President's Message: Moving Upstream Kicking and Screaming or Leading the Way

Bernard Fuemmeler, PhD, MPH, FSBM, SBM President

SBM has come early this year! In just a few weeks we will convene in Philadelphia for the 45th SBM Annual Meeting & Scientific Sessions. As president this year, I couldn’t help reflecting on the organization’s past – for, as Maya Angelou is credited for saying, “if you don’t know where you’ve come from, you don’t know where you’re going.”

In a paper titled “The Evolution of Professional Societies In Behavioral Medicine,” Freedland (2019) reflects on SBM’s history. He notes that in its early years SBM’s focus reflected, to a major degree, research on the psychosocial factors related to cardiovascular disease with a shift toward examining lifestyle behaviors and behavioral factors related to adherence and self-management of chronic medical conditions in subsequent years (1). For the history buffs, I also refer you to the very nice timeline put together by Marc Gellman, PhD, FSBM, and Sherry Pagoto, PhD, FSBM, which covers behavioral medicine’s history. More recently, our organization’s growth reflects an evolution toward a more multidisciplinary organization that has emerged to cover a range of health topics and a field that is well-represented in the international and national dialogue of health and medicine.

What will the next 45 years to follow look like? It’s hard to tell, but if past is prologue, then our organization’s shift toward greater integration with population and public health is inevitable. As Freedland discussed, a fundamental cornerstone to the growth of behavioral medicine was the “epidemiologic transition” – the changing patterns of mortality, life expectancy, and leading causes of death from those related to infectious disease to those related to chronic disease (2). This transition made it apparent that behavioral medicine and its psychological influence should also shift to address the bio-psycho-social intersections relevant to chronic disease.    

Today, we are in another phase of this epidemiologic transition. A transition reflecting a widening gap in chronic disease and mortality favoring a privileged group – non-minoritized groups and those holding greater wealth who are more highly educated (3). Further, it has become increasingly clear that the issue of health inequities deserves all hands on deck – including behavioral medicine. Not only because it is the right thing to do, but also because health inequities are costing our country nearly half a trillion for racial and ethnic inequities to nearly a trillion dollars for education inequities (4). These inequities are born from a history of discrimination, systemic racism, and devaluation of assets in minoritized communities (5,6). Thus, to address them will require looking upstream at some of the policy, structural, and social drivers that contribute to downstream health conditions (7).  

While a focus on upstream factors has not always been front and center, the field of behavioral medicine has included this focus within its purview. This was apparent to me from interviewing some of SBM’s past presidents for the Buzz in Behavioral Medicine Podcast. For instance, Dr. Kelly Brownell discussed the importance of making the connection between science and policy stronger to make systems changes more supportive of health. Likewise, Dr. Abby King discussed the citizen science approach she is using (OurVoice) to help communities bring light to the systemic issues impacting health within their own communities. All of them talked about the importance of multidisciplinary teams and the need to increase the diversity of individuals unrepresented in behavioral science to help us address upstream factors and the health inequities that result from them. Of course, the conference is centered on this theme and we are very excited to have presentations from several prominent scholars who are bringing to light to the importance of addressing upstream factors.

Ultimately, addressing health inequities and the social drivers of health requires an upstream lens. Behavioral medicine is needed to lead the charge at identifying not only the individual and interpersonal factors shaping health, but also demonstrate how those factors are shaped by the larger systems in our society and what we can do to intervene to change these systems to improve health. Identifying solutions to address upstream factors and reduce health inequities is our field’s next big challenge. Our science and the evolution of our field needs new leaders who bring novel perspectives from backgrounds (professional and personal) that are underrepresented in our field to help pave the way. So, for this next conference, come one and come all. I welcome you to join us in Philadelphia in helping us lead the way to addressing upstream factors to reduce health inequities in our society and beyond. See you soon!

References:

1. Freedland KE. The evolution of professional societies in behavioral medicine. J Behav Med. 2019 Feb;42(1):52-56. doi: 10.1007/s10865-018-9946-3. Epub 2019 Mar 1. PMID: 30825088; PMCID: PMC6938686.  
2. Omran AR. The epidemiologic transition. A theory of the epidemiology of population change. Milbank Mem Fund Q. 1971 Oct;49(4):509-38. PMID: 5155251.
3. National Academies of Sciences, Engineering, and Medicine. 2017. Communities in action: Pathways to health equity. Washington, DC: The National Academies Press. doi: 10.17226/24624.
4. LaVeist TA, Pérez-Stable EJ, Richard P, Anderson A, Isaac LA, Santiago R, Okoh C, Breen N, Farhat T, Assenov A, Gaskin DJ. The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US. JAMA. 2023 May 16;329(19):1682-1692. doi: 10.1001/jama.2023.5965. Erratum in: JAMA. 2023 Jun 6;329(21):1886. PMID: 37191700.
5. Jones CP. Levels of racism: a theoretic framework and a gardener's tale. Am J Public Health. 2000 Aug;90(8):1212-5. doi: 10.2105/ajph.90.8.1212. PMID: 10936998; PMCID: PMC1446334.
6. Perry, A., Rothwell, J, and Harshbarger. The devaluation of assets in black neighborhoods: the case of residential property. (November 2018). Brookings Institute. Retrieved Feb 14, 2024, from https://www.brookings.edu/wp-content/uploads/2018/11/2018.11_Brookings-Metro_Devaluation-Assets-Black-Neighborhoods_final.pdf
7. Domestic Policy Council Office of Science and Technology Policy (November 2023). The U.S. Playbook to Address Social Determinants of Health. Retrieved Feb 14, 2024, from https://www.whitehouse.gov/wp-content/uploads/2023/11/SDOH-Playbook-3.pdf.