Sm. Sci.Med. Vol. 35,No. II,pp.134LLl357, 1992 0277-9536/92S5.00+0.

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Printed in Great Britain. All rights reserved Copyright 0 1992 Pergamon Press Ltd

THE POTENTIAL OF TRANSDISCIPLINARY RESEARCH

FOR SUSTAINING AND EXTENDING LINKAGES
BETWEEN THE HEALTH AND SOCIAL SCIENCES*

PATRICIA L. ROSENFIELD
Carnegie Corporation of New York, 437 Madison Avenue, New York, NY 10022, U.S.A.

Abstract-The last decade of the twentieth century is witnessing a profusion of projects drawing together
social and health scientists to study and recommend solutions for a wide range of health problems. The
process-practiced in both developed and developing countries-is usually called multidisciplinary or
interdisciplinary research. Its historical precedents are briefly reviewed in this paper along with the types
of problems addressed. From a review and discussion of a sample of projects selected from two major
proponents of this approach to research, the Social and Economic Research Component of the
UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases and the
Applied Diarrhea1 Disease Research Project, conclusions are drawn about the nature of contributions
from such efforts-very useful for short-term problem solving, less so for longer-term programmatic
changes, especially beyond the health sector, and even more limited in impact on theory building for
coping with the changing human condition. The recognition of such limitations is now widespread in the
social and natural sciences beyond the health sector, in population, ecology, and the humanities. Following
these observations, I argue for a new approach to transcend the disciplinary bounds inherent in multi-
and interdisciplinary research. A transdisciplinary approach can provide a systematic, comprehensive
theoretical framework for the definition and analysis of the social, economic, political, environmental, and
institutional factors influencing human health and well-being. The academic and career challenges for such
researchers, while considerable, may be overcome since there is now a new flexibility in research-support-
ing organizations to encourage new ideas in international health, such as that of essential national health
research.

Key words-multidisciplinary, interdisciplinary, transdisciplinary, health and social sciences, public health

THE CONTEXT FOR COLLABORATION collaboration at the turn of the century as bacteri-
BETWEEN THE HEALTH AND SOCIAL SCIENCES ology became the dominant discipline, and to a
resurgence of interactions in the post-World War II
While the medical profession has long recognized that
era [2]. Since the first World Health Assembly of the
human health depends on a combination of physical,
World Health Organization held in 1948, there have
social, cultural, and economic factors, only since the
been periods of active collaboration across medical
1980s have social scientists come to play a major role
and social science, as well as periods when powerful
in research on health problems and programs.
centrifugal forces limited such collaborations [3].
William Petty, in the 16OOs, was possibly the first
In the 196Os, for example, medical and biological
nonmedical practitioner to analyze systematically the
sciences dominated the conduct of disease control
complex interactions of health, demographic, social
campaigns and economic assistance programs, which
and economic conditions. He started a tradition of
consequently focused primarily on medical services
‘holistic’ analysis of human health and well-being [ 11.
and the construction of hospitals where such services
But as the social and medical fields became structured
could be delivered [4]. In the 197Os, renewed interest
into formal disciplines and sub-disciplines, the analy-
in human ecology and ‘lifestyles’ sparked a renewed
sis of the factors influencing human health were also
awareness of social, cultural, and economic factors
partitioned. Kerr White and James Trostle have
influencing disease control and chronic illness preven-
separately reviewed the fascinating history of the
tion. This period culminated in the watershed Alma
collaboration between the health and social sciences:
Ata conference of 1978, sponsored by the World
from the prominence of social sciences in the nine-
Health Organization and UNICEF. The Alma Ata
teenth century health studies, through the demise of
meeting promulgated the goal of Health for All By
the Year 2000 (HFA 2000), a goal to be achieved not
*This paper is based on a presentation at the American by building hospitals, but rather through promotion
Anthropological Association Annual Meeting, Wash- of community-based primary health care, community
ington DC, 15 November 1989, at the Invited Session
participation, and intersectoral actions for health [S].
entitled: ‘Fostering Research Capacity in the Developing
World: Problems and Prospects in Medical Anthropol- The ‘HFA 2000’ strategy in turn made possible an
ogy.’ intellectual explosion in the 1980s of research efforts

1343
1344 PATRICIA L. ROSENFIELD

linking the medical and social sciences [6]. The 1980s practical impact necessary to sustain creative
saw a profusion of studies on: cultural and behavioral collaborative work and attract the most talented
aspects of specific diseases ranging from malaria to researchers, the most astute policy makers, and
leprosy and diarrhea [7]; social pathologies such as the most enthusiastic implementers.
suicide and drug addiction [8]; broad programmatic But creative collaboration requires more than
themes such as nutrition, family planning, child sur- social and medical scientists working on the same
vival, and safe motherhood [9, lo]; economics of problem as part of the same team. To achieve the
health and health services, including health care level of conceptual and practical progress needed to
financing [ 111; and, policy issues, from health-specific improve human health, collaborative research must
service policies to intersectoral activities for health transcend individual disciplinary perspectives and
improvements [12]. develop a new process of collaboration. A transdisci-
The new respect and support for interdisciplinary plinary approach, as argued for in this paper, will
research linking social and health sciences emanating yield qualitatively different results; it provides the
from the 1980s was given international credibility for critical element missing from collaborative research
the 1990s following the publication in ,199O of the as the latter has developed in the 1980s and 1990s.
report of the international Independent Commission While a disciplinary basis must be the natural starting
on Health Research for Development [13]. Its major point for each team member, the starting point
recommendation is to promote in each country ‘Es- rapidly becomes the limiting factor in problem defi-
sential National Health Research’ (ENHR). The re- nition, collection and analysis of data, and interpret-
port, introduced at a Nobel Symposium in ation of findings. Each team member needs to
Stockholm, states boldly that “The commissioners become sufficiently familiar with the concepts and
were convinced that it is essential for each country to approaches of his and her colleagues as to blur the
establish and strengthen an appropriate health re- disciplinary bounds and enable the team to focus on
search base” [14]. Its ENHR process aims to tie the problem as part of broader phenomena: as this
together research, policy, and action. The social and happens, discipline authorization fades in import-
medical disciplines are to work together to make this ance, and the problem and its context guide an
happen. appropriately broader and deeper analysis.
In the 1990s social scientists have become more Trestle discusses the community health movement
confident of their standing as they choose to raise emanating from South Africa in the 1940s which
both the contextual and practical, policy-oriented informed innovative health practice, research, and
issues for social science research in health. teaching in the United States and Israel [2b, p. 591.
For example, Nichter and Kendall, in a recent issue This movement illustrates an early effort to achieve
of Medical Anthropology Quarterly, are promoting a transdisciplinary perspective but there was one
interdisciplinary health and social science research on weakness; much of this effort focused on collabor-
“exploration of structures-social, economic and ation for practical application. While John Cassel,
symbolic-understanding of gender, household, one of the leaders of this effort, personally made
ethnic and community dynamics” (151. This trend substantial theoretical transdisciplinary contributions
bodes well for sustaining collaboration between the in developing this new field and may be considered
social and medical sciences. Indeed, the remainder of the father of American social epidemiology, the work
this paper argues that without further such contextual was not sufficiently diffused internationally to sustain
and conceptual emphases, the promising trends in the this perspective in other countries and in inter-
1980s and 1990s will dissipate into small-scale, fine national agencies. Indeed, the international commu-
tuning projects that have only short-term, immediate nity health movement has almost eschewed the
effects and possibly never contribute to long-lasting theoretical underpinnings in its search for new
improvement of the situation under study. methods and programs.
Reviewing other fields to assess whether a transdis-
ciplinary perspective is feasible, social science re-
THE LOGICAL EXTENSION OF INTERDISCIPLINARY
RESEARCH: DEAD-END OR NEW FIELD OF INQUIRY? search on agricultural problems nurtured at the
Consultative International Agricultural Centers
The premise of this paper is that for social science throughout the 1970s emerges as a powerful demon-
research on medical or health issues to contribute stration of a collaborative approach that led to new
to lasting improvements in practice and policies, methods and concepts, with concomitant positive
theories and concepts must be elaborated upon and practical outcomes that have led to continued de-
refined, taking into account the broader context mz7d for such collaboration. For example, an agri-
in which the health problem is situated. The impact cultural anthropologist, Robert Rhoades, working at
of such an approach is that social scientists with an international agricultural research center in Peru,
reasonable concerns about career options will be demonstrated the value of his field’s involvement in
drawn to this now uncertain academic track. Progress technological research. Rhoades worked alongside an
in developing new concepts will not only enhance engineer and the farmers themselves to develop
theory and academic careers but will also yield the approaches for storing seed potatoes. In the process
 Potential of transdisciplinary
the team developed a new conceptual framework
for technological innovation in agriculture, now
known as the ‘Farmer-back-to-Farmer’ method [16].
Consequently, anthropologists, economists, and
agronomists, drawing on that model, worked together
to examine decision-making of farmers in the context
of farm households to analyze why farmers would not
use new seed varieties for rice in the Philippines,
India, and West African countries. The resulting
interdisciplinary field of farming systems research
has now become a new field of social sciqnce inquiry,
improving agricultural practices as well as generating
new concepts, theories, and research methods. Impor-
tantly, this collaboration has been appropriately
institutionalized in academic programs for use by
current and future scholars and practitioners [17].
The exuberance of the social and medical scientists
who participate in collaborative research is often
palpable [6, especially Rubenstein and Lane]. Prac-
titioners in medical anthropology, in particular, as
evidenced by such comprehensive texts as those of
Johnson and Sargent [ 181or Coreil and Mull [19], have
evoked a spirited promise for future collaborative
enterprise. Yet, as a participant and participant ob-
server in programs and committees that have sup-
ported work in areas such as those referred to above,
I am concerned that social and medical collaborators
are not following the example of colleagues in agricul-
ture, but rather are treading down the same path of
the interdisciplinary social psychologists of post-
World War II that William Sewell cogently describes
in his paper, “Some Reflections on The Golden Age
of Interdisciplinary Social Psychology” [20]. The
flowering of that field soon withered. This was
brought about by the absence of significant shifts in
concepts and institutional support:
Unfortunately, the rather modest developments that took
place in social psychological theory and methods during its
Golden Age were not sufficient to serve as the basis for a
new interdisciplinary field Contrast this with the success
of the interdisciplinary programs in the natural sciences-
particularly those in molecular biology, where tremendous
theoretical breakthroughs provided the stimulus for a whole
new approach to biological studies [20, pp. 13-141.
Keyfitz and Easton have recently raised analogous
concerns for the fields of population [21] and
social sciences and humanities [22], respectively. The
theoretical breakthroughs necessary for sustaining
excitement and endorsement by academics and policy-
makers are not yet evident in the collaborative efforts
of social and medical scientists.
Drawing primarily on the collaborative social and
health sciences research experiences in two broad
health research programs, one on tropical diseases and
the other on diarrhea1 diseases, I argue that the reason
for this failure is that much of what is considered
interdisciplinary research has not been conducted in
a way that could lead to the convergence of concepts
and approaches necessary to transcend disciplinary
biases and secure the field-dishearteningly similar to
research 1345
what Sewell suggests happened in interdisciplinary
social psychology. Although the threshold of aware-
ness has been overcome by a long list of collaborative
efforts, full understanding and acceptability has been
reached in only a few instances. Moreover, while
funding for interdisciplinary research has been main-
tained in the 1990s there is rarely sufficient support
to sustain such interaction beyond a single follow-up
project. It is well recognized that with increasing
experience the social scientist becomes more sensitive
and insightful into the nature of social problems. With
continuing support to the same team over a suffi-
ciently long period of time and covering several types
of problems, it is more likely that disciplinary barriers
can be transcended and increased understanding and
confidence about the value of other disciplines can be
achieved. In addition to funding constraints, the
institutional ones also limit new intellectual ventures;
in almost all academic settings, the social and
health sciences still remain isolated in separate
departments or faculties, further constraining inte-
gration of teaching and research programs, let
alone the development of full-scale collaboration.
Constraints on the accumulation of knowledge and
experience necessary to support a new field of inquiry
remain severe.
Solving the human health problems of the next
century will require a new kind of integrative model-
the kind of model being sought in such fields as
ecological and peace studies [23]. More than new
paradigms, new modes of thinking and action and new
ways of relating to other modes of thought are
required. Combining research concepts and ap-
proaches is not sufficient, “there is a need for a
different approach to social science-natural science
interaction” [24], where instead of arguing for disci-
plinary ownership, there is an assimilation of concepts
and approaches.
In the following pages, I will review a sample of
project experiences drawn from the United Nations
Development Programme/World Bank/World Health
Organization Special Programme for Research and
Training in Tropical Diseases (TDR) and the Applied
Diarrhea1 Disease Research Project (ADDRP) funded
by the United States Agency for International Devel-
opment [25]. These serve as the basis for further
discussion of the need to develop what I call transcen-
dent interdisciplinary research, or transdisciplinary
research, along with associated training programs,
and attractive career structures.
TDR AND ADDRP: DIFFERING WAYS TO FOSTER
SOCIAL AND HEALTH SCIENCE COLLABORATION
Under TDR auspices, at the World Health Organ-
ization in November 1979 a special scientific working
group was established to support work on Social and
Economic Research (TDR/SER) in tropical diseases
[7a]. The author was the first responsible officer for
 1346 PATRICIA L. ROSENFIELD

FIRST SECOND
INTERMEDIATE INTERMEDIATE FINAL
OBJECTIVE OBJECTIVE
OBJECTIVE

Baseline information
Application of INCREASED
information EFFECTIVENESS OF
DISEASE CONTROL
To determine the MEASURES AND

1
impsct of socisl, To promote design PROGRAMMES
cultursl. demographic and use of cost- THROUGH
snd economic effective and INTEGRATION
conditions on disease acceptable disease OF HUMAN
transmission and control programmea BEHAVIOURAL**
control and policies FACTORS IN
Anticipated Anticipated PROGRAMME DESIGN
outputs outputs AND MANAGEMENT
,............. . . . . . . . . . . ,. . . . . . . . . . . . . . . . . . . . * v..............

Factors to be studied: Questions to be SER OUTPUT

Understanding Methods to:
studied: BECOMES
and ranking of
BLevels of knowledge
different factors
INPUT TO OTHER
snd .~.reness
snd how they What .re the costs b Assess PROGRAMMES:SWGs,
shout the tropical and effectiveness of psrticipstion WHO. Nstionsl
affect risk of
disesscs alternative measures in control control progrsmmes. etc.
disease
and strategies for activities
I Social, culturrl and control, monitoring
economic frctors Priority rsnking and surveillance?
incressing risk of of diseases and p Measure
humsn exposure to control meosures behsvioural
these discsses to be used What interventions changes
make behavioursl
change possible,
) Co”sequc”ccs of Establishment of t Measure
and how?
these discuses at methods to test effectiveness
the household, levels of of control
community and PWS*WlCSS What is the type and activities
country levels and to assess level of community and establish
economic and participation in costing
8Resources svailable social disease control procedures
to control these consequences activities?
disesses, including p Assess the
trsditionsl What ore possible interdisci-
methods institutional plinary team
and organizational approach
arrangements for
ensuring application
and management of
control measures?

* All studies sre carried out in coordinstion with disease-specific and traits-disease Scientific Working Groups (SWGs)
snd, when spplicsble, with other WHO progrrmmes.

** Bchsviour is defined to include social, cultural and economic factors.

Fig. 1. SER strategic plan of research* [26].

that group. Its strategic plan is given in Fig. 1. One ADDRP, started in September 1985, has been
explicit goal of the program was to demonstrate implemented by a consortium of the Harvard
how social science research, the definition of which Institute for International Development, Tufts
comprised all the social science disciplines, could University, and the Johns Hopkins School of
contribute to improving disease-control programs Hygiene and Public Health [27]. Its aims are given
and ultimately contribute to the control of tropical in Table 1. The author served on its Technical
diseases. Its first four projects were funded in 1979, Advisory Committee from 1987 until 1990. As of
and by mid-1987 (when the author assumed different 1991, 80 research projects (including work-
responsibilities), 66 field projects were underway in shops) have been or are being undertaken, in 12
more than 20 countries. The budget for the biennium countries [27]. Since their inception, both programs
198647 was slightly more than U.S. $1.6 million, have been formally evaluated, (the TDRjSER in
2.3% of the overall TDR budget. 1982 and 1987, and the ADDRP in 1988 and
 Potential of transdisciplinary research
Table 1. Applied diarrhea1 disease research program objectives
described in the 1990 ADDR Newsletter [27c]
The ADDR Project funds researchers in developing countries to
study diarrhea1 diseases and apply their results to policy and
program decisions. ADDR has four priority research themes:
l home use of foods and fluids in the management of diarrhea
l prevention and intervention studies
. invasive and persistent diarrhea
. behaviors of mothers/care-givers and/or health care
providers.
The Project has developed a model that focuses on the local
scientific community as the most important and effective agent of
policy change. ADDR encourages national scientific communities to
set their research agenda in collaboration with local diarrhea1 disease
control program authorities. The scientific results contribute
national health policy, and are of use to USAID Missions for
program planning.
1990) and these results are also reflected in this
paper.
One of the critical differences in the approach
to interdisciplinary research of these two programs
was the major orientation of the peer review commit-
tees. The role of such committees is a delicate subject
for most researchers, but the importance of under-
standing the constituent parts of review committees
is crucial for interpreting the outcomes and the
likelihood of supporting innovative path-breaking
research. The TDRjSER committee was primarily
grounded in the social sciences. The ADDRP Techni-
cal Advisory Group was mainly medical. Both
groups brought in scientists of the other disciplines,
but in relatively minor numbers. I consider this
balance to be a crucial indicator of the likelihood of
funding projects where social and medical scientists
are full partners and where strong theoretical and
conceptual work can be funded alongside of or as
part of the more practical specific problem-solving
research. In the early 1980s even in the projects
submitted to TDR/SER, the medical researchers were
the principal investigators and social scientists were
junior members of the team. The TDRjSER Steering
Committee insisted that if a medical researcher were
principal investigator, then a social scientist of
equal experience must be brought in as co-principal
investigator. Soon most TDRjSER teams had such
collaboration.
The concern about disciplinary balance of peer
review committees may seem misplaced in a paper
devoted to analyzing how to extend interdisciplinary
collaboration. But, for research to be truly interdisci-
plinary, and even move beyond that to transcend
disciplinary bounds, the social and medical re-
searchers must work not only as full partners but also
as interchangeable leaders [28]. This will lead to
scientifically integrated research-without which the
resulting recommendations may be inappropriate or
ineffective, leading to wasted resources and loss of
interest on the part of the researcher, policymaker,
and public. This kind of result has the additional
deleterious effect of reducing interest in future collab-
orative efforts.
1347
as
In the social and economic research program of
TDR, the committee consisted primarily of social
scientists (economist, geographer, anthropologist,
rural sociologist, linguist, social worker, M.D./health
planner, political historian, medical sociologist), plus
one epidemiologist/medical doctor delegated to the
committee from the epidemiology committee of
TDR. Collaboration with the medical professions
within WHO was also pursued; TDR/SER was situ-
ated in a medical research program and consistently
drew on the other disease-specific and epidemio-
to logical groups for advice. Of the 66 field projects
funded by 1987, 41 had social scientists as principal
investigators; only 14 projects were headed by non-
social scientists based in medical schools or medical
research institutions [7a]. As mentioned above,
projects eventually had high level representation of
both medical and social scientists at the co-investi-
gator level. With the change in leadership for the
TDRjSER program in 1987, an increasing number of
health scientists were involved in its activities and on
the peer review steering committee, creating more of
a balance in disciplinary representation [29].
In the ADDR program, social scientists (two
anthropologists, one anthropologist/geographer, one
economist) played an active role on the Technical
Advisory Group (TAG), but the leadership was
drawn from medical scientists. In 1990, the TAG was
disbanded; at the maximum, there were only four
social scientists on it. As a result, of the principal
investigators and institutional bases of the 80 re-
search projects (including 12 workshops) funded as of
1990, only 8 principal investigators have been from
the social sciences and only four or five social science
institutions have served as program bases [27a,
pp. 55-1511 There have been no requirements for
collaborative peer level leadership of any project.
But ADDRP, too, underwent a significant change.
Following its evaluation in early 1988, ADDRP
increased the level of involvement of the social sci-
ences. Since that evaluation, two social scientists (an
anthropologist and a sociologist) have been associ-
ated nearly full-time with its program secretariat,
resulting in much more explicit focus on strengthen-
ing the social and behavioral aspects of diarrhea1
disease research. Prior to 1988, only two projects had
principal investigators drawn from the social sciences.
Now, even the medical members of ADDRP are
actively trying to promote the use of social research
to influence and analyze interventions; the 1990
annual report emphasizes ADDRP’s interdisciplinary
perspective.
The projects funded by TDR/SER and ADDRP
described in this paper were selected because
they represent examples on the spectrum of pro-
jects supported by each group that illustrate the
diversity of approaches that fall under the label
‘interdisciplinary research.’ They provide the basis
for considering how to extend interdisciplinary
research, organize training programs, and enhance
1348 PATRICIA L. ROSENFIELD

the impact of interdisciplinary research in ensuring fevers as an indicator of the prevalence of malaria;
more sustainable solutions to human health prob- quantitative comparisons with sample studies of
lems, and securing a new field of inquiry. blood slides and serological tests (ELISA) showed,
possibly for the first time, perception of fever to be
Social science research in TDR a reliable indicator of malaria prevalence [31].
As indicated above, the TDRjSER projects were They have identified a variety of coping patterns
organized primarily by social scientists working in related to the new colonists and their reaction to
social science programs, bringing in medical scientists malaria. They concluded that transmission was not
from the university or control program staff from likely to take place within the house, the assumption
the ministry of health as co-principal investigators. underlying the spraying program. From the research,
Occasionally, projects were organized in public health it appeared more likely that the migrants were be-
or medical schools, even in ministries of health, where coming infected with malaria as they were going up
social scientists were asked to join the team either on the forest for cultivation. The team also identified
a full-time or part-time basis. The projects usually problems with the strategy for chemotherapy distri-
focused on a common problem related to control of bution and was able to work with the federal and
disease and all disciplines involved in the project were local ministries of health staff members on how to
brought to bear in differing degrees to help solve that link chemotherapy distribution and vector control.
common problem. They were able to assess the importance of malaria to
For instance, in Brazil, sociologists, economists, the migrant and show how those values influenced
regional planners, and demographers at the the migrant’s utilization of malaria control services.
Center for Regional Development and Planning Essentially, the migrant, even when there were family
(CEDEPLAR), of the Federal University of Minas members and neighbors who had suffered multiple
Gerais (UFMG) in Belo Horizonte, along with attacks of malaria and had died, felt that the oppor-
colleagues from Brazil’s national disease control tunity for a new life in this new environment far
program, SUCAM (the Superintendency for the outweighed the strong likelihood of becoming in-
Control of Endemic Diseases-now a part of the fected with, or even dying from, malaria. With no
National Health Foundation), identified the impact economic hope elsewhere, the migrants preferred the
of colonization of the Amazon on the spread of alternative of a new life, even with the disease.
malaria as a vital topic for the intersection of social, This interdisciplinary research project showed how
economic, and health analyses [30]. The team’s a social science team could bring together diverse
particular concern was to understand the coping disciplines to focus on the social and medical aspects
patterns of migrants moving into the area, especially of the medical problem and, by working closely with
those who had not previously been exposed to medical colleagues, make important contributions
malaria, and how their health and economic atti- to the objectives of the Ministry of Health. The team
tudes, and consequent behaviors, would influence the cemented relationships with the Ministry of Health so
success of the new colonization projects and the that now the core members of the team are involved
effectiveness of malaria control activities. Recogniz- in advising the Ministry of Health in its disease
ing the importance of working on a peer level with control efforts, primarily malaria control in other
medical colleagues, the social scientists developed colonization areas, particularly through developing
close collaboration with the Malaria Control the research component for a major loan from the
Program staff both in Brasilia and in the state of World Bank. Also, as part of this project, the anthro-
Rondonia where the project was located. They even- pologist doing in-depth studies on the migrant
tually incorporated in the project, inter alia, an families will be receiving his Ph.D.; other master’s
anthropologist from another Brazilian university, level and Ph.D. dissertations as well as numerous
epidemiologists from the medical school of UFMG, publications will emerge from this longitudinal pro-
an epidemiologist from Yale University, an epidemi- ject. The human capital in interdisciplinary research
ologist from the United States Center for Disease in health and social sciences will significantly increase
Control supported by the TDR malaria committee, as a result of this project.
an immunologist from the Oswald0 Cruz Foundation In Thailand, a team of economists addressed an
in Belo Horizonte, and vector control researchers issue of central concern to the Ministry of Public
from the Oswald0 Cruz Foundation in Rio de Health’s Malaria Control Program: Establishing the
Janeiro. The team explored ramifications of the main costs and efficiency of alternative ways of delivering
problem by analyzing how and where people were malaria control services 1321. They did so by examin-
getting malaria, their attitudes toward malaria, the ing in great detail the records of the malaria clinic:
impact of malaria on their lives, and how all of these the economists calculated patient time costs; local
factors coalesced to influence their attitudes and malaria staff calculated local costs; central malaria
expectations of success in the colonization projects. staff calculated central costs. The team analyzed the
As a contribution to enhancing control program location of referral centers and linkages among the
efficacy in migrant populations, the interdisciplinary clinics for malaria control at community level, ma-
team has been exploring the value of self-reported laria referral centers and hospitals. Malariologists
 Potential of transdisciplinary
working with economists developed an algorithm for
estimating costs and efficiency of alternative strat-
egies for malaria control, which after much discus-
sion, debate, and review, led the Malaria Control
Program to reorient its strategy to focus on strength-
ening local treatment and surveillance services to
improve quality, increase utilization of services, re-
duce the time costs incurred by malaria patients, and,
thereby, increase and enhance the cost efficiency of
the program [33]. This relatively small team demon-
strated how close collaboration across disciplines
could result in a new method to calculate the costs
and efficiency of a disease control program as well as
new strategies for the control program.
In Nigeria, a project based in the medical school
demonstrated another approach to interdisciplinary
research [34]. Through the African Regional Health
Education Center at the University of Ibadan, associ-
ated with the Department of Preventive and Social
Medicine of the College of Medicine, a health educa-
tor organized a large team composed of representa-
tives from many disciplines, including geography,
epidemiology, parasitology, entomology, environ-
mental health, sociology, and economics. Together,
they aimed to test health behavior models in relation
to transmission and control of four tropical diseases
in communities around Ibadan. This team from
Ibadan, composed of about 20 different members and
almost as many different fields of research, was able
to address a wide range of problems. The coherence
that might have come through the concept of model
testing, however, proved difficult to achieve even after
several years of research support.
The team became primarily committed to social
change. The members produced many publications,
developed appropriate training programs for commu-
nity health workers, introduced interventions such as
wells to prevent guinea worm, improve hygienic
conditions, and developed a technology testing pro-
ject for a guinea worm filter [35]. It also became a
very effective action research project where, through
the means of a newsletter, the team reached not only
its members, but also the community members in-
volved in the project and the community health
workers. The contributions to action were so signifi-
cant they overshadowed the theoretical develop-
ments, although several masters and Ph.D.s resulted
from this project, again contributing, as in the Brazil
project, to the expansion of the research community.
Social science research in ADDRP
In the Applied Diarrhea1 Disease Research Project,
the tendency had been to allow each scientist to
address the particular element related to his or her
discipline independently, rather than fuse the research
approaches and work together in data collection and
analysis and interpretation of findings. For example,
at the University of Ilorin in Nigeria, an M.D.
epidemiologist-demographer is leading a team that
consists of a sociologist (from a different university),
research 1349
other demographers and community health re-
searchers, including an American anthropologist [36].
The Nigerian principal investigator and his American
co-investigator were responsible for the overall pro-
ject design; a Nigerian social scientist was brought in
to assist with the informal interviewing of key infor-
mants and has been involved in some of the analysis
of the data. This project aims to analyze the relation-
ship between maternal education, maternal behavior
and risk factors for diarrhea1 diseases in the Yoruba
areas of Ilorin, Nigeria. The data are still being
analyzed. So far, the quantitative survey shows, for
example, no relationship between maternal education
and prevention of diarrhea in children. This finding,
contrary to those in other fields (e.g. family planning
and use of health services), was borne out by the key
informant interviews, which indicate that mothers
often had little say about hygienic practices related to
transmission of diarrhea1 disease [36, p. 2561. This
project also identified high rates of antibiotic use to
control diarrhea, a result of mothers’ concerns about
the immediate effectiveness of oral rehydration salts.
The team continues to work on the data and has been
involved in other projects as a result of this initial
effort [e.g. 9a].
In Mexico, as part of the Mexican Social Security
System, a team has been examining and developing
treatment algorithms for infectious diarrhea for use
by physicians in primary health care units, particu-
larly focusing on case management by the health care
provider, usually a Social Security physician [27a,
pp. 62-63, 371. This project, led by medical re-
searchers, drew on other medical professionals as well
as a sociologist from El Colegio de Mexico. Two
follow-up projects have resulted from this effort. The
first, led by the sociologist, has been to conduct
more in-depth analysis of the physicians’ acceptance
or rejection of the educational intervention [27a,
pp. 112-l 131. The preliminary analysis showed no
obvious predictors of social change in the physicians’
behavior. The investigator is collapsing some of the
categories to see if this will increase their explanatory
power. The second, managed by the medical team, is
examining implementation of their findings on ways
to bring about new treatment strategies on a larger
scale [27a, pp. 119-1201. The group has been encour-
aged by the findings which showed a 30% increase in
appropriate treatment at the intervention clinics and
will now expand to a third state. This sequence shows
an interesting progression in the research process
where the medical professionals took the lead in
developing the first project which was then followed
up by a separate project led by the social scientist who
maintained a close relationship with the medical
colleagues at the Social Security program, who then
continued their own research.
An ADDRP project funded in 1989, its first to be
led by a senior social scientist, was based in the
sociology and anthropology department at the
University of Yaounde [27a, pp. 105-1061. It was
1350 PATRICIA L. ROSENFIELD

Table 2. Characteristics of selected research projects as described in the paper

Funding Country Institutional Project
organization location base structure Outcomes
TDR/SER Brazil ss SS/MS/MOH Comprehensive analysis,
members of team new concepts, new
(joint effort) techniques, several
degrees, training
programs, policy changes,
more research

TDR/SER Thailand ss SS/MS/MOH Problem-specific results,

members of team new techniques, policy
(joint efforts) changes, additional
research, M.A.-level
training program

TDR/SER Nigeria MS SS/MS members of team Problem-specific results,

(parallel studies) M.A.-level training
program, several degrees

ADDRP Nigeria MS MSjSS members of team Problem-specific results,

(joint effort) new projects

ADDRP Mexico I. Social Security/MS I. SS/MS members of team Separate problem-specific

2. ss 2. MSjSS members of team results
3. Social Security/MS 3. SS/MS members of team
(sequential)

ADDRP Cameroon ss SS members of team; Problem-specific results

(parallel with MS/MOH
proJect)
[SS = Social Science; MS = Medical Science; MOH = Ministry of Health].

also the first to introduce a contextual analysis of conceptual grounding of the organizational base
political, social, and economic factors into a study and principal investigator-social or medical
of perception of diarrhea1 diseases, caretaking, and sciences;
administration of medications. The project, under- relationship to other disciplines-members of
taken principally by social scientists, complements a team working jointly, in parallel, or sequentially;
more medically oriented survey of diarrhea and nature of outcome-methods, policy changes,
malaria currently underway in Cameroon. In this new projects.
case, as in the Mexico project, the teams were in
From this small number of projects, it is already
close touch but worked separately; however, the
evident that there are several interpretations of inter-
Ministry of Health asked for more specific infor-
disciplinary research and how to conduct it. It can
mation on health behaviors and use of health services
mean bringing a number of different disciplines to-
by the study population [27a, p. 1061. The study
gether to work discretely on different aspects of a
findings include identification of the problems with
broad problem (multidisciplinary research, e.g. TDR-
community perception and use of the poorly-staffed
Nigeria); it can mean bringing disciplines together to
and -equipped health centers in two of the villages,
work-not necessarily at the same level of expertise-
in contrast to the third village, where utilization
on the same problem (interdisciplinary research, e.g.
was high. The prevalence of antibiotic and herbal
TDR-Thailand and the ADDRP projects). Or, as
remedy use was common, and the team has
an extension on the latter, it can mean cutting
recommended a targeted health education campaign
across disciplines through use of a common concep-
[27a, p. 1061.
tual framework to address a particular problem,
blending together commonly accepted concepts and
theories (transdisciplinary research, as approached by
TDR-Brazil and referred to below). While these terms
CHARACTERIZATION OF DIFFERENT APPROACHES
TO COLLABORATIVE RESEARCH are often used interchangeably, they represent differ-
ent approaches, have different implications for the
Lessons learned from TDR and ADDRP
training of researchers, will produce different out-
These two programs are very serious in their comes for health policies and programs, and-keep-
commitment to interdisciplinary research linking ing in mind the tarnishing of the golden age of
social and health scientists. The projects referred to interdisciplinary social psychology-they represent
above are a small but representative sample of the different outcomes for flourishing, sustainable
whole. As summarized in Table 2, they present collaboration between medical and social science
considerable variation in: researchers.
 Potential of transdisciplinary research
Table 3. A simple taxonomy of cross disciplinary research: multidis-
ciplinary, interdisciplinary, and transdisciplinary
Level one: Multidisciplinary
Researchers work in parallel or sequentially from disciplinary-
specific base to address common problem
Level two: Inkvdisciplinary
Researchers work jointly but still from disciplinary-specific basis to
address common problem
Level three: Tramdisciplinary
Researchers work jointly using shared conceptual framework draw-
ing together disciplinary-specific theories, concepts, and approaches
to address common problem
Distinguishing characteristics of multidisciplinary,
interdisciplinary and transdisciplinary research
The distinctions characterizing multidisciplinary,
interdisciplinary and transdisciplinary research are
summarized in Table 3 and described below.
In the multidisciplinary case, by far the most
common approach to collaborative research, while
there may be a common problem or set of problems,
each discipline works independently and the results
are usually brought together only at the end. Results
tend to be published as separate chapters in a report,
with an introduction or conclusion by the principal
investigator who summarizes the findings. Indeed,
some of the projects, such as the ADDR example in
Mexico, are only multidisciplinary if they are con-
sidered sequentially. This kind of research is not
usually conceptually pathbreaking but has shed light
on different aspects of a particular problem, leading
to immediate, but possibly short-lived, solutions.
In the conduct of interdisciplinary research, differ-
ent disciplines use their techniques and skills to
address a common problem as evident in the projects
described earlier analyzing costs of malaria control in
Thailand or diarrhea1 disease risk factors in Nigeria.
Here, new insights certainly result from the research
but, again,--especially with the larger teams-the
results are usually reported in a partial, discipline-by-
discipline sequence. These serious projects are con-
tributing new knowledge, but it is knowledge
partitioned off from other relevant elements. It is
only by removing the partitions which form the
disciplinary boundaries, as in the Brazil malaria
and migrants project, that more profound insights
will underpin analyses and interpretations of
findings, and, importantly, recommendations for
actions by individuals, disease control programs, or
other agencies.
Transdisciplinary research can provide a more
comprehensive organizing construct. Representatives
of different disciplines are encouraged to transcend
their separate conceptual, theoretical, and methodo-
logical orientations in order to develop a shared
approach to the research, building on a common
conceptual framework. Such a framework can be
used to define and analyze the research problem and
develop new approaches for health care that more
closely represent the historical and present-day reality
in which health problems are situated. The Brazil
1351
project, cited above, is exhibiting a promising
tendency in this direction. The malariologists, sociol-
ogists, epidemiologists, economists, anthropologists,
regional planners, vector biologists, demographers,
and immunologists worked together to define the
problem, confer about concepts, methods, and
results, and, finally, after this intense experience,
understand as one the common phenomenon they
were analyzing-migrants coping with a new disease.
Only then were they able to develop new social and
medical science concepts and approaches to disease
control. They redefined the concept and meaning of
malaria in a mobile population and developed more
feasible ways to assess and control the disease in that
context. The use of self-reported malaria instead of
blood slides for prevalence sur . eys in this population
group may seem a relatively minor outcome, but it is
a result that could save considerable resources of time
and money for migrants and ministries of health,
ensuring the practical impact of the research project.
The team, over nearly eight years of working to-
gether, despite several changes in its composition, is
still working toward the integrative approach that
will, as Ratcliffe has noted and the agricultural social
scientists have demonstrated, enable the team mem-
bers to analyze the “problem from all systems levels
at the same time” [23, p. 121. The perspectives of the
migrant, the mosquito, the malaria parasite, and the
ministry of health are related to the social and
economic forces that bind these elements together,
and the result is a comprehensive assessment of the
problem and its situation. Moreover, there is inter-
generational transfer of this experience through ex-
tensive involvement of students. The project has
resulted in new social and epidemiological concepts,
new disease control strategies, new Ph.D.s and
M.A.s-all necessary to sustain support and excite-
ment for collaborative work among medical and
social scientists.
Understanding the whole person is now considered
essential for successful medical treatment of disease;
similarly, understanding the whole ecosystem is con-
sidered essential for resolving any specific environ-
mental problems. A transdisciplinary perspective
would challenge the social and medical sciences to
expand their focus to the whole as well and-by
redefining or diffusing disciplinary bounds-produce
what Harwood in his recent review of the state of
medical anthropology calls “a new, more complete
understanding of the human enterprise” [38a].
A CONCEPTUAL RATIONALE FOR TRANSDISCIPLINARY
RESEARCH
A conceptual framework for transdisciplinary
research should explicitly incorporate structures of
society and bring into play all conditioning factors
which influence the extent of health problems.
Ratcliffe and Albrecht have proposed detailed formu-
lations [23,39]; in the TDR program, a scheme to
 1352 PATRICIAL. ROSENFIELD

I Inputs to health production

I

I
Distribution of
disease and illness

f
Individual/ Health
household/ system/
community health
service

Health technologies
Jl
J

Baseline societal Health * -Social

structural conditions outputs and
-
(social, economic, economic
political, environmental) outcomes

I Inputs to other production

I

Fig. 2. A possible schematic framework for transdisciplinary analysis of health conditions [41].

illustrate the conceptual relationship between social, showed openness and readiness to consider and com-
economic, political and intersectoral conditions and bine diverse concepts, the transdisciplinary process
impacts was developed, first to examine social and was initiated. As exemplified by this project, the team
economic consequences of tropical diseases, and interactions formed the basis for analyzing impli-
later, following adaptation, to examine the develop- cations for the at-risk population as well as insti-
ment and use of medical technologies [40]. This tutional and other social arrangements to improve
framework, presented in Fig. 2, explicitly includes those conditions and make sustainable changes. In-
contextual political, economic, and social factors deed in Brazil, the Ministry of Health adopted the
along with health inputs, inputs from other sectors, recommendations of the team, recommendations
and the combined impact on health, social, and carefully situated in concepts and context and, there-
economic outcomes which then feed back to change fore, acceptable and accepted, and sustainable.
the baseline conditions. To cope with the epidemiological transition-the
While the Brazil project did not present such a rise of chronic diseases in developing countries,
conceptual framework in its original design, it is one resurgence of infectious diseases such as tuberculosis
of the most fitting illustrations. During the course of in developed countries, and the global spread of
the project, the social scientists and malariologists social pathologies-the conceptual framework must
learned enough about the others’ field to argue transcend disciplinary bounds and, yet, draw on the
about psychological adaptation, economic markets previous knowledge and experiences of those disci-
and demand, and malaria transmission potential- plines. A new type of research should emerge that
diffusing the knowledge bounds and transcending the enables the analysis of a particular problem to be
original orientation of each individual. They had located in the transdisciplinary conceptual frame-
moved beyond the multi- and interdisciplinary ap- work, and to be analyzed accordingly. Recommen-
proaches. And, despite the realistic cautions about dations for action deriving from such an analysis, as
teamwork cited elsewhere in this paper, when the in the Brazil example, should be more readily im-
team moved as one almost from the beginning, and plemented and more likely to achieve lasting results.
 Potential of transdisciplinary research
Table 4. Implication of multidisciplinary, interdisciplinary, and transdisciplinary
paths, and health policies and programs
Type of research Academic programs
Multidisciplinary Within existing
disciplines and faculties
Interdisciplinary Between disciplines and
faculties; creation of
new joint programs
Transdisciplinary Synthesis of
departments-new
department, new field
of inquiry
Then, the social and medical sciences might overcome
recent as well as historical centrifugal forces and
consolidate findings into a general theory that illumi-
nates the interplay of all of the different factors that
influence human health and contribute to sustainable
improvements in health institutions, policies, and
programs, and ultimately in human health.
Transdisciplinary research is not research as usual.
When a problem is presented for analysis, even one
that seems so straightforward a social science prob-
lem as migrants coping with malaria, the transdisci-
plinary approach opens a full discussion of that
problem and leads to more in-depth as well as more
extensive analyses. A multi- or even interdisciplinary
approach to that problem, or research-as-usual,
would have led to education programs for the
migrants and possibly improved case finding and
treatment approaches for the health services. Instead,
the framework was expanded so that concepts from
sociology, demography, anthropology, epidemiology,
immunology, parasitology, and entomology coa-
lesced and linked with the basic economic concepts
underlying the migration and resettlement strategies
of the government. Sociologists pondered new
prevalence detection strategies and entomologists
explored changing human behaviors while anthropol-
ogists and demographers noted changed vectorial
behaviors. Paradigms and research practices are both
shifting in this project and the result-if sustained by
appropriate institutional changes in the university-
can lead to a scientific revolution for the next gener-
ation of Brazilian researchers and-by dint of
publications and presentation researchers elsewhere
as well.
IMPLICATIONS OF THE THREE LEVELS OF
COLLABORATIVE RESEARCH FOR EDUCATIONAL
PROGRAMS AND CAREER PATHS
“Calls to interdisciplinary research go unheeded
because of the organization of academic life” [21,
P. 61.
The three levels of research, multidisciplinary, in-
terdisciplinary, and transdisciplinary, have distinct
implications for academic programs, career paths,
and health care programs, as summarized in Table 4
1353
research for academic programs, career
Contribution to health
Career paths policies and programs
Attractive opportunities Specific short-term
problem solving
Needs strengthening New specific programs
plus problem solving
Does not yet exist Broadly-based tram-sectoral
programs and
actions with longer life;
new concepts, methods,
and policies
and described below. For participation in multi-
disciplinary studies, it is necessary to sensitize
students to cooperative endeavor. However, such
participation does not require major change in the
existing education system where disciplines have
developed their own expertise in, for instance, medi-
cal anthropology, medical sociology, or health econ-
omics. Here, when the problem is stated, such as
understanding how mothers can use local foods as a
supplement to ORS for diarrhea1 disease manage-
ment, the diarrhea1 disease epidemiologist can call on
the social scientist to conduct a survey to find out
what mothers are doing, what foods they prefer, what
constrains their using these foods along with ORS, or
using ORS alone. The social scientist needs to know
the usual methods of observation or surveys along
with some information about the problem. The social
scientist will then present his or her findings to the
diarrhea1 disease researcher or physician who will
then utilize that information in developing an appro-
priate program.
When those social science sub-disciplines are based
in the department of the primary discipline, they do
not often extend to include formal links with pro-
grams in schools of medicine or public health to
develop what is the next level of research, inter-
disciplinary programs. There may be one or two
experts in the sub-discipline who consider themselves
sufficiently interdisciplinary. As indicated above,
this results in limited or inadequate attention being
given to the perspective of the medical primary
disciplines-whether epidemiology, parasitology or
vector biology-in the research. Often, for example,
medical anthropological research does not incorpor-
ate an epidemiological perspective, namely the
numerical distribution of cases of disease (prevalence)
or rates of change in cases of disease (incidence). Few
health officials are interested in findings without such
measures, even though from a social science perspec-
tive the results may be scientifically sound. As Kochar
emphasizes, “A solid grounding in the basic discipline
was good enough when beginnings were made in
medical sociology and medical anthropology. Today
this is grossly inadequate” [42]. Kochar goes on to
note the academic setting often impedes access for
student and faculty researcher to knowledge and
 1354 PATRICIA L. ROSENFIELD

expertise in disciplines separated from the base training and research because of location [44].
department. Proximity, while representing a major advance in
In an interdisciplinary training program, students acceptance, may have no impact on informing con-
are more likely to become aware of the conceptual cepts, methods, or results of those outside the par-
frameworks and theoretical bases of the disciplines ticular department. Programs in schools of public
with which they will be collaborating. The ADDRP health in the United States illustrate that reality.
project in Nigeria would be the ideal case study for Almost all of the 25 schools have programs in social
students in such a program, illustrating how a team and behavioral sciences-but the course topics and
drawn from different disciplines can study maternal research agendas indicate tenacious academic inde-
behavior and risk factors of disease in the children. pendence to the detriment of interdisciplinary re-
The social scientists working with the epidemiologist search. Several programs have joint degrees with
designed the surveys to assure linkages between architecture, law, business-too few incorporate full-
different rates of diarrhea1 disease and different fledged joint programs, with joint degrees, joint
education, income, and hygiene conditions, in order appointments and joint research between, for
to examine why ORS was or was not used. Since example, anthropology and social medicine, where
data analysis is continuing, it is not yet clear how medical doctors, anthropologists, epidemiologists,
all the disciplines will be drawn together in economists, and sociologists can interact on a
the final analyses, but this is a promising project peer level in teaching and research. Role models of
for developing new analytical approaches and, full-scale interdisciplinary research are limited for
ultimately, new concepts. students [45].
As indicated by the most intensively collaborative Internationally, a remarkable program in Sri
of the projects reviewed, awareness of the different Lanka is breaking disciplinary, sectoral, and geo-
frameworks and approaches is not enough. The graphic bounds, and laying the foundation for higher
capacity to undertake interdisciplinary research re- order transdisciplinary research that overcomes the
quires both substantive and sensitization training. boundary constraints of multi- and interdisciplinary
Interdisciplinary seminars bringing together people approaches. At the University of Peradeniya in Sri
from different programs are needed, joint papers Lanka, the Triangle Program was established in the
encouraged. A respect for the contributions that mid- 1980s building on three years of research collab-
other disciplines can make to solving the common oration among the Departments of Pediatrics,
problem needs to be inculcated from the earliest Sociology, and Economics at Peradeniya and be-
stages of graduate training. This is not to say, in such tween those departments and the Departments of
cases, that the epidemiologist will be a poorly trained Community Health and Anthropology at the Univer-
or weak epidemiologist or that the medical anthro- sity of Connecticut in the United States [46]. The
pologist will lose his or her grounding in anthropol- collaboration among faculties of arts, medicine, and
ogy. Rather, they must be expert epidemiologists or later agriculture, led to the establishment of the
anthropologists and also be comfortable and confi- Center for Intersectoral Community Health Studies
dent enough to work together on a peer basis, at Peradeniya. With support from the Belgian
respecting other conceptual frameworks and research Government, Flemish Inter-University Council, and
paradigms, and contributing together to work in the the European Community, interdisciplinary training
health area. These are not less, but more, demanding and research programs with the University of
requirements of the specialist, and require, at least at Antwerp, Belgium, have also been organized [47].
the pioneering stages, a particular kind of intellectual Thus, in the Triangle Program, three universities and
risk taker. three sectors collaborate on “the development, moni-
Such exposure in academic programs and field toring, and actual implementation of a comprehen-
projects would contribute to reducing the skepticism sive research program addressing a variety of applied
of the medical establishment about the lack of rigor health issues in Sri Lanka. A strong inter-disciplinary
of social scientists and the social scientists’ concern approach to health problems is either implicit or
about (1) their loss of theoretical grounding and (2) explicit in all the studies conducted” [46, p. 21. The
the domination of medical models [21,43]. This research is aimed at the decision-making community
limited understanding of relevant medical concepts in Sri Lanka in the relevant fields; this program,
and issues on the part of social scientists has been though still very young, provides a rare opportunity
paralleled by the experiences of social scientists who to institutionalize a transdisciplinary and transectoral
have not until recently been able to identify medical program in health.
professionals knowledgeable or sensitive enough to
social science concepts and methods to collaborate
TRANSDISCIPLINARY RESEARCH: CURRENT
seriously with the social scientists. This situation CONSTRAINTS AND FUTURE PROSPECTS
occurs, despite the fact that many academic pro-
grams, particularly in schools of public health and ‘Transdisciphnary research’ has the potential to
departments of community or social medicine, believe move beyond the process of interdisciplinary research
that they can more easily promote interdisciplinary to a stage where disciplines can build on their distinct
 Potential of transdisciplinary research 1355

traditions and coalesce to become a new field of Ottawa, Canada, and the Swedish Agency for
research, such as has happened in molecular biology. Research in Developing Countries in Stockholm,
Keyfitz in assessment of population studies and Sweden, have consistently supported innovative re-
Easton in his review of the social sciences and search approaches linking social and natural sciences,
humanities, including area studies, concur that “inter- and have actively embraced the ENHR concept. Even
disciplinary areas have at best had only limited success the American private foundations, which reduced
in integrating fields of knowledge” [22, p. 131. The direct support for the social sciences in the 1970s and
institutional and financial obstacles impeding the 198Os, are encouraging ENHR efforts and some have
progression of knowledge and theory are far more joined forces to review the feasibility of establishing
stubborn than the conceptual ones. With the possible an international forum on health and social sciences
exception of the Triangle program, no comprehensive [48]. Two key multilateral technical assistance and
academic program fosters work in social sciences and lending agencies, the United Nations Development
health on a transdisciplinary basis. It is not difficult Programme and the World Bank, in their respective
to identify reasons why. Moving beyond multi- 1991 reports on development are warmly endorsing
disciplinary research requires supportive academic the transdisciplinary concept of human development
institutions, sufficient funding, and satisfying career as a critical component in economic productivity
opportunities. No prestige is bestowed on those who and growth [49]. The World Health Organization is
work with other disciplines, submerging their own building on this interest to promote the idea of health
disciplinary orientation to address a common problem as a conditionality for loans, focusing on one key
with new shared concepts. Multidisciplinary research, indicator to transcend sectoral bounds, namely, the
or ‘research as usual,’ succeeds because the disci- health status of vulnerable groups [50].
plinary specific members of the team can publish in For fundamental change to enhance the impact of
their own journals and build up their individual health programs, policies and institutions, trans-
resumes. disciplinary research is essential. Transdisciplinary
Within academe, tenure decisions emphasize single- research would firmly ground the particular health
authored articles and books, published in disciplinary condition under analysis in its social and economic
journals or by publishers respected within the disci- setting and enable the health decisionmaker to reach
pline. Prizes, honors, and medals are accumulated by across sectors and disciplines to work with his or her
those who have focused on basic questions in their own counterpart in agriculture, education, economics,
fields. There is nothing intrinsically wrong with this. planning, and finance to strengthen the basis for
But the rewards for those who venture out of their sustainable health and development policies. This
disciplinary nest to work on cooperative teams are approach and its outcomes could also lead to new
found elsewhere, namely in, the satisfaction of con- academic enterprise where more intensive and exten-
tributing directly to solving real world problems and sive scholarship would be focused on developing a
improving human well-being while at the same time general conceptual framework as the underpinning
developing new ways of thinking about and analyzing for research and educational programs. Transdisci-
the human condition. For this reason, it is crucially plinary research would not only sustain existing
important that those researchers who would pursue collaboration between social and health scientists.
transdisciplinary research be courageous risk-takers, More importantly, it would build a solid branch of
not discouraged by the limited number of tangible knowledge that would continue to extend and illumi-
incentives they are offered. nate understanding and improvement of the human
Despite the previous discussion of constraints, condition.
there is considerable basis for hope. We are at an
Ackno!+ledgemenrs-This paper has benefited from the
historical moment when the political and geographic
critical scrutiny of many conscientious and constructive
forces that separate societies are weakening. Inequities reviews. I would like to thank the following persons for their
in the human condition across class, income, ethnic special efforts: an anonymous reviewer,. Peter McEwan,
and racial lines are openly acknowledged and de- James Trostle. M. Gordon Wolman, Ralph K. Davidson,
bated. In the university world, there is constructive A. 0. Lucas, Nick Higginbotham, Polly Harrison, Frederick
Dunn, Mary Jo Good, Carol Vlassoff, Diana Oya Sawyer,
debate on the role of universities in bringing about Elias Sevilla-Casas, and Scott Shuster. Andrea Johnson has
societal improvements. From this dynamism, new been diligent in assisting in the preparation of the many
structures could emerge that foster transdisciplinary different versions of the manuscript. I willingly assume all
research. responsibility for errors of commission and omission. This
paper does not reflect official policy or endorsement of
Moreover, as mentioned in the beginning of this
the Carnegie Corporation of New York nor of the two
paper, in the health field, the concepts of essential groups with which the author was previously associated and
national health research (ENHR) seem to be from which the core material was used as the basis
striking a resonant chord throughout the developing for the paper, namely, the United Nations Development
world; this is likely to lead to increased local support Programme/World Bank/World Health Organization
Special Programme for Research and Training in Tropical
for innovative approaches to social science and Disease Research and the Applied Diarrhea1 Disease
health research. International donors such as the Research Project funded by the United States Agency for
International Development Research Centre in International Development.
1356 PATRICIA L. ROSENFIELD

REFERENCES Health Organization. Intersectoral Action for Health:

The Role of Intersectoral Cooperation in National
1. White K. L. Healing the Schism: Epidemiology, Medi- Strategies for Health for All. WHO, Geneva, 1986.
cine, and the Public’s Health, pp. 31-32. Springer, New 13. Commission on Health Research for Development.
York, 1991. Health Research: Essential Link to Equity in Develop-
2. (a) Trostle J. Early work in anthropology and epidemi- ment. Oxford University Press, Oxford, 1990.
ology: from social medicine to the germ theory, 1840 to 14. Task Force on Health Research for Development.
1920. In Anihopology and Epidemiology (Edited by Essential National Healih Research: A Strategy for
James C. R. et al.). D. 35. D. Reidel, Dordracht, 1986; Aciion in Health and Human Development, p. 3. Task
(b) Trostle J. Anthropology and epidemiology in the Force, Geneva, 1991.
twentieth century: a selective history of collaborative 15. Nichter M. and Kendall C. Beyond child survival:
projects and theoretical affinities, 1920 to 1970. In anthropology and international health in the 1990s.
Anthropology and Epidemiology (Edited by James C. R. Med. Anthrop. Q. 5, 200, 1991.
et al.), p. 59. D. Reidel, Dordracht, 1986. 16. Rhoades R. and Booth R. Farmer-back-to-farmer: a
3. Foster G. M. World Health Organizations behavioural model for generating acceptable agricultural technol-
science research problems and prospects. Sot. Sci. Med. ogy. Agric. Admin. 11, 127, 1982.
24, 709, 1987. 17. (a) DeWalt B. R. Anthropology, sociology and farming
4. World Bank. World Development Report 1991: The systems research. Hum. Organiz. 44, 106, 1985; (b) Biggs
Challenge of Development, p. 66. Oxford University S. and Farrington J. Agricultural Research and the Rural
Press, Oxford, 199 1. Poor: A Review of Social Science Analysis. International
5. World Health Organization, United Nations Children’s Development Research Centre, Ottawa, 1991.
Fund. Primary Health Care: Report of the International 18. Johnson T. M. and Sargent C. F. (Eds) Medical Anthro-
Conference on Primary Health Care, Alma-Ata, pology: Contemporary Theory and Methods. Praeger,
U.S.S.R. World Health Organization, Geneva, 1978. New York, 1990.
6. (a) Huss-Ashmore R. and Johnston F. E. Bioanthropo- 19. Coreil J. and Mull J. D. Anthropology and Primary
logical research in developing countries. In Ann. Rev. Health Care. Westview Press, Boulder, 1990.
Anthropol. 14, 475, 1985; (b) Heggenhougen K. and 20. Sewell W. H. Some reflections on the golden age of
Draver A. Medical Anthropology and Primary Health interdisciplinary social psychology. Ann. Rev. Social. 15,
Care: an Introduction and- Segcted Annotated Bibli- 1, 1989.
ography. Evaluation and Planning Centre for Health 21. Keyfitz N. Interdisciplinary analysis in four fields.
Care Pub. 22, London School of Hygiene and Tropical Options, 1991; reprinted in Bull. Am. Acad. Arts. Sci
Medicine, London, 1990; (c) Rubenstein R. A. and XLV 5, 1992.
Lane S. D. International health and development. In 22. Easton D. The division, integration and transfer of
Medical Anthropology: Contemporary Theory and knowledge. In Divided Knowledge: Across Disciplines,
Method (Edited by Johnson T. M. and Sargent C. F.), Across Cultures (Edited by Easton D. and Schilling C.).
pp. 367-390. Prager, New York, 1990; (d) Good M. J. Sage Beverley Hills, CA. In press, abridged and
Local knowledge: research capacity building in inter- reprinted in Bull. Am. Acad. Arts. Sci. XLIV 8, 1991.
national health. Sot. Sci. Med. 35, 135991367, 1992. 23. Ratcliffe J. W. Integrative, transdisciplinary research
7. (a) Rosenfield P. L. Social and economic research. In methodology: principles and application strategies.
Tropical Disease Research: A Global Partnership (Edited International workshop on integrative approaches to
by Maurice J. and Pearce A. M.), pp. 147-159. World research in agriculture, health and fertility. University
Health Organization, Geneva, 1987; (b) Henry F. J. British Columbia, Vancouver, British Columbia,
Combating childhood diarrhea through international Canada, 1989.
collaborative research. J. Diarrhoeal Dis. Res. 9, 165, 24. Bennett J. W. Social and interdisciplinary sciences in
1991; (c) Coreil J. and Mull J. D. (Eds) Anthropological U.S. MAB: conceptual and theoretical aspects. In Social
studies of diarrhea1 illness: A svecial issue. Sot. Sci. Sciences, Interdisciplinary Research and the Man and the
Med. 27, 1, 1988. Biosphere (MAB) Program (Edited by Zuke E. H.).
8. Sugar J. A., Kleinman A. and Heggenhougen K. Social United States Department of State, Washington, 1980.
and behavioral nathologies. In Health and Social 25. I should mention that this paper, while referring explic-
Change (Edited by Chen L. C., Kleinman A. and Ware itly to the work of TDR and ADDRP, is also informed
M.). Oxford University Press, Oxford, 1992. by the author’s personal contact with other similar
9. (a) Bentlev M. E. and Pelto G. H. The household ‘interdisciplinary’ efforts. At the World Health Organiz-
production of nutrition: introduction. Sot. Sci. Med. 33, ation, the Special Programme on Human Reproduction
1101. 1991: (b) Dav F. A. and Brown L. A. The field of and the Programme on Control of Diarrhea1 Diseases
family planning: a review and new conceptual frame- include working groups which focus specifically on the
work. Socio-econ. Plan. Sci. 20, 207, 1986. social sciences and on epidemiology and social sciences,
10. (a) Mosley W. H. and Chen L. (Eds) Child survival: respectively. The International Health Policy Program,
strategies for research. Pop. Dee. Rev. Suppl. 10, 1984; jointly sponsored by two U.S.-based foundations, Pew
(b) Maine D. Safe Motherhood Programs: Options and Charitable Trusts and Carnegie Corporation, along
Issues. Center for Population and Family Health, with the World Bank and the World Health Organiz-
Columbia University, New York, undated. ation, supports economists, health researchers, and
11 (a) World Health Organization. Economic Support for health policymakers in research projects and fellow-
National Health for 211 Strategies: Background Docu- ships. Carnegie and Pew jointly sponsor the Prevention
ment Al40 Technical Discussionsl2. WHO. Geneva, of Maternal Mortality Network in West Africa where
1987; (b) Division of Strengthening Health Services research teams are interdisciplinary, linking obstetri-
Health Economics: A Programme for Action. WHO, cians/gynecologists, social scientists, nurse/midwives,
Geneva, 1988; (c) Hoare G. Policies for financing the and health educators. Carnegie Corporation also funds
health sector. Hlth Policy Plann. 2, 1, 1987. _ a program to develop interdisciplinary training pro-
12. (a)
~ Stoddart G. and Feenv D. Policv options for health
I
grams in the social and health sciences in East Africa.
care technology. In Health Care Te>hnology: Effective- An impressive example of the effort to achieve inter-
ness, Eficiency and Public Policy (Edited by Feeny D., disciplinary research and training linking health
Guyatt G. and Tugwell P.), p. 225. Institute for and social sciences is the Rockefeller Foundation-
Research on Public Policy, Montreal, 1986; (b) World funded International Clinical Epidemiology Program
 Potential of transdisciplinary research
(INCLEN). INCLEN has explicitly included social and
economic scientists in its extensive research and training
efforts. And. the Rockefeller Foundation has also
funded two fellowship programs-one at the United
States-bound Social Science Research Council and one
managed internally in the special area of health and
social sciences. This is by no means an inclusive rehears-
ing of the interdisciplinary programs in this field, but it
does indicate that the level of donor support in the
1990s offers the possibility that new approaches argued
for in the paper could find sympathetic supporters.
26. UNDP/World Bank/WHO Special Program for Re-
search and Training in Tropical Diseases (TDR). Social
and economic research. In Tropical Disease Research:
Seventh Programme Report I January 1983-31 Decem-
ber 1984. D. 1215. WHO. Geneva, 1985.
27. (a) The ‘Applied Diarrhea1 Disease Research Project
(ADDRP). Annual Report 1990, Harvard Institute for
International Development, Cambridge, 1991; (b) End
of project evaluation, 1990; Trostle J. and Simon J.
Building applied health research capacity in less-devel-
oped countries: problems encountered by the ADDR
project. Sot. SC;. Med. 35, 1379-1387, i992; (c) The
ADDR Proiect Newsletter 1. 1. 1990.
28. There are rare instances where one person is fully
trained as an M.D. and Ph.D. in one of the social
sciences. This may resolve the leadership issue, but the
problems to be addressed in the future are possibly too
complex to be tackled by one person, even a renaissance
scholar.
29. Vlassoff C. Social and economic research in TDR:
future directions. Parisitol. Today 7, 37, 1991.
30. Sawyer D. R. and Sawyer D. 0. The ‘malaria transition’
and the role of social science research. In Advancing
Health in Developing Countries: The Role of Social
Research (Edited by Chen L. C., Kleinman A., Porter
J. and Ware N. C.), p. 140. Auburn House, Westport,
1992.
31. Singer B. and Sawyer D. 0. Perceived malaria reports
in mobile populations. Hlth Policy Planning 17, 40,
1992.
32. Kaewsonthi S. et al. Costs and performance of malaria
surveillance and monitoring in Thailand: a retrospective
study based on apportionment of expenditure under
budget headings; SER Project Reports No. 5. WHO/
TDR, Geneva, 1988.
33. Kaewsonthi S. et al. Internal and external costs of
malaria surveillance in Thailand; SER Project Reports
No. 6. WHO/TDR, Geneva, 1989. _ _
34. Brieger W. R., Adeniyi J. D., Oladepo O., Ramakrishna
J. and Johnson D. C. Impact of community need
differentials on health education planning. Hygie (7nt. J.
HIth Educat.) 3, 42, 1984.
35. (a) Adeniyi J. D. and Brieger W. R. Guineaworm
control in Idere. Wld Hlth. April-May, 8, 1983; (b)
Adeniyi J. D. and Brieger W. R. Acceptibility and use
of monofilament nylon filters in a Guineaworm endemic
area in Western Nigeria: an intervention study. SER
Project Reports No. 8, Geneva, WHO/TDR, 1991.
36 Oni G. A., Schumann D. A. and Oke E. A. Diarrhea1
disease morbidity, risk factors and treatments in a
low-socioeconomic area of Ilorin, Kwara State, Nigeria.
J. Diarrh. Dis. Res. 9, 2.50, 1991.
37. (a) Gutierrez G. Physicians’ behavior. A project in
Mexico City has succeeded in changing the way doctors
prescribe for diarrhoea. Dialogue on Diarrhoea, 43,
SSM 3511L-D
1357
December 1990; (b) Gutierrez G., Guiscafre H.,
Bronfman M., Martinez M. C., Padilla G. and Munoz
0. Strategies oriented to improve the prescription pat-
tern for acute diarrhea in primary care units. I. Method-
ology and description of the population and medical
facilities (in Soanish). Arch. Invest Med. Mex. 19. 335.
1988 (one of-10 papers describing the project in this
issue).
38. (a) Harwood A. Medical conditions and conventional
domains of knowledge. Med. Anthropol. Q. 4, 148, 1990.
Other related references include: (b) McElroy A. Biocul-
tural models in studies of human health and adaptation.
Med. Anthrol. Q. 4, 243, 1990; (c) Fabrega H. Plea for
a broader ethnomedicine. Culture, Med. Psychiat. 14,
129, 1990.
39. Albrecht G. A. Philosophical thoughts on a transdisci-
plinary model of human health. University of New-
castle, Australia, 1990.
40. (a) Rosenfield P. L., Golladay F. and Davidson R. K.
The economics of parasitic diseases. Sot. Sci. Med. 19,
1124. 1984: (b) Bonair A.. Rosenfield P. L. and Tena-
vald ‘K. Medical technologies in developing countries:
issues of technology development, transfer, diffusion
and use. Sot. Sci. Med. 28, 774, 1989.
41. This framework draws on the ones presented in [40]
Rosenfield, p. 124 and Bonair, p. 774.
42. Kochar V. The potential and promises of social research
on tropical diseases: some institutional, conceptual and
methodological barriers. In Social Research Methods for
the Study of Tropical Diseases: Leprosy, a report on the
national workshop, Hyderabad, 1989, p. 6. Centre for
Social Science Research on Leprosy, Sanali Memorial
Leprosy Foundation, Wardha,^l99&
43. Stanton B.. Black K.. Enele P. and Pelto G. H. Theorv-
driven behavioral intervention research for the control
of diarrhea1 diseases. Sot. Sci. Med. 35, 1405-1420,
1992.
44. Higginbotham N. H. Developing a social science com-
ponent within the International Clinical Epdemiology
Network (INCLEN). Sot. Sci. Med. 35, 132551327,
1992.
45. Rosenfield P. L. Changing Health Conditions: DeJining
the Mission of Schools of Public Health. Paper presented
in series on International Health and the Role of U.S.
Universities: Issues and Challenges, University of North
Carolina, Durham, 1992.
46. Pelto P. J. and Pelto G. H. Developing applied medical
anthropology in third world countries: oroblems and
actions. Soi: Sci. Med. 35, 1389-1395, 1992.
47. Silva K. T.. Aoonso H. A. and Peeters R. The Triangle
Programme: Feedback from Health Social Scie&
Research in Sri Lanka, Centre for International
Communitv Health Studies. University of Peradeniva,
Peradeniya; 1992.
48. Kunstadter P. and Higginbotham N. (principal investi-
gators). Toward asessing the feasibility of an inter-
national organization on social and health sciences.
Grant B 5613, Carnegie Corporation of New York,
1991 (Co-sponsored by the Ford Foundation).
49. (a) United Nations Development Programme Human
Development Report 1991. Oxford University Press,
Oxford, 1991; (b) The World Bank. World Development
Report 1991: The Challenge of Development. Oxford
University Press, Oxford, 1991.
50. World Health Organization Health Dimensions of
Economic Reform. WHO, Geneva, 1992.