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Strategic Planning

Strategic Planning Document -
Health, Safety and Food R&D

STRATEGIC PLANNING

GOALS AND OPPORTUNITIES

VISION

Improved health, safety and food security depends on scientific progress. CHSF will coordinate research and development, disseminate new knowledge, and support the development of sound and cost-effective national health, safety and food policies. CHSF plans an interactive mix of research and development investments that will improve our nation's health, safety and food, expand technological capabilities and stimulate growth. Fundamental scientific discovery will support technological development. Active surveillance will monitor current and emerging health, safety and food security issues. Knowledge- based evaluation will maximize program results and improvement. Multiple educational tools will inform the public about issues regarding their health, safety and food. CHSF scientists--fueled by accurate integrated information--will act on this plan in partnership with other dedicated professionals domestically and internationally.

THE CHALLENGE

CHSF is committed to meeting the many complex challenges to health, safety and food. Research fueled by accurate and integrated information is needed to meet these challenges, to improve our understanding of how to deliver cost-effective services to the public, and to apply the results of research to improve the technological capacity and economic health of the nation. The U.S. is at a juncture where rapid growth in biomedical knowledge and technology can greatly improve the health of U.S. citizens, control new diseases, prevent the spread of re-emerging diseases, and promote national growth and competitiveness. The national health care system is in the midst of major change, amidst widespread concerns about rapid increases in medical expenditures. Research is needed on how to improve the integration of personal and public health, on how to improve the balance between treatment and prevention, and on how to improve outcomes while managing costs. This research will improve returns on the nation's substantial health care investments. Research and development in health promotion, disease and injury prevention and in human nutrition can promote health, prevent suffering, and cut health care costs. Advances in fundamental and applied food science can improve traditional food production and processing to develop sustainable production systems, secure a safe and adequate food supply and a healthier global environment, and support U.S. food production capabilities and global competitiveness.

The CHSF strategy is to invest in priority areas of research and development where harnessing advances in sciences like microbiology, epidemiology and genetics will have the greatest returns. The returns on these investments include improving the nation's health, safety and food and stimulating growth, creating jobs, and promoting U.S. competitiveness. The CHSF strategy supports "Science in the National Interest" by identifying research to address national priorities such as health care quality and cost, welfare reform, food safety, violence and injury prevention, and improved health through nutrition. Science will improve our understanding of complex challenges like these:

Disease claims lives, causes suffering and costs money. Cumulative costs of treating HIV-infected persons are forecast to increase 48% over the next three years. About 1.2 million people will be diagnosed with cancer this year, and approximately 538,000 will die. Cardiovascular disease remains the leading cause of death, morbidity and disability among men and women. There are no effective therapies for Alzheimer's disease, which currently afflicts about 4 million Americans and costs about $90 billion annually.
Although health care spending has risen from 9.1% of the Gross Domestic Product in 1980 to 14% now, by many indicators, Americans are paying more and receiving less for their health care dollars than citizens of several other countries. Americans deserve a quality health care system that improves personal and public health and quality of life at lower cost. Every month, two million Americans lose their health insurance. Over the next 2 1/2 years, about one out of four Americans will have a lapse in their health insurance coverage for some period of time. U.S. health care resources are not distributed efficiently, equitably or cost-effectively, and the escalating costs of health care services continue to impoverish and erode our public health infrastructure, resulting in outbreaks of preventable disease and injury.
Although most diseases or injuries are caused by multiple factors, a recent analysis indicates that external factors account for approximately 2/3 of premature deaths in the United States. Of these external factors, the most prominent contributors to death among the U.S. population are tobacco, diet and activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit drug use. Injuries alone cost society $215 billion and account for about 150,000 deaths annually, and are the second leading source of direct medical costs in the non-institutionalized U.S. population. Many of these influences and risk factors can be cost-effectively modified through behavioral change and effective interventions.
A recent study reports that only five of the thirty years of life expectancy gained since the turn of the century are attributable to the efforts of the medical care system. The majority of the increase has been achieved through improvements and protections in the external environment and through behavioral change. Population-based strategies directed at groups rather than individuals can directly and efficiently reduce the personal, social and economic costs of a range of health problems, including premature birth, cancer, heart disease, mental illness, injury, existing and emerging infectious disease, drug abuse and tobacco use.
We must meet the growing food and water needs of a world population expected to double by the year 2050. Safe food and sustainable production systems can improve human and ecological health while improving agricultural productivity and U.S. competitiveness. In the U.S. alone, foodborne disease leads to 6.5-33 million illnesses, and $5-$13 billion in medical costs and productivity loss annually. To adequately and safely feed the nation's and the world's population in the future, we must implement sound strategies for food safety, accessibility and sustainability now.
Dietary factors strongly affect growth, development, and the risk of many chronic diseases: including diabetes, heart disease, certain cancers, stroke, osteoporosis, cataracts, and atherosclerosis. Over the past decade, obesity in the U.S. has increased dramatically. Now over one third of adults, or 50 million people, are obese. Minorities suffer disproportionately from obesity and many of its complications. There also has been a marked decline in the level of physical activity of the average citizen. Diet and sedentary activity patterns have been identified as the second leading underlying cause of death in the U.S., accounting for 14% of total deaths in 1990. Nutrition plays a pivotal role in optimizing health and productivity.

MEETING THE CHALLENGE: HEALTH, SAFETY
AND FOOD FOR AMERICA

On November 21-22, 1994 the CHSF and OSTP sponsored a national forum: "Meeting the Challenge: Health, Safety and Food for America". The purpose of the forum was to convene 450 of the nation's scientific experts to review and improve CHSF plans, share ideas, and develop and support our country's short and long-term objectives in health, safety and food R&D. The Forum endorsed the following priority areas for research and development. These areas reflect the Administration's R&D priorities for "A Healthy, Educated Citizenry". Research and development investments have been planned in each of these areas that will yield positive returns and expand national capabilities, growth, and competitiveness. Plans have been made in the following areas:

Biomedical, Socio-Cultural and Behavioral R&D;
Health Systems and Services R&D;
Health Promotion and Disease and Injury Prevention R&D;
Food Safety, Security and Production R&D; and
Human Nutrition R&D.

CHSF plans in these areas are outlined below. It is important, however, to first describe the scientific enterprise Forum participants envisioned to successfully meet health, safety and food challenges, both now and in the future. As the plenary speakers noted--including First Lady Hillary Clinton and Secretary of Health and Human Services Donna Shalala--the overall goal of 21st century science is to increase human understanding and ability. The challenge of science policy is to forge partnerships to assure that fundamental research is preserved and translated into applied research, to assure that research is focused, to assure that discoveries are shared across disciplines and among academic, government and industry scientists, to assure that technology applications are made and transferred to the marketplace, and to assure that the public is well informed about science and that consumers use scientific information to make more informed choices. When these partnerships are strong, investments in science are cost-effective investments in the future. Building strong partnerships is not easy. Forum participants agreed that the U.S. needs to address the following six key themes for a successful scientific enterprise that will support national capabilities, growth and competitiveness:

1. INFORMATION SYSTEMS FOR RESEARCH AND
DECISION- MAKING

Updating and integrating basic national health, safety and food data systems is critical if the nation is to maintain active surveillance and monitor risks, fuel vital research, evaluate results and inform the public. Such data is necessary to a successful science agenda. Data is needed to monitor and conduct surveillance on problems, document basic information on health, safety and food status, and quantify health related risk factors.

Coordinating and integrating ongoing public and private efforts to organize data will make better use of existing data. Surveillance systems should be expanded to include environmental, occupational and socioeconomic factors. In many fields of health, safety and food research; the areas where the Federal government could make the largest contribution are in supporting and maintaining integrated national data bases. Multiple research agendas could benefit from such a coordinated practice. The ultimate outcomes would include the potential for a better integrated portfolio of national research initiatives, as well as more judicious use of R&D resources.

2. INVESTING IN THE RESEARCH CONTINUUM

The nation needs a scientific agenda with a core of fundamental research that is interactively linked to applied research, clinical and field trials, technology applications, and marketed products. This scientific agenda will enable the nation to use research results to support knowledge-based, cost-effective health, safety and food policies, sustainable economic growth and increased competitiveness.

3. PARTNERSHIP FOR A NEW GENERATION OF
21ST CENTURY SCIENTISTS

The Federal government should train and support creative investigators--including beginning investigators--to conduct fundamental research that drives the scientific enterprise. Maintaining the leadership position of the United States in the life sciences depends on producing outstanding beginning investigators and supporting an array of professional opportunities for them. This is necessary not only to maintain a continuous pool of scientific researchers but also because beginning investigators are often most creative. We need to assess the effectiveness of current programs, both federal and private, that are designed to support and encourage beginning investigators. Programs should encourage applied research and cross-disciplinary activities.

4. LONG TERM RESEARCH

The Federal government should support "pre-competitive" research--especially in higher risk, fundamental research with a long term uncertain "pay-off". Private sector incentives to conduct fundamental research should be improved. In order to assure that research is maximally effective, priority setting for all research should be done jointly by public and private sectors. A peer-review and competition process should be used.

5. PARTNERSHIP/ CONSORTIA WITH GOVERNMENT,
ACADEMIA AND INDUSTRY

Research and development partnerships are needed across agencies and disciplines and with the private sector. Such partnerships can leverage public and private resources, maximize the results of research, reduce the time required to put inventions into practice, and assure cost-effective technology transfer into health, safety and food industry arenas. Consortia must be crafted so that the primary result of this cost-sharing is enhancing the current health care system or investment in the health care infrastructure. Consortia should also simultaneously provide secondary benefits through strengthening the nation's industrial base, increasing our economic security and/or making new products available to both private and public sectors. Since R&D partnerships and consortia spread multiple benefits across many disciplines and sectors, they should be established or continued where possible.

6. INFORMATION DISSEMINATION AND PUBLIC
EDUCATION (SCIENCE LITERACY)

A continuous effort is needed to effectively communicate research results to the public. This includes basic K-12 science education, day-to-day science writing and reporting, and targeted communication to enable the public to use the results of research to guide personal choices. Coordinated science education will increase public understanding, willingness and ability to use science-based products and information.

The success of the CHSF strategic planning hinges on addressing the themes above. But they go well beyond CHSF boundaries. These themes are congruent with concerns expressed at the National Forum on Fundamental Science and in the resulting report, "Science in the National Interest". They are also consistent with many of the R&D policy principles articulated by the Administration in the May 1994 Gibbons- Panetta memorandum. CHSF is raising these themes to communicate concerns of Forum participants and to describe how CHSF plans mesh with the Administration's overall science policy: "Science in the National Interest". The CHSF plan addresses the themes identified above to the extent possible (e.g. within current resource levels in the areas of health, safety and food R&D). Additional planning may be needed beyond the CHSF plan to address them effectively.