The Center for the Study of Health and Illness was established as a response to the changing health care landscape in the U.S., and reflects marked changes in major health threats as well as renewed interest in prevention and multidisciplinary research.  For many reasons, social, economic, and behavioral research have become increasingly important in medicine and health care.  As a consequence, the primary focus of the Center is on the integration of these social and biobehavioral sciences with more traditional biological sciences and chemistry at the interface with biomedical research. 

One important factor that has prompted these developments is the dramatic change in the major health threats and problems over the past century.  At the turn of the 20th century, major causes of mortality were predominantly infectious, including pneumonia and influenza, polio and tuberculosis.  One hundred years later, modern medicine had conquered many of these diseases, and chronic diseases such as heart disease, hypertension, cancer, and diabetes have taken their place.  Unlike infectious illnesses, modern chronic illness is caused in part by aging and lifestyle, and presents management as well as prevention and treatment issues.  To some extent stress, lifestyle, exercise, diet, drug and tobacco use, life quality, and other social and psychological factors appear to contribute to wear and tear on the body and to an acceleration of the aging process.  Most of these variables are modifiable and offer important new ways to reduce disease risk as well as the personal, financial, and medical toll of many chronic diseases.  These changes in the nature of serious illness, marked by the emergence of chronic diseases caused by behaviors and lifestyles, pose a number of important issues for study. 

The word “chronic” in this context has two related but separable meanings.  These diseases often take a long time to develop.  For some cancers, for example, 10-15 years may be required before a tumor is detected.  Several independent mutations may need to occur in the same cells and affect the same proliferation-relevant regions of the cell’s genome in order to “cause” a cancer to develop, and many more events appear necessary before it grows to detectable size.  Heart disease and atherosclerosis also involve slow processes that unfold over a lifetime, as are the bases of some metabolic disorders, arthritis, and the like.  At the same time, people are often ill with these diseases for a long time after its discovery and diagnosis.  Treatments may take a long time or last a lifetime, recovery may not be complete, and recurrence is typically possible.  All of these factors, from chronic pathogenesis of disease to long-term treatment and post-treatment issues, introduce new challenges for biomedical research and health care. 

Paralleling many of these developments and contributing to some, there has been an increasing awareness of how the brain, and the thoughts and emotions associated with it, affect health and well-being. Ultimately, research will address why they are key components of most aspects of health and illness.  With the changes in the nature of major illnesses, the limitations of the traditional medical model were revealed and more comprehensive, holistic approaches have been developed.  Even infectious illness, caused by bacterial or viral agents, appeared to have non-biological causes or moderators.  Research has since shown that behaviors, thoughts and emotions do affect the immune system in ways which increase vulnerability to infectious pathogens, and diseases (such as heart disease) and metabolic illnesses (such as diabetes) appear to have psychosocial triggers or behavioral components of both recruitment and control of the dangers posed by them.  Clearly, more complex models are needed to better explain, treat, and prevent these diseases. 

The nature of many chronic diseases suggests that a good deal of the variation in whether one develops a disease is modifiable (to the extent that behaviors, thoughts and emotions can be modified).  This suggests numerous ways to affect the disease process and its course.  It also indicates that prevention, education, and community outreach should be key aspects of the effort to control chronic diseases and of the CSCD’s proposed  activities.  Exercise, diet and other behaviors that contribute to disease can be controlled with systematic interventions and proven approaches to behavior change.  Research on evaluation of and implementation of programs to help people prevent serious illness will be an important focus for CSCD activity.  Hand-in-hand with such efforts, the Center will undertake an educational mission as well, with particular attention to addressing disparities in health care associated with ethnic-or gender-related characteristics. 

Activities in the CSCD will help to coordinate and organize research in areas already well represented on the UT Arlington campus, and to develop research in particular important areas not actively pursued on campus.  The Center will also serve as an important rubric for collaboration across research institutions and investigators at those institutions.  Such developments have already started with UTSW.  The development of a biobehavioral research focus on prevention and care of cancer patients has been initiated among faculty from the Medical Center and The University.  It should also be a boon for teaching and training, providing new contexts and different foci to a range of classes and programs. 
Planned initiatives include the promotion of studies of the etiology and treatment of cancer, as well as of conditions such as pain.  Studies of cognitive aging, drug abuse, trauma, and application of new molecular and imaging techniques in novel ways, will be facilitated.  The role of stress in aging, in the treatment of cancer and in responses to medical care will be featured, as will intervention trials and studies of quality of life.  Interactions among faculty in the Departments of Psychology, Chemistry and Biology in the College of Science and in the School of Nursing, Health Education and Kinesiology, and with faculty in the College of Engineering, will help to establish collaborations involving CSCD scientists and to create new partnerships and approaches to the study and solution of medical problems.