Disease and injury are constant threats to humankind and are never static. Diseases, such as HIV/AIDS, SARS, pandemic influenza, obesity, and many other conditions can emerge at any time. Twenty years ago, the impact of Alzheimer’s disease was not fully appreciated, and its causes were not known. Bioterrorism did not figure prominently in the scientific research and development agenda in 2001, but is now a top priority for numerous HHS divisions, including FDA, NIH, and CDC.
As a result of success in preventing and treating acute and short- term conditions such as heart attacks, stroke, cancer, and many infectious diseases, people are living longer. The increasingly older population faces the new challenge of multiple chronic conditions that now consume about 75 percent of health care expenditures. The Nation is in a continuous race against the overwhelming health and economic consequences of disease and human suffering. Therefore, we must utilize research and development to its maximum capacity to transform health care, public health, and human service practice efforts.
The 21st century is an era of great scientific opportunity. Advances in the understanding of basic human biology allowed NIH to sequence the human genome by 2003, 2 years ahead of schedule, and to complete the haplotype map, showing the variation between individual humans, in October 2005. New advances enable new treatments that could lead to the transformation of medical treatment in this century. The hope is to usher in an era in which medicine will begin to be predictive, personalized, and preemptive. Personalized medicine has the potential to transform health care through earlier diagnosis, more effective prevention and treatment of disease, and avoidance of drug side effects.
Basic science is the foundation for improved health and human services. However, once a basic discovery is made, the findings must be applied and translated into practice for health and human service improvement to result. This continuum from basic and applied research to practice is a significant emphasis of HHS’s scientific research and development enterprise.
Strategic Goal 4, Scientific Research and Development, seeks to connect this path from basic research to practice through four broad objectives:
Strengthen the pool of qualified health and behavioral science researchers;
- Increase basic scientific knowledge to improve human health and development;
- Conduct and oversee applied research to improve health and well-being; and
- Communicate and transfer research results into clinical, public health, and human service practice.
A number of HHS operating and staff divisions, including the Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA) and, most significantly, the National Institutes of Health (NIH), sustain and contribute to a full spectrum of scientific research and development activities.
NIH supports and conducts investigations across the full range of the health research continuum, including basic research, which may be disease oriented or related to the development and application of breakthrough technologies; observational and population-based research; behavioral research; prevention research; health services research; translational research15; and clinical research,16 as well as research on new treatments or prevention strategies.
FDA supports the research and development goal as a scientific regulatory agency. It is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, and the Nation’s food supply. FDA also ensures the safety of cosmetics and products that emit radiation. FDA advances the public health agenda by helping to speed innovations to market that make medicines more effective and to provide the public accurate, science-based information needed regarding medicines and foods to improve its health. FDA plays a significant role in addressing the Nation’s counterterrorism capability and in ensuring the security of the food supply. FDA conducts applied and translational research that enables it to develop regulatory standards and risk assessment criteria to reach sound, science-based public health decisions on regulated products. All of these activities are conducted in collaboration with numerous public and private partners, including academic research institutions; nonprofit foundations; and vaccine, pharmaceutical, and medical device industries.
CDC focuses primarily on epidemiological and public health practice research. AHRQ has established a broad base of scientific research and promotes evidence-based improvements in clinical practice and in the organization, financing, and delivery of health care services.
Below is a description of each strategic objective, followed by a description of the key programs, services, and initiatives the Department is undertaking to accomplish those objectives. Although HHS supports a wide array of research and development activities, these represent the major areas of the emphasis for the Department over the next 5 years. Key partners and collaborative efforts are included under each relevant objective. The performance indicators selected for this strategic goal are also presented with baselines and targets. These measures are organized by objective. Finally, this chapter discusses the major external factors that will influence HHS’s ability to achieve these objectives, and how the Department is working to mitigate those factors.
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