The IOM Report: The Individual and Social Structure M. Powell Lawton D r. Schaie's request to me was to address issues in the interface between the individual and the social structure from the perspective of the IOM research report of 1991, Extending Lifer Enriching Life. To do so requires an explication of the IOM report's goals and methods. The IOM Committee on a National Research Agenda on Aging was convened in 1989 "to develop priorities on age-related research for the next 20 years" (Lonergan 1991 f p.vii). member Committee called on 63 scientists plus others for expertise in the production of their reportr subtitled "A National Research Agenda on Aging." organized The Committee's work was An 18- around 5 areas, which form the main sections of its 131-page published report: Basic biomedical research, clinical research, behavioral and social sciences, health services delivery research, and research in biomedical ethics. Each of these 5 sections includes a short list of primary research priorities plus a supplemental method of development needs. The Social Structure of the IOM Report The origin of the Committee was apparently within the IOM, although no details are provided regarding the origin of the idea the NIA, Congress, or other constituencies. Whatever multiple inputs may have supported the idea, the home of the Committee was Presented at a symposium on the Aging Individual and Social structure, organized by K. Warner Schaie, at the Annual Meeting of the Gerontological Society of America, Washington D.C., November 21, 1992 clearly in the social structure composed of the medical interests of our society. Although a minority of Committee members were themselves physicians, the IOM sponsorship marked the purpose as that of generating a research agenda on health and aging. I have read many times the published report and I do not find any clear delimitation of the scope of the Committee's concern to the health-related aspects of aging. The subtitle is all-encompassing: "A National Research Agenda on Aging," the commission refers to "age-related research for the next 20 years," and the repeated emphasis is on "general research priorities," Thus the expressed goal is to weigh all possibilities for research and make recommendations for what were the most important directions. The structure supporting these recommendations was the biomedical organizational structure of science, but the goal was to specify the research priorities in aging that would guide governmental and private research funding and, therefore, the efforts of research scientists, for the next 20 years. To what extent did the medical research social structure succeed in addressing the full spectrum of concern for the aging individual and our aging society? A close analysis of the content of the report reveals what one would expect from the locus of the social structure that produced the report: Healthrelated aging# not aging in general, i > the topic of the IOM j. Committee's report. I'll repeat the titles of 4 of the main sections, which account for 80% of the content: Basic biomedical research, clinical research, health services, and a minor section on biomedical ethics. Presumably it might be the 5th topic, behavioral and social sciences, where the non-medical aspects of aging would be given their due. I have therefore given my closest attention to this section. The behavioral and social sciences section of the report d o e s , in fact, deal with manyf perhaps most, of the important content areas in this scientific domain. The light cast onto this domain is curiously refracted, however, because in virtually every statement made about a researchable topic, health is either the dependent or the independent variable. In my discipline, we have a thriving sub-area called "health psychology," but it constitutes only a small portion of psychology. Even if we add the much larger sub-area of clinical psychology, you still account for much less than half the total research effort in psychology. I imagine one could make the same type of estimate Nonetheless, the report is very rich in the field of sociology. in this domain. I f v e stated my conclusion. Now let me document it. The research priorities are preceded by a discussion of 3 underlying themes. One deals with the interaction of individuals and social contexts; here it is stated that "medical research can no longer by separated artificially from sociological, economic, or psychological research" (p.73). A second theme is "Differentiation," which stresses subgroup patterns of aging, the George Maddox "aging differently" theme. This one too acknowledges that although "aging surely has a biological component, the list of explanatory factors must include those that are predominantly social and behavioral" (p.74). "Modifiability" is the third background theme, where the work of Willis and Schaie on plasticity of learning and Rodin on selfesteem are noted. The health emphasis is strong in all 3 of these themes, but the discussion prepares the reader for both health-related and non-health-related research priorities. This expectation is not met, however, in what follows: 3 major research priorities, a secondary group of "additional research opportunities" in social science and behavioral research, and a separate group of research issues in crosscutting areas. The titles of the 3 major priorities portend well Basic social and for aging research in its total expanse: psychological processes of aging, population dynamics, and our topic of today, social structures and aging. I performed my own homemade content analysis on this section of the IOM report, admittedly without benefit of multiple raters and kappas. I examined each sentence to determine whether health or illness was noted as an antecedent or consequence of some social or behavioral process, whether on an individual or societal level. For the first priority, basic social and I counted 25 sentences, of psychological processes of aging, which 17 met the health-related criterion, 6 referred to nonhealth-related relationships, and one was not classifiable. The population dynamics priorities consisted of 19 sentences, 14 of which were health-related, 3 confined to social-psychological issues, and 2 unclassifiable. Finally, the research priority on social structures and aging was the only one that featured more research issues dealing with social structure and the person, exclusive of health -- 14 of these, with only 8 having the health 4 connection. For the record, 3 brief additional social issues dealt only with social and personal issues, while all 3 additional behavioral issues are health-related. the discussion of the cross-cutting issues -- Virtually all gender, race and was health- SES, population dynamics, and brain and behavior -- related, perhaps appropriate if one considers health a necessary definer of a cross-cutting issue. Putting together the 4 essential health sections and the distribution of topics within the SBS section, my conclusion is that the emphasis on health-relatedness of the total report amounts to about 93%. Let me hasten to acknowledge that research efforts to identify major concerns of older people reveal that health is a high priority, perhaps the highest priority. This is very different from saying that health affects or is affected by every facet of older people's lives. Poor health overrides many other features of life when present, but, as we have repeatedly learned, the majority of elders are functionally independent, they are no more depressed than other age groups, and their selfevaluations of health are far more positive than would be presumed by their high prevalence of chronic illness. My wish regarding the 3 major priority areas is that the IOM Committee might have recognized research needs exclusive of the health arena. The first priority, "investigating... the mechanisms underlying the interrelationships among social, psychological, and behavioral...aging" (i.e. omitting the other term, "biological") covers an immense territory that includes familial and peer relationships, meaningful activity, participation in the larger social world, community and neighborhood integration, high-level performance, new learning -- on. the list could clearly go Who is ready to say that topics like these gain significance as national research priorities only when they may be shown to vary with biological health? By the same token, "population dynamics" includes matters such as national and subgroup fertility, population movement and individual migration, and the geographic distribution of age groups, all of which have major aspects that are independent of mortality and morbidity. The recommendations within the third priority area, "the manner in which social structures and changes in those structures affect aging" give us a small view of some of the non-health-related world of aging in our society. Differential access to our social and economic resources, changing familial and residential structures, work-force participation, and social attitudes toward aging are a few of the social structures affecting aging of the individual that are noted as deserving further research. It thus seems that this confluence of person and social structure emerged as the one point in the Committee report where the total life of the aging person was given its due. The point in the social-structure discussion that I see as especially deserving of note is its acknowledgment of a number of positive goals for elders: "Performance," "productivity," "wellbeing," social "ties," "psychological competence," "adaptive capacity," and "sense of effectiveness" are terms used in this section. To note that these are possible outcomes of transactions between the individual and the social structure acknowledges the independence of these goals from health issues. However, such positive goals need also to be studied as a function of purely intrapersonal processes such as developmental and experiential history, social roles and social objects, and contemporary physical and social environmental contexts. In shortr the major criticism to be made of the IOM report as a national research agenda is the implicit message that good health may prevent negative psychological outcomes, but that positive goals are f for the most part/ not significant enough to be acknowledged as possible research foci. This underemphasis of the positive is certainly not unique to the IOM report. The history of psychology has been marked by periodic reminders of the importance of such factors as challenge/ growth/ and positive affect. Our field is still attempting to catch up with Bradburn's demonstration a couple of decades ago that mental health had to be defined by both an absence of negative emotion and a surplus of positive emotion. It is becoming clearer that influences from outside the person -- that is f from a stimulating microenvironmentf satisfying personal relationships, incentives to develop competence/ to perform activities for their own sake -- positive emotional states. are particularly conducive to Such knowledge underlines the desirability of further research in how these environments/ relationships/ and social structures may be altered to maximize positive personal goals. Further/ there is the converse: How may the older person become more effective in recognizing/ choosing/ and even designing contexts that foster such goal attainment? Once againf we can certainly not afford to overlook the ways in which health moderate the person-environment or the person-social structure relationship. But for the majority whose health is satisfactoryf the relationships of greatest interest are those between separate facets within the personf between the person and her interpersonal networkf between person and social structure, and between both person and social structure, on the one had, and population dynamics, on the other. In summary, a biomedical world view leads the social structure of research on aging human beings. Carroll Estes noted yesterday her diagnosis of what ails services for elders, that too many of the rewards of services go to the medicalpharmaceutical-proprietary sector rather than to the older client. As researchers embedded in this same social structure, our rewards will be increased to the extent that our research can be located in the behavioral health sector. We are in danger of having our personal goals and behaviors subverted by this healthdominated social structure. The social structure of the We now need a epistemology of aging owes us one at this point. research agenda for the mid-1990s that will facilitate our efforts to discover how all human goals of older people and of the society in which they are an indivisible component may be approached. It would be especially desirable if such an expanded mandate could include health as an intrinsic aspect of goal attainment. Because the IOM report split off the health sector and did so well with this limited sector, what remains is to produce an equally thoughtful set of research priorities that treat the "other side," that is, the social, psychological, economic, and political aspects of aging. 8 How about it, NIA and NRC?
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