What biomedical research agenda will successfully involve promising investigators and transfer discovery from the laboratory to the marketplace?
What research procedures will protect human subjects, and promote diversity in the populations involved in research?
What human capital is needed for the nation to utilize scientific knowledge to improve the cost-effective social, behavioral and economic development of our citizens?
How can the nation enable U.S. citizens to assume greater responsibility for their individual decisions regarding the use of health services, their personal health and the health of their communities and workplaces?
What are the policy barriers and information gaps that constrain our ability to create a healthy environment and promote healthy behaviors?
How can we most efficiently and cost-effectively involve individuals and communities in preventive intervention? How can we best develop sustainable health promotion and disease prevention programs?
How can we effectively evaluate the application of prevention programs to establish a sound science base?
How can the nation best preserve, maintain, characterize and utilize the genetic resources of life forms important to food production?
What food safety technologies and practices can minimize food-borne disease?
What data are required to improve risk assessment methods so that food safety and human health protection can be assessed?
How do nutrients interact with human genes to alter disease risk?
What factors affect the adoption and maintenance of behaviors that support optimal nutrition and physical activity patterns? How can scientific knowledge of optimal nutrition be translated into effective human interventions?
In addition, the CHSF strategies include initiatives to develop integrated health information systems to support necessary research and other health, safety and food issues. The need to maintain, update, build and better integrate data and information systems necessary to conduct research, operate surveillance and monitoring systems, and evaluate programs was the single largest obstacle to CHSF agency efforts. The following are CHSF's major scientific goals and research priorities.
The nation needs a research agenda harnessing the rapid growth of knowledge and technologies to improve the health of its citizens and to support national growth and competitiveness. For example, progress in biomedical research has contributed greatly toward improved detection and treatment of many disease/conditions. Advances in molecular biology and genetics have identified genes for colon cancer, familial breast cancer, Huntington's disease, cystic fibrosis, and many others from the Human Genome Project. Scientists and clinicians have used gene therapy to correct a number of congenital conditions, and to retard the growth of tumor cells and disease progress. These examples are illustrative of bridging fundamental biomedical and clinical research. Future research must continue to foster effective interfaces so that research findings are appropriately channeled toward improved clinical and health care and technology development. To further improve health, research is also needed on the biomedical, social, cultural, psychological and behavioral factors which influence individuals' exposure, susceptibility, treatment and recovery from disease. Variations in ability to comply with treatment regimens need to be better understood. The influences of social context, peer, family and community pressure in such situations also need to be better understood. Gender, socioeconomic, as well as racial/ethnic differences in disease incidence and prevalence must be examined.
We must foster collaboration among academia, industry and government, not only to share resources, but also to advance commercial research applications and technological progress. For example, bioinformatics (the science and technology of managing, modeling, and manipulating biological data) may lead to major industrial growth as large pharmaceutical companies seek sequence/analysis partnerships that merge computer software capabilities with medical diagnosis and therapy. We need to protect human research subjects and ensure that research includes an appropriate mix of the population. Support for productive beginning investigators, increased understanding of the wide range of human capital resources necessary for cost-effective human interventions, utilization of innovations, transfer of innovation into economic growth, and data systems for research and development are necessary. CHSF plans to focus future effort on a partnership for beginning investigators, a partnership for human productivity, and information dissemination and public education (science literacy) to help consumers make more informed choices.
In an era of constrained resources, health systems and services research and development is beginning to show how the U.S. can improve the return on its existing health care investment. For example, two recent clinical practice guidelines, addressing problems of low back pain and fluid in the inner ear of children, could reduce health care expenditures by more than $15 billion if these two guidelines are followed. Research and development on the effectiveness of the entire health care system--from clinical, preventive, and public health interventions to managerial, organizational, and financial strategies--coupled with research on the effective dissemination of these findings-- can improve the value we receive for our health care dollars. It is also important to link existing public health and personal care data bases in the public and private sectors. This will call for an unprecedented level of federal-state and public- private sector cooperation. CHSF plans to focus future effort on an integrated multi-disciplinary health systems and services research and development agenda.
Technological advances provide significant challenges and opportunities for the future. Some technological advances save and prolong life--while others have produced hazardous waste sites, and environmental contamination in the food chain. For example, radiation research has provided many beneficial diagnostic and treatment uses, but has also increased the need to understand the health impact of natural and man-made sources of radiation exposure. Research is needed to better understand the human risks of technological innovations.
Research and development on societal changes and their impact on health also provide significant challenges and opportunities. Lifestyle, community, and workplace diversity have altered exposure patterns and consequent patterns of injury and disease. Such changes have prompted the need to better understand the influence of cultural, behavioral, and socioeconomic factors on health. The following areas of research and development have received increasing attention by the scientific community, policymakers, the media, and the general public. CHSF plans to expand or form new research and development partnerships in the areas of vaccine development, emerging health threats, aggressive and violence-related behaviors, prevention of mental disorders, environmental and occupational health risks, computer aided design (CAD) tool and databank for injury control and prevention, and surveillance. These prevention partnerships are research investments that can reduce avoidable human suffering and monetary health care costs.
Effective interventions in these and other areas will require proactive involvement of federal, state and local programs; universities, medical schools, industry and other institutions. Coordinated effort spanning diverse fields of basic and applied science expertise are needed. Such research and development collaboration will result in more effective solutions to complex health promotion and disease and injury prevention issues.
Dietary factors profoundly affect growth, development, and the risk of many chronic diseases--including diabetes, heart disease, cancer, and osteoporosis. We need to better understand the mechanisms underlying nutrient effects on disease and health, and to improve dietary guidance. Recent advances in molecular biology and genetics provide new opportunities to apply cutting edge insights on bionutrition. Despite the tremendous health potential of sound nutrition, major segments of the U.S. population suffer from poor nutrition and activity habits. Over the past decade, obesity in the U.S. has increased dramatically. Over 1/3 of adults are obese, and obesity is also on the rise among children. The level of physical activity of the average citizen has also greatly declined in recent decades. A major goal of nutrition research is understanding the effects of diet and exercise on nutrient balance, to assure lowest possible risk of morbidity and mortality.
An important goal for nutrition research must be to enhance the scientific basis for recommending guidelines for nutrients and food patterns, as well as to develop the means to implement what is already known about good nutrition in the American diet. To effectively change energy balance and nutrient intakes for a target audience, it will be essential to understand their food choices and physical activity patterns as well as the cultural, socioeconomic, attitudinal and educational factors that influence lifestyles. CHSF intends to focus future efforts on an integrated multi- disciplinary human nutrition research agenda.
In health systems and services R&D, data standards should be developed cooperatively with other countries to facilitate future international collaborative and comparative research. Such comparative research would greatly improve understanding of all areas in health systems and services. Descriptive and evaluative studies usually focus primarily on the financing, organization and delivery of personal care services. There is a dearth of information on the nature, cost, and effectiveness of public health strategies in other countries. In addition, many of the metrics on which international comparisons are based, such as infant mortality, lead to misleading comparisons because of lack of standardized data.
In health promotion and disease and injury prevention R&D, the major challenges and opportunities have immediate and wide-ranging global implications and applications. International travel and trade have made the world a global community, but has also contributed to the rapid spread of new and re-emerging infectious diseases. Once expected to be eliminated as a public health problem, infectious diseases remain the leading cause of death worldwide. Emerging infectious disease threats are a reminder that no nation can be complacent regarding human vulnerability to the microorganisms with which we share our environment. Domestically and internationally, infectious disease increasingly threatens public health and contributes significantly to the escalating costs of health care. Disease prevention activities in individual countries have a direct international impact. In order to address these international health challenges, cooperative scientific partnerships across national boundaries benefit all.
In food safety, security and production R&D, new sustainable practices and information will be needed to help slow global environmental degradation and help assure adequate food and water supplies now and in the future. Other benefits include a safer supply of food imports for U.S. consumers, reduced costs of U.S. economic or military aid, the elimination of needless food waste, environmentally sound production, processing, and storage strategies; and the potential to eliminate malnutrition and starvation and improve worldwide health. Global information transfer must be actively coordinated and pursued, and policies to address foreign needs in the absence of sustainable practices elsewhere must be developed to protect U.S. interests.
The private sector depends on the germplasm and knowledge provided by the public sector to maintain its supply of seeds, tree and fish stock, and animals to food producers. The U.S. has long depended on foreign sources of germplasm for developing and maintaining strong food production systems, but if increasingly restricted access to foreign germplasm continues, the U.S. must conserve its native and acquired genetic resources. The U.S. should take a lead role to help resolve the global controversy over patents and intellectual property rights affecting genetic resources. Barriers to international trade and technology transfer must be overcome. Competitiveness in international markets hinges on illustrating to importing countries that U.S. products are safe and produced under safe conditions (e.g. with HACCP quality assurance systems). The same assurances should be required for food imports. Research is needed to resolve technical barriers to trade, particularly the presence of pests and pathogens in foods, and to provide a scientific basis for trade embargo policies.
In human nutrition RD, better understanding of the best diet and exercise patterns for optimizing health and productivity has global importance. Likewise, unraveling the role of nutrients in gene expression and disease will benefit the international community. Nutrient influences on disease and impact on health is a major concern in developing countries, as is deficit energy balance. At the 1992 International Conference on Nutrition, 159 countries entered into a plan of action that includes the commitment to basic and applied scientific research "to more clearly identify the factors that contribute to the problems of malnutrition and the ways and means of eliminating these problems, particularly for women, children and aged persons." This strategy also addresses the Year 2000 goals of the World Summit for Children. In countries whose people are becoming more affluent, research on populations that are moving from undernutrition towards obesity and a more sedentary lifestyle will be important for understanding the development of chronic diseases. The possibility of nutritionally detrimental environmental contaminants is also an issue that transcends national borders. Finally, improved understanding of how to design effective community interventions could have significant international influence on setting nutrition/food policy at the national and community levels.