repeat of those in the Executive Summary. Each recommendation could be useful to a practicing physical therapist, or has the potential to be used as the foundation for a project in 1 or more courses in a physical therapy curriculum. For example, a student could be directed to develop a research project, a policy document, a health promotion project, or a campaign to change public health strategies at the local or state level. This report is an excellent source of evidence-based information on the connection of behavior and health. It goes beyond the examination of individual behaviors to look at the behavior of the family, social, and organizational systems. Biological factors are thoroughly explored as the channel for these effects on health. Each finding is supported by extensive research and each chapter contains a long list of references. The text introduces important public health topics and explains how behavior can be changed not only at the individual level, but the community and societal level as well. I would highly recommend this book to both the practicing physical therapist and the physical therapist student whose goal it is to provide primary and secondary health prevention. It could be useful in a course in public health, health promotion, psychosocial aspects of illness, or as a component of a course on administration. Nancy Sharby PT, MS Associate Clinical Specialist Department of Physical Therapy Northeastern University Boston, MA