Preventing chronic disease and improving health: broadening the scope of behavioral medicine research and practice.

There has been much progress made over the past 50 years in developing and applying the behavioral medicine evidence base to improve the health of individuals and populations. In particular, there has been progress made in applying behavioral and social science research and theories to the challenge of promoting health and disease prevention. These gains notwithstanding, not all sections of the population have benefited equally, either within or between countries. The disparities in social, mental, and physical health between the most advantaged and the most disadvantaged population groups are in the main, as great as, if not greater, than ever. This represents a tremendous challenge to all of us as behavioral medicine practitioners, teachers, and researchers. Although understanding more about the so-called upstream determinants of health that generate such health disparities is clearly very important, this knowledge will only make a difference if it is used to generate appropriate multilevel intervention strategies over a long and sustained period of time. However, such outcomes will also be affected by diverse aspects of the global natural ecological environment, and by striving for what has been described as a health-sustaining environment. With the increasing impact of globalization on most aspects of our lives, including health, it is important to consider the implications of this for preventing disease and promoting health across traditional national borders. This should challenge us to think about the importance of appropriate dissemination and diffusion of effective interventions at an institutional or policy level not only within a single country, but also between countries. Given the rapid economic and social changes occurring globally, and the tremendous impact of global environmental change on health, there is a need to broaden the scope and practice of behavioral medicine.