Public Health Magazine: Winter 1995, Vol.5, No.1
Division profile: Sociomedical Sciences

Illuminating the social, political and behavioral context of health care

As a society, we have increased our awareness about how the major influences on health are related to individuals' lifestyles and the way communities organize their delivery of health services. We know, for example, the effects of smoking, unsafe sex, lack of exercise and not following prescriptions. But what motivates people to smoke or not to smoke? Or, to practice safe or unsafe sex, to exercise or not to exercise, to maintain or not maintain medical regimens? How can medical services be better organized to reach all groups in our society and influence such behaviors?

Efforts based on the answers to these questions have reduced some of the major causes of death, such as cancer, heart disease and AIDS. The causes of these behaviors, explained the director of CSPH's Sociomedical Sciences Division (SMS), Professor Eugene Litwak, Ph.D., are well beyond the scope of modern medical care. "It's not enough to just describe what segments of the population are engaging in risky behavior," Litwak said. "It's necessary to know something about human behavior, about the nature of organizations and how behavior can be changed."

SMS has been seeking such answers ever since Jack Elinson, Ph.D. founded the division in 1968. He coined the term "sociomedical sciences" to describe the need to incorporate into the health field a range of social and behavioral sciences: sociology, anthropology, economics, history, political science and social psychology. Associate Professor John Colombotos, who teaches one of the division's core courses in medical sociology, said that "many health problems have social and psychological components. All you have to do is look at the relationship between gender and health, or poverty and health."

This pioneering program became a model for other schools of public health in setting up social science programs. The Ph.D. degree, which is jointly supervised by faculty from CSPH and Columbia's Graduate School of Arts and Sciences, requires equal course work in both schools. It is a monument to collaboration which most other universities have yet to achieve. The doctor of public health and master of public health programs are administered solely through CSPH, but benefit from the interdisciplinary faculty and approaches to study health problems.

The division's original goal, to train basic researchers, has been complemented since 1991 by an entirely new track: the Health Promotion and Disease Prevention Program (see adjacent article). HPDP, as it is known, provides the professional education for careers in such settings as government health agencies, community-based organizations or the private sector. The incorporation of this program into a basic research and training program has permitted communication between two groups of health professionals who ordinarily would have little opportunity to exchange ideas on a daily basis.

This track responds to the increasing public policy demands that research methods be applied to program development and evaluation. Improving and insuring health, within the SMS context, calls for first understanding behaviors from cultural, social, and psychological points of view and then developing programs that improve health outcomes.

The 30 members of the faculty and research staff in the division are committed to the use of social science methods and theory in the study of contemporary health issues. Current SMS faculty research underscores the socio-cultural aspects of many of today's problems: drug use, violence and trauma, alcoholism, adolescent health, gender and mental health, health problems of minority groups, gay and lesbian health, the relationship between pain and stress, social supports, health of the aged, social aspects of disability, the organization of health care, health promotion and disease prevention program evaluation, and the social/ethical impact of AIDS.

Student training is facilitated by the ongoing faculty research into these ever-changing real world health crises. One example is the evaluation of Ryan White Care Act Title I programs in New York City. The project, which is headed by Peter Messeri, Ph.D., and Cheryl Healton, Dr.P.H., evaluates HIV services and thus assists the HIV Health and Human Services Council in setting priorities for funding of Title I by analyzing staffing needs, current staffing, service needs, and health outcomes.

"This is the division's effort to draw upon the analytical and technical expertise of the school, which is normally directed towards basic research, into an area of applied and practice settings, with the ultimate hope that good research and good practice can go hand in hand," Messeri said.

Ann Brunswick, Ph.D., conducts a multidimensional study of AIDS risk in a black community. Among this population, she has found that there is a larger rate of infection among females than the nation as a whole. Within this sample, 75 percent of the African- American males who are HIV positive are unaware that they are infected. In addition, those people who had poor health in adolescence were most likely to be infected as adults.

Mindy Thompson Fullilove, M.D., and Robert Fullilove, Ed.D., have been conducting public health research in communities of color since 1986. Their work encompasses examinations of the AIDS epidemic, drug abuse, violence and homelessness, all viewed from the context of the collapse of the inner city. They were among the first investigators to predict that the crack cocaine epidemic would place many crack users, particularly those who exchange sex for drugs, at risk for HIV infection. The Fulliloves have also studied the relationship between violent trauma and crack cocaine use and have been in the forefront of efforts to improve drug treatment by screening for trauma related disorders among users in recovery.

Mary Clare Lennon, Ph.D., uses her skills in psychiatric epidemiology and sociology to study factors that might affect rates of depression in women and explain the distribution of mental health problems in the population. "I look at men's and women's positions in the family and on the job and at how being in those positions might dispose them to certain types of health problems," said Lennon, who has found that women have twice the rate of depression as men.

From a handful of students pursuing the Ph.D. in 1968, student enrollment in the three degree programs has grown to nearly 200. The division offers three tracks within the master's degree program. In addition to the HPDP track are two research-oriented tracks: the Standard and the recently added Outcomes and Effectiveness research track, which assesses health care.

The division offers a broad range of classes including the basic core courses in medical sociology, medical anthropology, health psychology and Introduction to Sociomedical Sciences; qualitative and quantitative research methods; and substantive courses covering prevention, ethical and political controversies, media interventions, public policy in both homelessness and sexuality, health problems of African-Americans, women's health, worksite health programs, and caregiving in chronic illness.

These classes reflect the mission of SMS: to broaden skills and integrate thought beyond the limitations imposed by the traditional division of human knowledge into separate sciences.