Social and Behavioral Sciences A considerable literature on individual behavior and public health has developed in the second

half of the twentieth century. The general failure of public health to pick up and nurture the more macro social science perspectives to the same degree has limited the full potential of the impact of the social and behavioral sciences on public health, particularly because the historical roots of public health in the latter half of the nineteenth century included a strong social structural viewpoint. Since that time, the theoretical development of economics, political science, sociology, and anthropology has accelerated, but it was often not brought to bear on contemporary public health issues because these issues were often defined in terms of the characteristics of individuals rather than as characteristics of social structure. The argument is, then, that public health picked up the wrong end of the social science stickthe individual (micro) end rather than the sociocultural (macro) end. This assertion is supported by any perusal of public health journals or literature on social and behavioral science in public health in the second half of the twentieth century. Nonetheless, as the end of the twentieth century in public health witnessed increasing concern with social concepts such as social inequity, inequality, and community interventions, the disciplines of sociology, anthropology, economics, and political science had a more important role in public health, for the determinants of health were being defined in terms of a social and behavioral perspective. For example, many individual behaviors were recognized as risk factors for poor health, but were also seen as embedded in a wider social context. In addition, a social scienceinformed healthful public policy was seen by many as a key to the development of public health strategies to improve health.

The Social and Behavioral Science Disciplines

The social sciences are concerned with the study of human society and with the relationship of individuals in, and to, society. The chief academic disciplines of the social sciences are anthropology, economics, history, political science, and sociology. The behavioral sciences, particularly psychology, are concerned with the study of the actions of humans and animals. The key effort of the behavioral sciences is to understand, predict, and influence behavior. The chief academic disciplines of the behavioral sciences are anthropology, psychology, and sociology, with the distinction between social and behavioral science often blurred when these disciplines are applied in public health research and practice, particularly in schools of public health and governmental agencies. Many, if not most, public health approaches are problem focused and lead to a multidiscipline solution encompassing several social and behavioral science disciplines and combinations of them (such as social psychology), in addition to other public health disciplines such as epidemiology and biostatistics. Anthropology. Anthropology is a broad social science concerned with the study of humans from a social, biological and cultural perspective. Historically it is a Westernbased social science with roots in Europe and North America. It includes two broad areas of physical and sociocultural anthropology; both are relevant to public health. Physical anthropology divides into two areas, one related to tracing human evolution and the study

of primates, and the other concerned with contemporary human characteristics stemming from the mixture of genetic adaptations and culture. Medical anthropologists with this perspective are often concerned with the relationships between culture, illness, health, and nutrition. Sociocultural anthropology is concerned with broad aspects of the adaptation of humans to their cultures with social organization, language, ethnographic details, and, in general, the understanding of culturally mitigated patterns of behavior. In recent decades this perspective has taken a more ecologically focused view of the human species. From a public health perspective, this approach to anthropology is probably most salient in terms of the methodological approaches used by anthropologists. They have a critical concern with understanding communities through participant observation. Indeed, participation is probably the key concept linking modern-day anthropological approaches to twentieth-century concepts of public health community interventions. Although the methodology of rapport-based structured interviews and observation is a highly developed methodology among anthropologists, it has had limited application in public health. More recent efforts in public health to address issues of inequity at the community level have created more attention to anthropological approaches. Economics. Economics is perhaps the oldest of the social sciences, with its concern with wealth and poverty, trade and industry. However, current economic thinking generally dates from the last three centuries and is associated with the great names in economic thinking, such as Adam Smith, Robert Malthus, David Ricardo, John Stuart Mill, and Karl Marx. Present-day economics is an advanced study of production, employment, exchange, and consumption driven by sophisticated mathematical models. Basically, the field breaks into two distinctive areas: microeconomics and macroeconomics. Microeconomics is largely concerned with issues such as competitive markets, wage rates, and profit margins. Macroeconomics deals with broader issues, such as national income, employment, and economic systems. The relationship between economics and health is obvious because in developed countries the percentage of gross national product consumed by the health care industry is significant, generally ranging from 5 to 15 percent of the gross national product. In the poorer countries, the cost of disease to the overall economy can prohibit the sound economic development of the country. In recent years there has been a concern with both the global economic burden of disease as well as with investment in health. That poverty is highly related to poor public health is a widely accepted tenet of modernday thinking in public health. However, economic systems ranging from free enterprise through liberal socialism and communism offer quite differing alternatives to the reduction of poverty and the distribution of economic resources. Psychology. Psychology is probably the most common disciplinary background found in the application of the social and behavioral sciences to public health. Modern psychology is a large field that encompasses physiological psychology, concerned with the nervous and circulatory systems, as well as social psychology, and concerned with the behavior of individuals as influenced by social stimuli. In general, psychology is concerned with the relationship of living organisms to their environment. In addition to studies focused on physiological mechanisms, psychology is concerned with the broad area of human cognition, including learning, memory, and concept formation. The subfield of abnormal

psychology is concerned with mental disorders, ranging from psychoses to neuroses. The subfield of clinical psychology offers direct patient-care mechanisms to treat mental problems in individuals. Thus the application of psychological approaches to health is quite apparent. However, the most salient branch of psychology for public health practice, and particularly for the task of understanding the determinants of health, is probably social psychology. A major focus of social psychology is on attitudes, opinions, and behaviors. Thus, there is an emphasis on understanding how groups and individuals interact with one another. The degree to which many interactions are easy or difficult can play a major role in determining the stability of groups and individuals. Therefore, broad concepts such as stress, social cohesion, peer influence, civic trust, and others derive strong theoretical and research support from social psychology. Sociology. Sociology is perhaps the broadest of the social science fields applied to public health. It is also characterized by being eclectic in its borrowing from the other social sciences. Thus, sociology is also concerned with organizations, economics, and political issues, as well as individual behaviors in relation to the broader social milieu. A key concept in sociology, however, is an emphasis on society rather than the individual. The individual is viewed as an actor within a larger social process. This distinguishes the field from psychology. Thus the emphasis is on units of analysis at the collective level such as the family, the group, the neighborhood, the city, the organization, the state, and the world. Sociology is concerned with how the social fabric or social structure is maintained, and how social processes, such as conflict and resolution, relate to the maintenance and change of social structures. A sociologist studies processes that create, maintain, and sustain a social system, such as a health care system in a country. The scientific component of this study would be the concern with the processes regulating and shaping the health care system. Sociology assumes that social structure and social processes are very complex. The Social and Behavioral Sciences Working Together Many social and behavioral scientists who work in public health have strong, disciplinary-based, undergraduate and graduate training in one of the social sciences. However, the practice of academic and governmental public health involves disciplinary bases that are seldom as narrow as they would be in traditional, university-based academic departments. Indeed, in many government institutions of public health such discipline-trained social scientists may be simply referred to as health scientists or even as social epidemiologists. Public health practice is largely problem-focused, and whatever disciplinary base is appropriate to the problem will be used. Thus, it would not be uncommon for a person trained as a psychologist to be involved with a program addressed at community change or for an anthropologist to be involved with individual behavioral change. Nonetheless, all of the social and behavioral sciences share a commonality in approach to public health that differs from that of the biomedical approach. Disease is usually seen as a distal outcome, the focus being on those social and

behavioral processes that prevent and reduce disease in people. Generally, the social sciences take a view that health and sickness are only one part of people's lifestyle. The social and behavioral sciences have varied and broad-based methodologies. Discussions of methodological approaches to knowledge attainment are at the heart of many discipline-based discussions. Perhaps the greatest ongoing debate is that over the role of qualitative and quantitative approaches to understanding. Many researchers and practitioners in public health consider data to be the sine qua non of public health. Often data are perceived as being quantitative and numerate. The social and behavioral sciences take a much broader view of what data is. Data can be personal accounts and stories as well as statistical presentations. Nonetheless, the rigor underpinning the appropriate collection of good data applies to both the quantitative and qualitative approaches. There is a strong appreciation that many quasiscientific cognitive ideas, such as race, poverty, or trust, cannot simply be quantified and understood numerically, yet still play a key role in determining health outcomes. .