A Research Agenda for America's
Health, Safety, and Food

An important objective of the NSTC is the establishment of clear national goals for Federal science and technology investments in areas ranging from information technologies and health research, to improving transportation systems and strengthening fundamental research. The Council prepares research and development strategies that are coordinated across Federal agencies to form an investment package that is aimed at accomplishing multiple national goals.

To obtain additional information regarding NSTC, contact the NSTC Executive Secretariat at (202) 456-6100.

To obtain additional information regarding the OSTP, contact the OSTP Budget and Administration Division at (202) 395-7347.

Improved health and a better quality of life are goals we all seek for our families and ourselves. Achieving these goals in the 21st century requires that we continue our strong commitment to a Federal role in supporting research and education and fostering the scientific talent of our young people.

Since the 1860s, the Federal Government has invested in health, safety, and food research and development -- a sustained investment that has paid off for all Americans. The average life expectancy of 76 years for Americans today represents an increase of more than 60 percent over the typical life expectancy of 47 years at the turn of the century. Much of that increase in life span can be attributed to better food, better sanitation, and medical advances, including vaccinations, that have reduced or eliminated many childhood diseases.

Our strategy for continuing to improve America's health, safety, and food emphasizes investing in the fundamental research necessary to assure our future well-being; promoting prevention in the areas of both health care and environmental protection; and educating Americans so they can improve their own health and safety decisions. This strategy will lay the foundation for a healthier, safer future for all Americans.

As part of the public consultation, the Office of Science and Technology Policy, the NSTC, and the Institute of Medicine convened a national forum on November 21-22, 1994 at the National Academy of Sciences. The forum addressed questions fundamental to the health and well-being of Americans and elicited a remarkable outpouring of sound advice from a cross section of the country's outstanding leaders in science and technology drawn from industry, academia, research laboratories, government, and professional societies. We thank each of the participants, more than 300, who generously shared their ideas and advice.

We would like to acknowledge the individuals who contributed to the success of the forum, the co-sponsoring foundations and professional societies for providing support and participation, the executive team of federal scientists who devoted considerable time and commentary and critiques on early drafts. We would like to give special thanks to members of the Office of Research and Development at the Veterans Health Administration for their particular role in analysis and synthesis of the wealth of information shared at the forum and for their dedication to the preparation and editing of this statement.

Members

Staff

Past investments to create the health, safety, and food knowledge base of today have enjoyed broad public and bipartisan support and have proven to be among the most cost-effective ever made. The foresight of the leaders who initiated these investments, sometimes made at times of great economic and social strife, appears quite noteworthy. The first major Federal investment in civilian research and development came with the creation of the land grant university system through passage of the Morrill Act during the Civil War. This visionary program has yielded enormous returns in improved agricultural productivity, food safety, and human nutrition.

The national research investment has produced major advances in health and agriculture over the past 50 years and the biological revolution continues to yield new approaches to current problems. Health research has produced vaccines against polio, hepatitis B, and many other infectious agents; drugs to treat hypertension, mental illnesses, and infectious diseases; methods to safeguard the supply of blood and blood products; recommendations for health-promoting diet and life-styles to lower the incidence of heart disease and other chronic diseases; diagnostic methods such as magnetic resonance imaging and the Pap test; new surgical methods, including organ transplantation and implantation of pacemakers and artificial joints; and sound regulatory policies to protect the food supply and to lower risks encountered in the home, school, workplace, and the environment. Investment in agriculture research undergirds the nation's economy and sustains the well-being of every American. Food and fiber products contribute to the credit side of our balance of trade, represent over 15 percent of the Gross Domestic Product, and account for an estimated 18 percent of all civilian jobs.

This Administration has worked diligently to preserve the bipartisan understanding of the value of investing in knowledge for the future while, at the same time, developing priorities to help us meet present challenges. While the nation engages in its unprecedented period of debate about the role of government in our society, its size and cost, we must continue to move forward in the areas central and essential to our national interest. This is especially important in areas that directly and tangibly affect the daily lives of Americans. We therefore put forward four strategic goals to guide research and education policies in the broad areas of health, safety, and food:

• Create the fundamental knowledge necessary to sustain world leadership in the sciences needed for enhancing the nation's health, safety, and food
• Prevent problems in health, safety, and food through research-based strategies and science-based regulation
• Harness the information revolution to increase the effectiveness and impact of research in health, safety, and food
• Raise the scientific and technological literacy of Americans to enable them to make informed decisions about their health, safety, and food and to prepare them for the workplace and scientific challenges of the future

Initiatives

• Maintaining the United States' leadership position in the sciences necessary for improving health depends on producing outstanding scientists and engineers and nurturing their development. This is necessary not only because we need to maintain a continuous pool of scientific researchers but also because young investigators often produce the most creative insights and innovative solutions. Therefore, we will recommend creating a Presidential Early Career Scientist Award combining the resources of member agencies of the NSTC to support and encourage beginning investigators.

• The advent of the Information Age--the rapid transfer and exchange of electronic information--holds the potential for revolutionary developments for research and improved programs and policies in health, safety, and food. However, the need for better information has exceeded the capacity of existing data systems. These systems include those used in biomedical research; worldwide disease surveillance; monitoring the nation's health, nutrition, and safety; and food safety and production. The NSTC will strengthen the domestic health, safety, and food data systems by integrating existing systems and by improving their timeliness and responsiveness to public health problems, quality, accuracy, access, and privacy.

• Nutrition plays a pivotal role in optimizing health and productivity and reducing the risk of diet-related disease. Dietary factors profoundly affect growth, development, and the risk of many chronic diseases -- including diabetes, heart disease, cancer, obesity, and osteoporosis. The NSTC will strengthen its integrated, multidisciplinary human nutrition research initiative to: 1) apply the new techniques of molecular biology to understanding how diet causes such profound ill consequences for health; and 2) stimulate healthy food, nutrition and physical activity behaviors.

• Sound food-safety policy, innovations in food production to increase safety, and consumer education to improve food safety practices depend on a scientific foundation. The NSTC, in partnership with the agricultural and food processing industries, will design and implement an integrated research agenda to develop technologies to assure the safety and quality of food for consumers.

• Improving the science base, methods, and measurements used in health promotion and disease-and-injury-prevention research and development will enhance our understanding of controllable factors in disease, injury, and disability and lead to more effective programs and policies. The NSTC will improve, develop, and standardize methods for assessing: 1) exposures in the home, school, workplace, and the environment; and 2) the socioeconomic, behavioral, biomechanical, biomedical, and public health factors influencing health.

Although there is much that we cannot predict about the next millennium, we have an obligation to the generations that succeed us to ensure that the decisions we make today in the name of deficit reduction do not undermine our ability to understand and manage future challenges. In no area is this more true than in the investments that the nation makes in the creation of new knowledge and its applications. Past investments made by the United States to create the knowledge base of today have proven to be among the most cost-effective ever made, and they continue to enable the nation to remain at the forefront of a rapidly changing and increasingly sophisticated global economy. Several contemporary examples in the areas of health, safety, and food, presented here, illustrate this point. Although we must remain vigilant that advances in knowledge do not themselves create new and difficult challenges for the future, we must be bold and preserve the pioneering, entrepreneurial spirit that typifies America.

Our investments in science, knowledge creation, and applications have generally enjoyed broad public and bipartisan support, and rightly so. As several governors recently noted in a statement to Congress:

"Federally sponsored research translates directly into the knowledge that is now the most important form of capital and the primary source of our well-being and economic strength."

The need for the nation to invest in new ideas and scientific discovery was recognized during the 19th century. In 1862, President Lincoln, aware that the nation's economic future depended upon its food security, established the U.S. Department of Agriculture. Congress passed the Morrill (1862) and Hatch (1887) acts, which established the state land-grant universities, and supported agriculture experimental stations. These institutions presaged a new model linking research, higher education, and public outreach. They produced ideas and programs that led to advances in agricultural production, food safety, and human nutrition and a greater access to the results of research and higher education that previously had been restricted to a wealthier segment of the population. It is remarkable that the nation made such a critical and far-reaching investment during the Civil War, a period of considerable societal stress. This courage and foresight sets a high standard for actions today.

"Through scientific discovery and technological innovation, we enlist the forces of the natural world to solve many of the uniquely human problems we face--feeding and providing energy to a growing population, improving human health, taking responsibility for protecting the environment and the global ecosystem, and ensuring our own nation's security."

--President William J. Clinton
Science in the National Interest
August 1994

The late 19th and early 20th centuries witnessed the scientific understanding of the bacterial causes of disease and a growing public demand that state and federal government authorities assume new roles in protecting the public health. Local governments and states established boards of health and vested them with authority to conduct inspections, identify and quarantine cases of infectious diseases, order evacuations, and establish and maintain sanitary standards. A National Hygienic Laboratory, established in New York in 1887 and later relocated to Washington, D.C., grew to become the world-renowned National Institutes of Health. Congress passed the Food and Drug Act in 1906, which set safety controls on the processing, labeling, and sale of food.

The U.S. Public Health Service, established in 1912, began to administer physical and mental examinations to immigrants and to establish demonstration projects and control programs for infectious diseases. In 1922, Congress passed the Sheppard-Towner Act, which established a Federal Board of Maternity and Infant Hygiene and provided funds to states for programs in maternal and child health. From these beginnings, the current state-federal partnerships for research and public health protection arose. The Federal role in research and regulation expanded in recognition of the common need for knowledge and the nature of the problems posed by infectious diseases and food in interstate commerce.

In the 20th century, we have realized the returns from these earlier investments and continued to invest in ideas that have manifestly changed our destiny. Much of the philosophy that guided Federal research investment during the last half of the 20th century was embodied in the 1945 policy statement developed by Vannevar Bush and presented to President Truman, Science: The Endless Frontier. This philosophy served us well post World War II and during the cold war. A new concept of the role of science and science education in our future was envisioned by this Administration in Science in the National Interest, a policy statement to the American people in 1994.

The Clinton Administration has worked diligently to preserve the bipartisan understanding of the future value of investments in knowledge. The Administration's science policy, as defined in Science in the National Interest, articulates the importance of sustaining our knowledge base and developing new scientists and a scientifically literate workforce. The document details the links between investments in research and education and five national goals, all critical to the nation's long-term security:

• improved health,
• an improved environment,
• economic prosperity,
• a first-rate national defense, and
• improved quality of life and safety.

An ongoing evaluation of the status of our Federal research investments, continual assessment of priorities, and new approaches to interagency cooperation will be needed to maintain the excellence of our research endeavors in the face of fiscal constraints imposed by reducing the national deficit. Above all, we must avoid making a tragic misjudgment regarding the value of long-term investments in scientific research and education, upon which all of our futures will depend.

This is no time for complacency in the areas of health, safety, and food. Over the next half century, projected population and economic growth will require that global food production and distribution to at least double. Meeting this demand and achieving sustainable food production will require new crops and new methods to maximize crop and livestock yields while minimizing chemical, energy, and water usage and environ-mental damage. In developed countries, as we learn more about the relationship of dietary intake to health and chronic disease development, education programs will stimulate changes to the eating patterns of our citizens. This, in turn, will lead to shifts in the types and balance of crops and livestock produced to meet the demands for more nutritious foods.

Increasing global trade will pose new challenges to food safety. Furthermore, the ease and rapidity of world travel makes disease surveillance and prevention a very different challenge in the 21st century as evidenced by the AIDS epidemic and the recent outbreak of the Ebola virus in Zaire. Our successes in health, safety, and food research have provided the United States with a substantially lower disease burden, a varied and generally safe food supply, and a safer home, school, and workplace than the citizens of the 19th century enjoyed. However, the rapid pace of change will necessitate a constant renewal of our efforts if we wish to preserve and extend our past gains for those who follow us.

Research that yields insights into reducing injuries and preventing diseases serves as the cornerstone of modern regulatory policy. Safety research is the basic and applied research foundation for regulating the risks and hazards arising from the food we eat, the drugs and medical devices we use to treat disease, and the environments in which we live, work, and play. Sociobehavioral and biomechanical research underpin regulatory policies that have substantially reduced injuries occurring in occupational, residential, and recreational settings, saving about $2.5 billion annually by preventing injuries from home electrocutions, poisonings, power mower accidents, and fires.

Today, we are engaged in a national debate about Federal spending, how best to deliver health care and at what cost, and how and what to regulate. The imperative of reducing the Federal deficit frames the way these and other issues are being decided. While Americans generally accept the necessity to reduce the Federal deficit, the long-term implications for public health and safety of the pathways chosen to do so are not well understood. Science-based strategies offer the best solutions for complex national problems, such as that of containing costs while maintaining access to and quality of health care services or that of regulating to protect the public from hazards without overly constraining the marketplace.

The need for coordinating science and technology policy at the federal level has been recognized by many administrations and implemented through such structures as the former Federal Coordinating Council on Science, Engineering, and Technology (FCCSET), and currently, the National Science and Technology Council (NSTC), which the President chairs. This document is the NSTC's research agenda for furthering the national goal of improved health. However, the priorities and strategies suggested here will also contribute to improving our economy, developing sustainable agriculture and environmental management, improving our overall quality of life, and contributing to our national defense by improving our international disease surveillance and food security.

The process that helped to define and shape this document involved wide consultation both within government and the private sector. In November 1994, OSTP and the NSTC Committee on Health, Safety, and Food sponsored a national forum, Meeting the Challenge: Health, Safety, and Food for America, to address issues related to improved health and quality of life, major goals stated in Science in the National Interest. This forum convened more than 200 of the nation's scientific experts from academia, government, and the private sector at the National Academy of Sciences to discuss and review plans for the national health, safety, and food research agenda. The forum, co-sponsored by the Institute of Medicine, foundations, and professional societies, encompassed five areas of priority research in health, safety, and food: (1) biomedical, sociocultural, and behavioral research; (2) health systems and services research; (3) health promotion and disease and injury prevention research; (4) food safety, security, and production research; and (5) hum an nutrition research. White papers in each of these five areas were drafted by the NSTC Committee and discussed during the forum. In March 1995, this Committee issued its 1995 Strategic Planning Document, which defined scientific goals and research priorities for health, safety, and food derived from the forum and extensive Committee discussions.

This policy document, Meeting the Challenge: A Research Agenda for America's Health, Safety, and Food, articulates the issues for a broader constituency and focuses on a few crosscutting strategies and first phase initiatives that are feasible in today's fiscal climate. Four common themes have emerged, cutting across all priority areas. This document sets forth a strategic goal for each theme, and defines specific research initiatives in some detail. These themes are:

• Investing in Health, Safety, and Food Research for the 21st Century
• Promoting Prevention
• Sharing Information
• Educating for a Healthy America

Strategic Goal: To create the fundamental knowledge necessary to sustain world leadership in the sciences needed for enhancing the nation's health, safety, and food

Our World Leading Research Heritage

"From a health standpoint, there is no question that the money invested in science over the past five decades has been very well spent. Americans are living longer, better, and, since the turn of the century, one should note that the average life expectancy has increased from 47 to 75 years." --Phil R. Lee, M.D. Assistant Secretary for Health U.S. Department of Health and Human Services, and Chair Committee on Health, Safety, and Food Research & Development National Science and Technology Council

"The average rate of return from investment by private industry is in the 20 to 30 percent range. The average rate of return from investment by the Federal Government in research and development is probably greater than 50 percent." --Laura D'Andrea Tyson, Ph.D. Assistant to the President for Economic Policy National Economic Council

Our commitment to fundamental research has produced the world's finest scientists, trained to identify promising new research directions while taking advantage of developments in other areas of research. Our peer-review system for funding research, in which investigators suggest projects and panels of qualified scientists evaluate their proposals, remains unparalleled in the world. It should be sustained and strengthened as the primary mechanism for sustaining scientific excellence.

Government can smooth the path from initial idea to technology development and commercialization by fostering interactions among Federal agencies, industry, and academia. Although we expect the revolution in knowledge sharing made possible by advances in computer sciences and other disciplines to help speed the time between a new discovery and the reaping of its social and economic benefits, it will continue to take decades to capitalize fully on new ideas and innovations. Thus, our investments in health, safety, and food research require stability, predictability, and patience.

For example, an estimated $92 billion of our current Gross National Product derives from 10 biomedical discoveries made before 1980. Industries adapted these discoveries, based on Federally-funded basic research, and produced freeze-dried foods; an effective vaccine against Marek's disease in poultry; warfarin, a common and effective rodenticide; and flexible endoscopes, an important result from fiber optics technology. Successful cooperative efforts were stimulated even further, particularly in the area of drug development, by the Technology Transfer Act of 1986, which allowed Federal scientists to enter into research agreements with private industry.

From Research to Results

"The current preeminent status of U.S. health, safety, and food research rests on the foundation of investigator-initiated, peer-reviewed studies and on our investments in fundamental research for new knowledge and technological advances that improve the health of all Americans." --Wendy Baldwin, Ph.D. Deputy Director for Extramural Research National Institutes of Health

"We must remember that advances are meaningful only if they are widely applied." --Harold Varmus, M.D. Director National Institutes of Health

The complex interplay among different types of research offers rich opportunities for new scientific advances and improved health and quality of life. For instance, neurodevelopmental and behavioral research have revealed that excessive lead exposure can cause severe cognitive and neurologic problems. The discovery that blood-lead concentrations once considered safe have detrimental effects on neurological functioning raised concerns for the health of thousands of children exposed to lead-based paint and other lead sources each year. With the development of sophisticated biophysical techniques, such as atomic absorption spectroscopy, the ability to detect low amounts of lead in the body's organs and tissues became possible, and the correlation between low blood-lead concentration and good health led to setting even lower safe limits for lead in the blood.

Finding the ill effects of even low-level lead exposure in childhood raised questions about lead's health effects in adults with workplace or environmental exposures. We now know that there are low-dose concerns for adults, albeit for effects other than those for children.

The multidisciplinary research that identified the harmful effects of lead exposure led to Federal policies to reduce those exposures and to monitor progress toward that end. These included phasing out lead seams in canned foods, placing controls on lead emissions from factories, banning lead as an anti-knock additive in gasoline, and regulating the use of lead in paint. Public health experts continue to work on long-term strategies to educate parents about the health hazards of lead and to reduce lead in homes and the environment, while pharmacological researchers search for drugs to promote excretion of lead from people already exposed and applied physicists seek noninvasive methods for determining body-lead concentrations. The health, safety, and food challenges of the 21st century will be similarly multidimensional in nature, and also will benefit from the sustained support of a broad range of scientific research.

"It is essential to keep in mind that important advances in priority areas often result from research in fields that at first appear to have no direct connection to the goal." --Gloria M. Coruzzi, Ph.D. Professor of Biology New York University

"The remarkable success of American research universities and health science centers in creating new fundamental knowledge and in research training form the necessary underpinnings for American leadership in pharmaceutical, biological, and medical devices." --Ken Shine, M.D. President Institute of Medicine

Partnerships for Future Research

International Cooperation

For example, research into the development of hardy, disease-resistant grains can help to alleviate hunger and reduce soil erosion internationally while providing more cost-effective means of food production with less exposure to pesticides and fertilizers for both farmers and consumers. Methods that control industrial wastes, protect workers, and save money are critical for industrialized countries as well as developing nations. In the words of the preamble to the Program of Action adopted for the International Conference on Population and Development, "Never before has the world community had so many resources, so much knowledge, and such powerful technologies at its disposal, which, if suitably redirected, could foster sustained economic growth and sustainable development."

"To better establish and maintain commitments with international partners, it is essential that the international partners be included in all research program phases including planning, development, implementation, and evaluation." --Lucille L. Adams-Campbell, Ph.D. Acting Director, Cancer Center and Professor of Medicine Howard University Cancer Center

"The foundation of the U.S. food system is based upon science, technology and research--to sustain it will require strategic focus, innovation, collaboration, and commitment." --Susan Harlander, Ph.D. Vice President Research and Development Green Giant Division The Pillsbury Company

Better Health Care

"Health services research provides the tools that will strengthen the health care marketplace--improving quality and reducing costs." --Clifton R. Gaus, Sc.D. Administrator Agency for Health Care Policy and Research

Socioeconomic and Behavioral Research

"In the absence of research on how cost containment affects health, the danger is that the pressure to reduce costs will result in a 'flight to mediocrity' in American medical care." --Robert H. Brook, M.D. Director of Science Director of Health Services Programs, and Corporate Fellow of The RAND Corporation

"The potential for health services and health systems research in the United States has only begunto be tapped." --Barbara Starfield, M.D., M.P.H. University Distinguished Service Professor School of Hygiene and Public Health The Johns Hopkins University

Summary

Agricultural biotechnology offers the prospect of higher quality agricultural products, better protection of the nation's crops and farm animals against disease, and the ability to harness sunlight to produce certain plastics, chemicals, and even pharmaceuticals from new crops rather than from petroleum sources."

--George Bruening, Ph.D.
Professor in Plant Pathology
University of California, Davis

Photo: A technician examines tomatoes at different stages of ripening.

Genetic engineering is allowing modern scientists to be the benevolent wizards of the future. The practical viability and potential contributions of genetic research to all aspects of our lives, including food production, is recognized as a potent and beneficial tool for scientists. Although molecular advances in genetic engineering are on the cutting edge of technology, agriculture has benefited from a much older form of genetic engineering since the beginning of civilization, through plant and animal breeding.

Farmers have long sought to develop better crops by selecting and using plants with the most desirable crop characteristics. Plant breeders used the same approach to identify plants with superior traits and, through repeated cross-breeding and selection, to eventually produce offspring with a desired combination of traits. Breeders successfully used this process in the past to produce improved crop varieties with steadily increasing yields in all the major crops grown worldwide. Rice varieties that resist disease and have short, stout stems to withstand wind storms are but one example.

However, this method of improving crops has its limitations. For one, it is tedious and time-consuming, taking on average between 8 and 15 years to develop a single improved variety. Also, a desirable genetic trait does not always exist within the species that can be crossed. Additionally, introduction of a desired trait may result in the inadvertent introduction of linked, detrimental qualities. Modern genetic engineering provides a means to overcome these limitations, and enables breeders to introduce a wider array of new traits in a more controlled and predictable manner than they could previously.

From fundamental research conducted in a laboratory in the 1970's arose the basis of a new era in plant and animal breeding. Genetic engineering came to life when scientists doing basic research discovered they could disconnect and rearrange DNA segments in a test tube. Using the application, scientists determined that genes from one organism could be inserted into the DNA segments of another organism. DNA and its counterpart RNA are the fundamental genetic materials in all living things. DNA and RNA carry the information that determines an organism's characteristics. By isolating and inserting genes responsible for particular traits, scientists found they could engineer plants across species.

The technology has already yielded improved foods. Genetically engineered crops developed to date and formally approved by the U.S. Food and Drug Administration (FDA) as safe for consumers include herbicide resistant soybeans, potatoes that are resistant to a damaging beetle, and a virus-resistant squash. These foods may soon be available in the marketplace. To date, only one genetically engineered, FDA approved food is available to consumers: a tomato.

Farmers and gardeners know that tomatoes left to ripen on the vine taste better than those that ripen on the way to the market. However, ripe tomatoes are soft, and pose transportation and spoilage problems. Even if they reach the market undamaged, they tend to have a short shelf life.

The genetically-engineered tomato now available in the market has many qualities that appeal to consumers--better flavor, firm texture, and a longer shelf life. To create this high quality tomato, an industry research group sought a way to allow tomatoes to reach their full flavor on the vine and still get to market in a quality condition. Identifying the genes that cause tomatoes to soften after ripening enabled scientists to produce a reversed version of the gene and reintroduce it into the tomato. The altered gene slowed the after-ripening process, allowing the tomato to stay on the vine longer and to maintain high quality even after harvest. This high quality tomato, currently sold in select market areas in the Midwest and California, is being favorably received by consumers.

The world population is growing at a rate that will result in more than 10 billion people by the mid-21st Century. Science can meet the food demands of this growing population while meeting food and environmental safety goals. Research in genetic engineering will help lead to increased crop yields on the same acreage by developing crop plants that withstand frost, insects, and disease. Engineered traits that slow spoilage will be introduced to reduce post-harvest losses, keep costs down, and increase availability.

Nonfood crops benefit from genetic improvements as well. Scientists have engineered cotton to carry a gene from the bacterium Bacillus thuringiensis. This inserted gene produces a protein toxic to the tobacco budworm, cotton bollworm, and other damaging caterpillar pests that cost an estimated $93 million annually to combat insects in Mississippi alone. On a similar front, the U.S. Department of Agriculture (USDA) and university scientists recently found and cloned a crucial plant gene--the N gene--that provides a built-in defense against a viral plant disease. Evidence suggests that this mechanism could protect many crops against a broad range of viral, fungal, and bacterial infections. Research underway on genetic mapping of major food plants likely will identify other disease-resistant genes.

Genetic engineering will also produce value-added products such as foods with higher nutritional value or other desirable qualities. A flavorful, high quality tomato is just a beginning.

Biotechnological advances are also being extended to the animal world. Tremendous potential exists to improve animal, fish, and shellfish production with the application of genetic engineering to production systems. Scientists from USDA, together with state and international collaborators, are mapping the genetic make-up, the genome, of cattle, swine, sheep and poultry. Just as improvements in geographic mapping facilitated the age of exploration in the 15th Century, so will genome mapping guide the course of future biological discoveries to enhance agricultural production, food safety, and product quality. Genome maps will make it possible to identify which genes code for specific desired traits in livestock, such as lower fat content. They will permit scientists to breed animals that not only meet market and consumer demands, but also provide a safer food source through resistance to food-borne pathogens such as E. coli O157:H7 and Salmonella. And scientists can apply information gained from mapping the chromosomes of these bacteria to disease control in both animals and humans.

"The foundation for applied solutions to real world problems is the continued advance of our knowledge and understanding of the fundamental mechanisms of plant and animal systems and the complex environment in which they function."
--R. D. Plowman, Ph.D.
Administrator,
Agricultural Research Service
U.S. Department of Agriculture

Seeking genes related to plant aging, a scientist examines card showing DNA fragments separated by electrophoresis

The genetically-engineered tomato now available in the market has many qualities that appeal to consumers--better flavor, firm texture, and a longer shelf life. To create this high quality tomato, an industry research group sought a way to allow tomatoes to reach their full flavor on the vine and still get to market in a quality condition. Identifying the genes that cause tomatoes to soften after ripening enabled scientists to produce a reversed version of the gene and reintroduce it into the tomato. The altered gene slowed the after-ripening process, allowing the tomato to stay on the vine longer and to maintain high quality even after harvest. This high quality tomato, currently sold in select market areas in the Midwest and California, is being favorably received by consumers.

The world population is growing at a rate that will result in more than 10 billion people by the mid-21st Century. Science can meet the food demands of this growing population while meeting food and environmental safety goals. Research in genetic engineering will help lead to increased crop yields on the same acreage by developing crop plants that withstand frost, insects, and disease. Engineered traits that slow spoilage will be introduced to reduce post-harvest losses, keep costs down, and increase availability.

Nonfood crops benefit from genetic improvements as well. Scientists have engineered cotton to carry a gene from the bacterium Bacillus thuringiensis. This inserted gene produces a protein toxic to the tobacco budworm, cotton bollworm, and other damaging caterpillar pests that cost an estimated $93 million annually to combat insects in Mississippi alone. On a similar front, the U.S. Department of Agriculture (USDA) and university scientists recently found and cloned a crucial plant gene--the N gene--that provides a built-in defense against a viral plant disease. Evidence suggests that this mechanism could protect many crops against a broad range of viral, fungal, and bacterial infections. Research underway on genetic mapping of major food plants likely will identify other disease-resistant genes.

Genetic engineering will also produce value-added products such as foods with higher nutritional value or other desirable qualities. A flavorful, high quality tomato is just a beginning.

Biotechnological advances are also being extended to the animal world. Tremendous potential exists to improve animal, fish, and shellfish production with the application of genetic engineering to production systems. Scientists from USDA, together with state and international collaborators, are mapping the genetic make-up, the genome, of cattle, swine, sheep and poultry. Just as improvements in geographic mapping facilitated the age of exploration in the 15th Century, so will genome mapping guide the course of future biological discoveries to enhance agricultural production, food safety, and product quality. Genome maps will make it possible to identify which genes code for specific desired traits in livestock, such as lower fat content. They will permit scientists to breed animals that not only meet market and consumer demands, but also provide a safer food source through resistance to food-borne pathogens such as E. coli O157:H7 and Salmonella. And scientists can apply information gained from mapping the chromosomes of these bacteria to disease control in both animals and humans.

"The foundation for applied solutions to real world problems is the continued advance of our knowledge and understanding of the fundamental mechanisms of plant and animal systems and the complex environment in which they function." --R. D. Plowman, Ph.D. Administrator, Agricultural Research Service U.S. Department of Agriculture

"We must work through the political process to make sure that equitable health care is available to all Americans. But, we must also work with scientists--particularly social scientists--to evaluate the system's effectiveness and to make sure it is both innovative and cost-effective."
--Vice President Al Gore
Forum on Meeting the Challenge: Health, Safety, and Food for America
November 1994

The growing demand for accountability, for proof that our health care dollars are well spent, is transforming America's health care system. Health care practitioners now ask the same pointed questions posed just a few years ago by purchasers, policymakers, and consumers: Which treatment, procedure, or technology is most effective? How do we determine which physician or health plan offers excellent but cost-effective care? Which health services are necessary to treat a specific condition, and are they worth the price? What savings can we realize with preventive strategies?

Health services research focuses today on questions such as these because they represent central issues in efforts to improve health care accountability. This research seeks to improve decision-making and accountability in three ways: through research on the quality, effectiveness, and cost-effectiveness of health care services; the translation of those findings into easy-to-understand information for consumers, purchasers, and policymakers; and the development of effective and efficient ways to organize, structure, finance, and deliver those services.

For example, until recently, we did not have the tools to enable purchasers to measure quality or to assist health care practitioners in improving the quality of their services; and we knew little about the effectiveness or cost-effectiveness of most medical or surgical procedures. Today, we see our knowledge of what works in day-to-day practice rapidly expanding through a combination of patient outcomes and effectiveness research, technology assessments, clinical practice guidelines, and the development of quality indicators.

In just one of these areas, clinical practice guidelines, health services research has demonstrated the potential to improve quality of care and patient satisfaction, and to reduce health care expenditures. Consider, for example, pressure ulcer (bed sores) prevention guidelines which emerged from a comprehensive review of scientific research. Salt Lake City-based Intermountain Health Care saved nearly a quarter of a million dollars over a 6-month period at just one of their hospitals by utilizing these guidelines. The potential national savings appear enormous because one-third of nursing home patients and one-tenth of all hospital patients currently develop pressure ulcers.

Health services research also has demonstrated the importance of focusing on the needs of health care consumers as well as practitioners. Consumers need more and better information to make more-informed decisions. These decisions include which practitioners to consult, the risks and benefits of alternative treatments, what preventive care and lifestyle choices to make, education for self-treatment, and selection of the most appropriate health plan. Purchasers need the tools to compare the values of various health plans, measured in terms of both cost and quality outcomes, to make more informed purchasing decisions.

Health services research is responding through the development of health plan enrollees satisfaction surveys; practitioner, institution, and health plan report cards; and innovative approaches such as interactive video disks for informing patients of the risks and benefits of alternative preventive and treatment approaches.

By monitoring health services, researchers can determine the impact of a consolidating market on access to care, quality of care, and physician and patient satisfaction. In an era of increasing mergers and alliances among hospitals, physicians, and managed care entities, it is imperative that both individuals and organizations monitor the effect these organizational changes have on health.

Another crucial role of health services research involves measuring the costs and effectiveness of organizational and procedural changes. One of the most famous examples of such work led to Medicare's prospective payment system for hospitals, known as Diagnosis Related Groups (DRGs). The introduction of this payment method in the early 1980's reduced the rate of increase in hospital room rates by one half. If the DRG payment system had not slowed the rise in hospital costs, national expenditures for hospital care in 1990 alone would have totaled more than $100 billion above what they did. With greater efficiency in service delivery and management, hospitals achieved these economies without reductions in quality of care.

Finally, health services research continues its traditional focus on the best ways to organize, structure, finance, and deliver health care services. The rapid transformation of the health care system now under way as a result of mergers, consolidations, and the emergence of new delivery systems makes this research more important than ever. Taken together, these health services research initiatives offer policymakers, purchasers, and consumers the tools by which they can improve the accountability of health care for everyone.

A health care provider discusses prostatectomy with a patient, using interactive video disks. This innovative health care approach provides patients with information to understand their health condition and make informed choices.

Strategic Goal: To prevent problems in health, safety, and food through research-based strategies and science-based regulation

Today, only a small fraction of our Federal spending goes towards prevention of disease and injury. For example, during 1994, health care in the United States cost an estimated $4,000 per person, with only about $50 devoted to community-based preventive services and public health activities. These activities included health education; injury prevention; monitoring of air, water, and food; surveillance and control of infectious diseases; regulation of consumer products; and monitoring of workplace and recreational hazards.

Preventive and public health measures pay for themselves. For example, for every dollar spent to prevent pregnant women from smoking, three dollars in savings resulted from averted medical costs. For every dollar spent on child safety seats, we save thirty-three dollars in societal costs. For every dollar spent on the Women, Infants, and Children Supplemental Food Program (WIC), studies show a savings in health care costs of $1.77 in Florida and $3.13 in North Carolina during the first 60 days postpartum.

The Administration's research agenda to achieve effective disease and injury prevention focuses on the following research priorities:

• Defining the factors, especially nongenetic ones, that promote health and prevent disease and injury. This will require multidisciplinary approaches, high-quality data collection and analysis, and strong policy support for research and preventive intervention;

• Developing the scientific basis for regulations that protect the health and well-being of Americans at work, home, school, and play;

• Establishing the role of diet in health promotion and disease prevention; and

• Ensuring a safe, high-quality, and sustainable food supply.

Prevention's Benefits

"We have focused too long on how technology can help diagnose and treat disease and not long enough on how science and technology can prevent disease and help us control the costs of health care." --John H. Gibbons, Ph.D. Assistant to the President for Science and Technology Director, Office of Science and Technology Policy "We've made tremendous progress in significantly reducing death and disability from cardiovascular disease and stroke. But there are still many mysteries about these diseases that challenge health professionals. It's a puzzle we're only beginning to learn about, such as how heart disease and stroke affect women differently than men. These unsolved problems still touch too many lives for us to ignore. We must continue to support biomedical research efforts, and advance our ability to prevent and treat heart disease and stroke, our nation's leading cause of death." --Sidney C. Smith, Jr., M.D. President American Heart Association "Although important advances have been made in preventive medicine in recent years, e.g., smoking cessation, further research is needed to demonstrate the effectiveness of a number of commonly performed screening tests in improving health status." --Steven H. Woolf, M.D., M.P.H. Chair, Practice Guidelines Committee American College of Preventive Medicine

The mortality and morbidity stemming from numerous diseases, illnesses, and injuries can be prevented or postponed by immunization, medication, or healthier lifestyle. Witness heart disease, an outstanding prevention success story. The United States death rate from heart disease dropped by 51 percent between 1972 and 1992. Part of this decline clearly resulted from new diagnostic techniques, drugs, and surgical procedures such as angioplasty and bypass surgery. But preventing premature illness and death by controlling risks proved an even greater contributor to saving lives. This dramatic improvement came about through the efforts of many groups working together, including government at all levels and voluntary health organizations such as the American Heart Association. The strategy identified modifiable risk factors for heart disease through large-scale epidemiological research and applied these findings to heart disease prevention through education and environmental change. Risk factors such as smoking, high blood pressure, elevated cholesterol, sedentary lifestyle, and obesity were identified and targeted by governmental groups and partners in the private sector. However, to continue these gains, we must extend prevention efforts to all segments of the population.

Physicians can effectively treat many diseases detected at an early stage. Prevention research has led to early detection methods and some substantial reductions in morbidity and mortality. The death rate from cervical cancer has dropped by 41 percent since 1973, attributable in part to widespread use of one screening test--the Pap smear. Age-adjusted mortality from stroke has decreased by more than 50 percent since 1972, largely due to earlier detection and treatment of hypertension. Preventive interventions and new means of screening for diseases are continually being developed. However, in many cases, gaps in scientific evidence exist regarding the effectiveness of certain screening methods and preventive services, who should receive them, and at what cost.

New Dynamics, New Challenge

Technological advances over the past century have provided many opportunities to promote better health and prevent injury, disease, and disability. At the same time, many of those advances and changes have created key challenges. Our society continues to witness the introduction of new synthetic chemicals, industrial processes, and workplace environments, about whose health effects we know little. Potential health risks such as hazardous waste sites, outmoded nuclear facilities, and contamination of the food chain illustrate problems that previously emerged and have remained unsolved. We must increase prevention research so occupational and environmental health can meet such challenges and we can take advantage of yet-to-come technological progress.

Changes in the structure and composition of communities and the workplace also have provided challenges and opportunities. Changes in our population have given us an opportunity to learn and profit from different cultures and to understand better the effects of cultural, behavioral, and socioeconomic factors on health, injury, and disease. For example, although positive changes in health behaviors--such as reduced smoking, lower alcohol consumption, and improved diet--have occurred in our population as a whole, minority and socioeconomically disadvantaged groups have changed their health behaviors less.

"In recent years, the disparity of health status between poor, predominately minority communities and more affluent sectors of the population has widened. Innumerable health status indicators have demonstrated that poverty is strongly associated with ill health and results in significant reduction in quality of life, increased morbidity, and overall reduction in life span." --Liza Solomon, Ph.D. Department of Epidemiology The Johns Hopkins School of Hygiene and Public Health

Defining the Factors that Promote
Health and Prevent Disease and Injury

Injuries

"It is estimated that nongenetic risk factors such as tobacco use, diet and activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit drug use account for approximately half of all deaths in the United States, while the national investment in prevention of these exposures is estimated at less than 5 percent of the total annual health care cost." --Patricia A. Buffler, Ph.D., M.P.H. Dean, School of Public Health and Professor of Epidemiology University of California, Berkeley

Violence

"The spectrum of infectious diseases is expanding rapidly with changes in our environment and society. While great strides have been accomplished in the control of infectious diseases via antibiotics and vaccines, we are faced with a large number of new and re-emerging infectious agents." --Gail H. Cassell, Ph.D. Charles H. McCauley Professor and Chairman Department of Microbiology University of Alabama at Birmingham

Tobacco, Illegal Drugs, and Alcohol

Abuse of alcohol and illegal drugs imposes a substantial cost on the economy, through increased workplace accidents, long-term disabilities, motor vehicle crashes, and violence. Today millions of people abuse alcohol and illegal drugs for reasons no one understands well. More effective preventive measures will evolve only with further research.

Infectious Diseases

The worldwide HIV/AIDS epidemic and the recent plague and Ebola virus outbreaks have focused attention on the interdependence of all nations. Effective prevention and control of such diseases depend on advances in vaccines and antimicrobial drugs, constant vigilance, and on understanding human motivations and behavior.

The United States must maintain its leadership role by both strengthening its public health infrastructures and assisting other countries to make disease detection and control a national priority. We must also continue our role as a leader by assisting in training new research scientists inother countries and by encouraging our own research scientists to explore the international ramifications of their work.

"AIDS is an epidemic that also reminds us of our need to understand behaviors--in this case, sexual behaviors and drug abusing behaviors--that impact on health." --Jane Menken, Ph.D. Director, Population Studies Center University of Pennsylvania

Protecting the health and well-being of Americans
in the workplace, home, and community

"The best means of eliminating the personal suffering and associated direct and indirect costs related to accidents is to prevent the accidents and exposures to hazardous materials in the first place. We need to re-visit the tried and true principles of accident prevention as well as provide the freedom to seek new approaches. New research and development in injury and exposure prevention is desperately needed." --Tara O'Toole, M.D., M.P.H. Assistant Secretary Office of Environment, Safety, and Health U.S. Department of Energy

Establishing the role of diet in health promotion
and disease prevention

"Research in occupational and environmental health is essential for the development of cost-effective and sound regulation, and for maximizing the multi-million dollar private and public investments that we make in disease and injury prevention in environment and occupational health" --Ellen K. Silbergeld, Ph.D. Professor of Toxicology and Epidemiology University of Maryland Medical School "We are at a crossroads. As we examine welfare reform proposals that may alter food assistance programs, we should measure them by whether or not they assure access to a healthy, nutritious diet and promote health." --Ellen Haas Under Secretary for Food, Nutrition and Consumer Services U.S. Department of Agriculture "The food and agriculture industry is the largest in the country, representing 16 percent of our Gross National Product, exceeding that of health care, and the importance of nutrition is increasingly recognized as a fundamental element in efforts to improve the public health." --Irwin Rosenberg, M.D. Director USDA Human Nutrition Research Center on Aging Tufts University

Inadequate nutrition underlies many chronic conditions, but how nutrients and genes interact and how this leads later to disease are questions only now yielding some answers. Scientists have identified the underlying epidemiologic relationships between dietary and activity patterns and obesity, cardiovascular disease, cancer, osteoporosis, and diabetes. However, effective prevention strategies may require an understanding of the basic biological mechanisms involved. Many components of foods seem to offer protection againstoxidative damage associated with cancer, cataracts, heart disease, and failure of the immune system. Similarly, physical inactivity is both a specific risk factor for heart disease and one contributor to obesity. Obesity, in turn, plays a role in most of the major chronic diseases. The United States is currently experiencing a major epidemic of obesity, beginning in the earliest childhood years. Nonetheless, the vast majority of both medical and self-help treatments have high failure rates. The recent exciting discoveries of genes leading to obesity in both humans and rodents may one day provide early identification of some at-risk individuals and lead to promising pharmaceuticals for use in treatment. Most obesity experts recognize human obesity as a complex set of disorders and will not readily yield to a simple solution. Thus, studies of both nutrition and physical exercise warrant an integrated, mechanistic approach, and research on human motivation to modify behavior deserves a high priority.

Americans today enjoy abundant food choices, yet few consume the variety of foods necessary to obtain in the appropriate amounts--the levels associated with the lowest prevalence of disease and longest life--all the nutrients and protective compounds found in food. Improving people's health will also require many to reduce their consumption of potentially harmful substances in the daily diet--especially total fat, saturated fat, cholesterol, and sodium--increase their consumption of vegetables, fruits, and grains, and maintain a healthy weight through regular physical activity. Today, most Americans do not follow the research-based advice on good nutrition summarized in the Dietary Guidelines for Americans. We need a better understanding of why and how to change this behavior. At the same time, food technologists must develop more health-promoting food without sacrificing flavor, texture, and appeal. The interactions of food, nutrients, energy expenditure, genetic heritage, and chronic and infectious diseases are the priority areas for preventive-nutrition research in the next decades.

Genes, Food, Development, and Chronic Disease

Energy Balance and Obesity

Ensuring a safe, high quality, and sustainable food supply

Food Safety

"A highly integrated information base to support risk assessment from food contaminants, and appropriate methods for monitoring and estimating the potential hazards in the food supply are needed." --Alicia L. Carriquiry, Ph.D. Assistant Professor of Statistics Iowa State University "Sustainable growth in the production of quality, affordable food requires that agriculture shift from a resource-based to a knowledge-based enterprise, and this knowledge-base depends on the understanding that comes from fundamental research." --R. James Cook, Ph.D. Chief Scientist National Research Initiative Competitive Grants Program Cooperative State Research, Education and Extension Service, U.S. Department of Agriculture "The global demand for seafood is going to increase substantially in the future, yet harvests from ocean capture fisheries are stable or declining. Aquaculture is key for increasing seafood production, and continued research in this area will assure an adequate supply of high quality, safe, and affordable U.S. fish and shellfish." --Kenneth K. Chew, Ph.D. Professor, School of Fisheries and Director, Western Regional Aquaculture Center University of Washington

Continuing and enhancing our strong research program in food safety will further ensure public health and safety and prevent food-borne diseases. However, we also need a system that integrates prevention, detection, intervention, and attention throughout the food cycle and makes use of technological advances in food processing and packaging, and pest control. Such a research program will build the scientific foundation for sound food safety regulation and policy, for innovation in food safety and production, and for educating consumers to improve their food safety practices and increase their understanding of the relative risks and benefits.

Agriculture Production

Insect and weed resistance to traditional agricultural pesticides is rising at an alarming rate. To combat agricultural and farm losses to pests, agricultural researchers must develop a new spectrum of controls, including more specific chemicals as well as non-chemical methods. Combining both approaches can minimize the ability of pests to develop resistance or otherwise adapt to control mechanisms.

Agricultural Sustainability

Research into sustainable agriculture carries high international implications because our food supply increasingly depends on sources worldwide. The United States is uniquely positioned to help meet the world demandfor food, both through sharing technology with developing countries to help them achieve self-sufficiency in food production and through exports as part of international trade. Greater international collaboration and research into issues such as food production, sustainability, and aquaculture will benefit all countries.

Genetic Diversity

Researchers must access existing United States and international collections to identify gaps and needed genetic resources; they must also develop appropriate databases that identify their availability, quality and economic traits. We must encourage multidisciplinary research approaches that combine the traditional tools of breeding and selection with the new tools of molecular genetics, with the goal of enhancing germplasm traits that contribute to improved food productivity and environmental sustainability. The public and private sectors must collaborate in research, development, and technology transfer to ensure an adequate flow of improved germplasm for major food and fiber species.

"A significantly increased investment in prevention-based research and development, as well as a multi-faceted, partnership-oriented strategy will contribute to a significant outcome--improved health for all Americans." --Richard S. Schweiker Chairman, Board of Directors Partnership for Prevention

Summary

"The ability to predict emerging threats to health, safety, and food and to be prepared with the knowledge base necessary to develop prevention strategies is highly cost-effective. Our failure to do so, may cost us not only personal health, but national economic security as well." --M.R.C. Greenwood, Ph.D. Former Associate Director, Office of Science and Technology Policy; Dean, Graduate Studies; Vice Provost, Academic Outreach, University of California, Davis

Diseases have ravaged humans since the beginning of time. As society advanced and scientific knowledge grew, people learned the benefits of turning an infectious disease against itself. By using vaccines made from dead or weakened bacteria or viruses, scientists learned that they could halt the attack of some diseases. Today, science is battling new and recalcitrant diseases in an attempt to develop vaccines to stop them.

The bacterium hemophilus influenzae type b (Hib) causes a variety of childhood infections, most notably meningitis. Before the introduction of Hib vaccines in 1985, 1 in 200 children developed invasive Hib disease by the age of 5. Children ages 6 to 12 months suffered the highest rate of attack. Hib caused more than 10,000 cases of bacterial meningitis per year in United States children under the age of 5. Despite treatment with antibiotics, about 5 percent of the infected children died from Hib meningitis, and about one-fourth of the survivors suffered significant neurologic damage, including learning disabilities, seizures, hearing loss, and mental retardation. Prevention became a high-priority target; the disease ravaged the body, even with a cure.

Efforts to reduce the toll of Hib meningitis focused on developing an effective vaccine that would prevent childhood infections. The first generation of Hib vaccines became available in 1985. But these vaccines produced only weak antibody responses in children under the age of 2. Science had to take another step to guarantee protection for all.

Scientists began to develop a second generation vaccine against the disease. By joining together Hib complex sugars with proteins, they succeeded in producing an effective vaccine. The second generation of Hib vaccines, effective in children as young as 2 months of age, has resulted in a more than tenfold drop in the number of Hib meningitis cases reported in the United States.

The obvious payoff of this government research on Hib is healthy children. However, the benefits stretch even beyond, to economic benefits as well. Use of the improved vaccines has yielded an estimated twenty-fold annual return to the public on its relatively small investment in research. Whereas in the past those ravaged by the disease required costly care, those expenditures have lessened. In the past, the people who suffered Hib meningitis in a single year may have cost the country as much as $470 million for long-term institutional care; now the vaccines will save most or all of that expense.

Despite significant progress in development of new and improved vaccines against Hib, pertussis, chicken pox, and other childhood maladies, compliance with vaccination schedules remains embarrassingly low in many parts of the country. For example, retrospective surveys conducted in Washington, D.C., in 1991 revealed that only 39 percent of children there had received all recommended immunizations by the age of 2. In contrast, data from the World Health Organization shows that in many developing countries, immunization rates surpassed the overall rates for 2-year-old United States children. The high proportion of infants and children without age-appropriate immunizations exposes these children to an unnecessarily high risk for a variety of serious, vaccine-preventable diseases.

In this continuing effort to rid our country of disease, we need two concerted efforts. First, we must continue to fund research in an attempt to stay ahead of the ever-increasing number of diseases that arise. Second, for preventable diseases, we must develop better ways to guarantee that all children receive the immunizations that they require and deserve. Immunization is a highly cost-effective public health strategy. Although vaccine development remains crucial, if we do not widely vaccinate children and adults alike, the vaccines are useless.

Preventing Injuries

Preventing Drinking and Driving

Local police departments and courts have contributed to the increased awareness about the dangers of drinking and driving through enforcement and adjudication of drunk driving laws. Young people (especially those ages 15 through 20) are special targets of traffic safety and health education programs because they are almost twice as likely to suffer injury or death as a result of combining drinking and driving. In addition, student-based groups have further affected the attitudes and behaviors of young people concerning traffic safety. Legislation such as the National Minimum Drinking Age Law, which makes it illegal for persons under age 21 to purchase or publicly possess alcoholic beverages, have enhanced these public education campaigns. Minimum drinking age laws have saved an estimated 14,000 lives since 1975.

Federal alcohol incentive grant programs have encouraged States to enact strong, effective antidrunk-driving laws and improve their enforcement. Coupled with education, tougher laws against driving while intoxicated or under the influence of alcohol have had a deterrent effect, particularly on those individuals who do not chronically abuse alcohol but might drive home after just a few drinks. Research continues to show that very small amounts of alcohol, sometimes as little as one to two drinks, impair reactions. Both the threat of losing one's license and the possibility of serving jail time deter many people from breaking the law.

Educating for Safety

As an added incentive for consumers, many insurers offer discounts to people who regularly wear their safety belts or use motor vehicles equipped with passive restraint systems. These and other public health initiatives have resulted in a drop from 50,894 motor vehicle crash deaths in 1966 to 40,676 in 1994. In addition, the benefits of all highway safety programs, including vehicle programs, traffic safety programs, and highway engineering programs, exceed their costs by a ratio of 9 to 1.

Public policies that reduce injury, death, and disability from motor vehicle crashes result directly from research into the types of injuries sustained in crashes, the effects of protective devices, and the dangers of driving while intoxicated. Gathering these data required cooperation among hospitals, insurance companies, drivers, and police. Future collaboration of this type may reduce the likelihood of injury and death even more. One goal of Healthy People 2000, a U.S. Department of Health and Human Services document, is to reduce motor-vehicle-related mortality to 14.2 deaths per 100,000 Americans by the year 2000. To achieve this, researchers must better understand the biomechanics of injury in order to improve the prevention, treatment and rehabilitation of injuries. Finally, we need further research on methods to change the behavior of those Americans who still do not always buckle up; those who choose to ignore traffic laws; and those who still choose to put themselves and others at risk through drinking and driving.

Prevention works. Child safety seats are proven effective in the prevention of needless traffic injuries and deaths each year.

Obesity in America

• Research links obesity to five of the 10 leading causes of death in the United States
• Estimates put the annual economic cost of obesity at $86 billion
• More than one-third of U.S. adults--over 50 million people--are estimated to be overweight or obese
• Obesity is on the rise in children as well as in adults
• Poor diet and activity habits contribute to more than 300,000 deaths in the United States

With these disturbing facts in mind, we must give careful consideration to the research we support so that our investment will serve the best interests of the American people.

"Our goal is to awaken everyone in this nation to the insidious nature of obesity. It silently crept up and captured an entire generation and is threatening the next. The solution is within our grasp; we must apply our ingenuity and resources to intervention research at the individual, workplace, and community levels."
--Barbara J. Moore, Ph.D.
Shape Up America!

Basic research has taught us much and we must protect it because we have solid evidence that nutrients in food affect metabolism and interact at the most fundamental molecular level. To identify effective obesity prevention and treatment strategies, we must understand the details of exactly how this occurs. Dynamic collaborations between researchers in genetics and nutrition will elucidate the precise ways in which dietary factors influence our future health by affecting specific genes. This will help us identify individuals at increased risk for developing obesity and will open the door to future innovative treatment and prevention approaches.

In a recent startling discovery, NIH-supported obesity researchers reported finding a gene in mice that causes a combination of profound obesity and diabetes when it is damaged. The evidence indicates this gene turns on in fat tissue, where it directs the manufacture of a protein that enters the bloodstream and travels to the brain. In the brain, this protein appears to act on the appetite-controlling region that helps regulate the amount of food we eat and metabolism (the rate at which we burn calories). Although still considered basic research, these findings may lead one day to dramatically more effective therapies for weight control that are based on detailed knowledge of specific genes, their modes of action, and their effects.

Clearly, obesity poses a complex problem, one that involves behavior and environment as well as genetics. Effectively changing human behavior and the amount and types of food we eat depends on a thorough understanding of neural processes, memory and learning, appetite regulation, and control of food intake.

Effectively motivating children and adults to adopt more active lifestyles depends, in part, on basic research in neuroscience, psychology, physiology and metabolism. Such research will lead to an improved understanding of why we behave as we do and point the way toward helping us willingly adopt more sound dietary and activity patterns no matter what our age and regardless of our cultural or genetic background.

To support all of this, we need a clearer understanding of how our environment influences our behavior. We now face a new challenge in the creating of communities that will encourage children and adults to safely and easily engage in activity (walking, cycling, field games, etc.) that will promote weight control and the maintenance of health. Research is critically needed to help us design appropriate community interventions. Results thus far indicate we need this urgently, yet we know the least about this important tactic for promoting weight control.

The epidemic of obesity that has swept the United States in recent decades reflects the complex interactions among different genetic backgrounds, unhealthful individual lifestyles, and a societal environment that encourages physical inactivity and poor food choices. Defining the factors that influence our choices of foods and patterns of physical activity will lead to targeted prevention strategies for high-risk individuals and groups, as well as for society in general. Research represents the key to solving this problem. We need to identify individuals at risk for obesity and help them permanently alter their behavior to improve their metabolic fitness and health. Learning to prevent obesity will have a major impact on reducing the development of many chronic diseases. The potential benefits to society are enormous: enhanced individual well-being, reduced suffering, increased productivity, and decreased health care costs.

More than one-third of adults in the United States--over 50 million people--are estimated to be overweight.
The prevalence of overweight varies with age and gender.

An overweight vs. normal mouse. A gene discovered in mice plays an important role in body weight.

A surprised and distressed American public watched in 1993 as an outbreak of food poisoning on the West Coast unfolded among people who had eaten undercooked fast-food hamburgers contaminated with the bacterium Escherichia coli O157:H7, a common food-borne pathogen. The outbreak stirred public demands for better protection against food-borne pathogens.

Bacteria other than E. coli O157:H7 cause major public health concerns in the United States. Each year, Campylobacter causes an estimated 2 million cases of illness and from 200 to 800 deaths. Another pathogen, Listeria monocytogenes, causes serious illness to 800 to 900 Americans annually. Also, about 44,000 cases of non-typhoidal sickness from Salmonella are reported annually to the Centers for Disease Control and Prevention (CDC).

The CDC estimates that as many as 6.5 million cases of food-borne illness occur annually in this country, contributing to as many as 9,000 deaths, with an overall toll on society of $5 billion to $13 billion in medical costs and productivity losses. Improper handling of food at home or in food service establishments continues as the most frequent cause of microbiological food contamination. We need to educate continuously workers and consumers, as well as develop the tools to better detect and improve the control of microbes in foods.

"We have few greater responsibilities to the American public than to ensure a safe, adequate, and sustainable food supply. While the U.S. food supply is one of the safest in the world, we still have a lot to learn. Research in this field will return large dividends, globally, and we must have the foresight to increase that investment."

Lawrence N. Kuzminski, Ph.D.
Vice President, Technical Research and Development
Ocean Spray Cranberries, Inc., and
Chair, US FEAST, Institute of Food Technologists

Science is taking many approaches to fill these gaps. Methods to detect and prevent contamination of foods are being developed that provide increased information and reliability, and faster, more accurate results. While traditional microbial detection methods require at least 48 hours, researchers at the U.S. Department of Agriculture (USDA) recently developed an easily-done, 5-minute test to qualitatively detect high levels of bacteria on beef, pork, and poultry carcasses in processing plants. If the test proves itself in field trials now in progress, it will represent a significant advance in assuring meat safety. In addition, an 8-hour test specific for E. coli O157:H7 holds promise for the future.

Researchers also are striving to develop technology to reduce the contamination of meat and fish products by pathogens. Hazard Analysis and Critical Control Point (HACCP) systems analyze food production, slaughter, and processing operations to identify critical steps or points where microbes might contaminate foods and where best to control or prevent the problem. As a preventive measure, HACCP provides a greater assurance of food safety than end-product testing alone. Based on the HACCP concept, improved management and monitoring practices are now being developed and adopted at critical points throughout the production and processing of livestock, seafood, and aquaculture to assure food quality and safety.

Scientists and safety experts have understood the benefits of food irradiation in safety assurance for some time. Irradiation shows great potential for assuring safety during the processing of raw poultry, hamburger, and other uncooked meats. However, although irradiated products are approved as safe for human consumption, experience has shown that much of the public refuses to accept this, and the resistance to buying irradiated products has limited their use. A public education program would help greatly in promoting consumer understanding and acceptance of this technology.

Many other new technologies show promise for improved food safety--competitive exclusion to reduce Salmonella levels in live poultry, for example. USDA scientists inoculate newly hatched chicks, which lack natural protection against pathogens, with a harmless bacteria that competitively excludes less desirable microbes. Researchers spray the chicks with a mixture of naturally occurring bacteria from mature chickens' intestines. The chicks ingest the microbes and gain protection from Salmonella. Tests show the mixture, called CF-3, reduces Salmonella in the chicks' intestines by 99.9 percent, even when they are exposed earlier to 10,000 Salmonella bacteria apiece.

USDA researchers have even taken a first step toward building immunity to pathogens into animals' genes. They successfully isolated a mouse gene that produces an antibody against E. coli O157:H7. The researchers then inserted the mouse gene back into mice and into pigs and sheep, and found high levels of the antibody in the blood of the mice and pigs, and in one type of white blood cell in the sheep. This particular antibody, only one of many antibodies against E. coli, cannot by itself provide immunity to the animals. However, and most importantly, the results indicate that scientists can program immunity against these pathogens into animals' genes.

Researchers have developed a computerized "early warning system" that predicts growth patterns of microorganisms such as Salmonella, Listeria, Shigella, E. coli O157:H7, and Staphylococcus. Intended to assist food processors in designing foods and controlling processes, the program analyzes which ingredients, conditions, or processes might promote or inhibit bacterial growth in a product. Advances such as these will aid scientists in realizing the future vision for microbial food safety--fewer organisms in foods and a significant reduction in associated illnesses and deaths.

Strategic Goal: To harness the information revolution to increase the effectiveness and impact of research in health, safety, and food

Today, scientific communication is changing dramatically. In some fields, researchers now publish their results electronically as well as on paper, with journals acting more as a permanent record for findings already transmitted via the Internet. The implications of this change for science are still evolving. For three centuries, for example, scientists won recognition by publishing original research results in scholarly journals and this served as a major motivating force within science. Electronic publishing is changing this recognition system. Video conferencing systems permit scientists even on different continents, to meet face to face. Scientists far apart, but meeting in the same virtual reality room, can share transparencies, draw on whiteboards, and discuss data with other speakers in real time. New ways of doing science will evolve to take advantage of these and other new capabilities.

"Personal computers and information networks have created the Information Revolution, transforming the nature and conduct of science in ways that will lead to a better and safer future." --Robyn C. Frank Head, Information Centers Branch National Agricultural Library U.S. Department of Agriculture "Better information shared more widely with an increasingly health conscious population, who now have nutrition labeling to assist in making food choices, could boost the behavioral pay-off on nutrition education sharply." --Patrick M. O'Brien, Ph.D. Economic Research Service U.S. Department of Agriculture

The future promises even more for our citizens. Smart cards that could include an individual's entire medical history on a credit card will appear soon. Kiosks in grocery stores, shopping malls, and places of employment--forerunners of the future--now allow people to browse basic information on foods to eat, health care providers and health plans, and treatment options.

One cannot overestimate the importance of the new information technologies and the speed with which information reaches the public health and agriculture communities. The Administration recognizes this importance and invests heavily in the information revolution through its initiative on the National Information Infrastructure. The Administration's agenda for research includes extending information sharing technology to the health, safety, and food research communities with special focus on:

• coordinating data acquisition and the integration of health, safety, and food information through Federal agencies;
• developing a harmonized language system for health, safety, and food information; and
• providing leadership in creating global databases for disease surveillance.

"Over the last two decades, the amount of time it takes to locate a human disease gene has dramatically decreased as a result of the high-quality maps produced by the Human Genome Project which are made readily available on the Internet. The rapid sharing of mapping and sequencing information has been a hallmark of the project and a key to its success." --Francis S. Collins, M.D., Ph.D. Director, National Center for Human Genome Research National Institutes of Health

Data Acquisition and Integration

One basic foundation for better information resources relies on data acquisition that is complete, timely, and well-coordinated among all parties. Information should be collected once and collected as complete as possible so that users will find the data sets useful for different applications. Successful contemporary data collection efforts, such as the human, plant, and livestock genome mapping projects, the Protein Data Bank, and the Germplasm Resources Information Network, provide examples of high-impact, easily accessible data collections. Given the fiscal constraints felt by government and industry, we must better coordinate public and private research data collections and expand them to include environmental, behavioral, occupational-health surveillance, and socioeconomic factors relevant to assessing our progress in accomplishing national goals.

"Food security depends not only on production capacity but, in times of a crisis requiring a biological solution, on rapid access to a database describing carefully preserved and accurately evaluated germplasm resources underpinning the threatened commodity." --Henry L. Shands, Ph.D. Associate Deputy Administrator Genetic Resources Agricultural Research Service U.S. Department of Agriculture

Data Interchange

Effective interfaces to move information between user communities are also needed to foster the sharing of knowledge gained from research in health, safety, and food. Using such tools, will enable basic biomedical, agricultural, environmental, and clinical research teams to move research findings much more quickly from the laboratory to the bedside, the factory, and the food production site.

True sharing of scientific information means more than the electronic links that modern computer networks provide. Information sharing rests upon making the contents of each data resource understandable and usable to everyone without the need for a specialized vocabulary. Translating the existing science base, methods, and measurements into a universally understood language is a crucial first step. Specifically, we must standardize the nomenclature, analytical methods, methods of expressing hazard and risk, and coding and labeling of data used in health, safety, and food research. Modern information modeling technology and data interchange protocols can be applied and specialized to health, safety, and food information systems, allowing them to work together more effectively. This will facilitate the development of integrated systems of databases, expert systems, and scientific software that will provide easy access, without prior training, to the full range of information on health, safety, and food.

"In the National Networks of Libraries of Medicine, the spirit of sharing within the library and medical communities permitted the work of the National Library of Medicine to be fruitful. The human network, in other words, preceded the electronic network--as it always must if useful services are to result." --Donald A. B. Lindberg, M.D. Director National Library of Medicine National Institutes of Health

Databases for Global Disease Surveillance

"The density of the world's population and the pace of its commerce have wrought great changes in the human condition. Every day, a million travellers cross international boundaries by air, and uncounted others by land and sea. It is imperative that we have early and accurate intelligence on emerging disease threats, and can exchange diagnostic and therapeutic information on an equally timely basis. Diseases we once thought exotic are appearing on our doorstep, and could at any moment initiate new outbreaks--to match what we have seen from pandemic influenza in 1918 and AIDS in the 1980's. --Joshua Lederberg, Ph.D. Professor The Rockefeller University

Summary

Strategic Goal: To raise the scientific and technological literacy of Americans to enable them to make informed decisions about their health, safety, and food and to prepare them for the workplace and scientific challenges of the future

The nation widely recognizes that traditional science education, from its earliest introduction to its most sophisticated post-baccalaureate stages, needs strengthening and revision.

The need for enhanced education is especially important in the areas of health, safety, and food. This is because both the information revolution and the biological revolution brought about by the powerful tools of molecular biology have radically reshaped the approaches to accomplishing our national goals. The convergence of these two revolutionary fields has made new products and industries not only possible but increasingly a part of every citizen's life. Not since the time of Pasteur has science so fundamentally altered our knowledge of how to approach the challenges of improving our health, safety, and food.

We have two specific challenges: science literacy and training a new generation of scientists, physicians, and engineers. Our citizens must all obtain and have opportunities to renew basic scientific and quantitative skills. This will become increasingly urgent. For example, in 1950, 60 percent of all jobs were estimated to be unskilled; in 1990, 35 percent; and by the year 2000, only 15 percent will be unskilled. The initial acquisition of basic skills will depend upon our primary and secondary schools meeting the challenge of substantially increasing science and math literacy. In the next century, the jobs of an estimated 44 percent of United States workers will involve collecting, analyzing, storing or retrieving data. To maintain a global competitive edge, our nation will have to harness the information revolution to provide informal learning experiences that keep our citizens abreast of new ideas and methods via personal access and individual initiative.

"I challenge you to continue to educate the American people about basic scientific research and its vital importance to our future." --Donna Shalala, Ph.D. Secretary Department of Health and Human Services "It is essential that as many K-12 students as possible be exposed to a stimulating science program, emphasizing a "hands-on" approach at an early stage." --Verlan T. Lamikanra, Ph.D. Professor and Assistant Dean College of Engineering, Sciences, Technology and Agriculture Florida A&M University "In pre-professional education, we need to learn how to foster creativity in both teaching and research, how to teach students: how to learn, how to integrate diverse information, how to 'invent' new models, especially how to integrate cross-disciplines and ultimately, how to self-educate. It is essential that students learn to use knowledge from the social, behavioral, and biomedical sciences." --Cheryl Achterberg, Ph.D. Associate Professor and Director Penn State Nutrition Center The Pennsylvania State University "If our nation is to fulfill its promise of improving the health and safety of its citizens, it is necessary to guarantee that our research and educational institutions continue to attract and support talented, dedicated scientist/educators." --Anne M. Etgen, Ph.D. Professor Departments of Neuroscience and Psychiatry Albert Einstein College of Medicine

It is increasingly clear that the rapid availability of information and the extraordinary opportunities provided for self-education by the information revolution will radically revise how and when our citizens have access to lifelong learning experiences. The increasing speed with which research results become available through the media and electronic communication provides the public with a dazzling amount of information, and this will continue to increase. By its very nature, new research sometimes contradicts or modifies prevalent views about health-promoting behaviors, medical treatments, and the safety of our food supply and workplaces. Our citizens and their leaders must recognize that they need some degree of science literacy just to make everyday decisions about their own and their family's health and safety--whether to take a cold remedy, when to vaccinate a child, how to change their diet based on perception of disease risk.

The second challenge to educating for a healthy America is that we continue to produce the scientists and engineers who will make new discoveries and design new applications, thereby maintaining our leadership in science and technology. To do this, a larger proportion of our population will need bachelor's degrees in science and technical fields, and we will need a more flexible group of scientific leaders.

For most of the 20th century the United States and Europe dominated in producing this critical cadre of the modern workforce. However, by 1990 other countries had significantly increased the number of scientists and engineers trained at the baccalaureate level. For example, six Asian countries now produce more than 500,000 scientists and engineers a year, slightly more than the United States and Europe combined.

Post baccalaureate and scientific professional training in the United States remains the best in the world. However, as several recent reports emphasized, we need to improve the scope of graduate education to make these highly trained individuals more flexible and better able to work in the global industrial sector with greater confidence, leadership, and integrative ability. Wide agreement exists, especially in the areas of health, safety, and food research, that we must move more rapidly from discovery to successful application. We need to strengthen the educational experiences of our young investigators for them to become leaders in this arena.

The Next Generation of Scientists

"The next generation of scientists, who will use complex systems models to guide the development and evaluation of intervention programs, needs broad-based expertise and methodological sophistication that extends beyond traditional disciplinary lines. Incentives should be provided to create innovative, multidisciplinary training opportunities that cut across existing disciplines and departmental boundaries, and to develop researchers who are also highly effective communicators." --Leann L. Birch, Ph.D. Professor and Head Department of Human Development and Family Studies The Pennsylvania State University "For the United States to gain world leadership in basic science, mathematics and engineering, the research community must add public education to its mission." --Daniel E. Weber Executive Director Institute of Food Technologists "In an age of science and technology, it is vital for the future of this country that we maintain a cadre of world-class scientists and engineers. Thus, it is important to provide encouragement and recognition for them early in their professional careers." --Mary E. Clutter, Ph.D. Assistant Director Biological Sciences National Science Foundation

Students should be encouraged to view scientific research as a viable, exciting career option throughout their educational experience. The government and the private sector both can encourage students through the use of scholarships, summer internships, mentorships, outreach, and other programs that stimulate interest and encourage leadership in science. National standards for mathematics and basic science education are critical. The increasing presence of women and minorities in scientific careers can provide role models for students and young professionals and broaden the creative perspectives brought to bear on solving contemporary problems. The successful workforce for the 21st century will reflect the increasing presence of women and underrepresented minorities. Hence, we must continue to provide access and encouragement to women and minorities who are underrepresented in the sciences related to health, safety, and food.

The current fiscal climate and the priority placed on deficit reduction must not result in the loss of a generation of scientists especially in the critical and rapidly changing fields of science related to health, safety, and food, which impinge directly on the everyday lives of our citizens. The career paths of newly trained research scientists have gradually shifted over the past decade so that an increasing number now seek employment in industry. Those who do remain in the competitive research settings of universities and research institutes find the funding environment becoming more discouraging. Fewer new research scientists are able to successfully compete for the existent funding. Thus we face the very real possibility that the newly trained minds in this country may miss the opportunity to help move the knowledge base of the country forward, just when reason suggests that their talents are especially needed. Although some who raised the concern that we may be training too many Ph.D.s, many others note that the next century will require more, not fewer, individuals with advanced technical knowledge and skills.

To make sure that we do not lose a generation of researchers, we must resist quick fix or parochial job market solutions, such as reducing the number of trainees in certain fields. Scientific and technological advances promise to make the next decade one of the most progressive ever in health, safety, and food research. These advances, even if made in other countries, will lead to new technology and industry in the United States, but only if we have trained personnel and a strong infrastructure to capitalize on the findings.

Science Literacy

Individuals will benefit from their understanding of science through broadened economic opportunities in new businesses such as biotechnology and home health care delivery. Even entry level careers in these new areas require scientific literacy and proficiency with new technologies.

Although we realize the importance of enhancing the scientific literacy of the entire population, our understanding of the most effective ways to do so remain limited. Nonetheless, we know that most Americans depend upon the media for much of the understanding they gain after formal education in areas related to health, safety, and food. Although some public television and specialized print media have done excellent programming and articles in selective scientific areas, we will need much more sophistication in presenting scientific and quantitative concepts in the future. The potential of such innovative communications networks as the World Wide Web and its successors must become reality for us to guarantee access to new information and skills outside of formal educational settings or programs with restricted air time or availability.

Efforts to boost science literacy have met with some success, but we must expand these achievements using 21st century tools and methods. The science agencies that conduct research and education in health, safety, and food must continue their efforts within government and with the private sector to increase the knowledge base of our whole society, as well as to produce new knowledge and its applications. Community education has proved effective in targeted groups as a means of changing behavior: for example, in preventing cardiovascular disease and AIDS; in workplace and consumer product safety; and in water conservation and recycling. Nonetheless, most educational efforts have relied on traditional and limited tools of communication that are neither as interactive nor as flexible as those we expect to have available to a broad segment of the American public within the next decade or two. We must forge a coalition for science literacy unlike any we have developed before if we expect the next century to provide high quality employment and personal options for our citizens.

"The strength, progress and relative socioeconomic position of a country in a global community is highly influenced by the educational and knowledge base of its citizens, who in turn contribute to a country's prosperity and development during periods of fluctuating intensities of change and challenges." --Gary L. Jensen, Ph.D. National Program Leader Cooperative State Research, Education and Extension Service U.S. Department of Agriculture "To increase public confidence and understanding of the regulatory system and scientific applications so regulated, a strategic science promotion and education program in partnership with industry is urgently needed." --Simon G. Best CEO and Managing Director Zeneca Plant Sciences

Summary

During the first half of the 20th Century, scientists identified nutrients essential to health (vitamins and trace elements) and the importance of an adequate intake of protein, fat, and carbohydrates. Public education following these discoveries led to the virtual elimination of nutritional deficiency conditions. By the end of 1945, deficiency malnutrition was uncommon, but the average American diet contained an increasing excess of calories and fat, with 42 percent of calories as fat, up about 10 percentage points from early in the century. This evolution from undernutrition to unbalanced nutrition coincided with an epidemic of coronary heart disease.

"Never forget that good nutrition comes from good food, not simply from an array of nutrients. Food comes from agriculture; that is why research on nutrition of healthy Americans through better quality food and balanced diets is so very deserving of continued support."

--Floyd Horn, Ph.D.
Deputy Under Secretary for Research, Education and Economics
U.S. Department of Agriculture

Research on Heart Disease

Concerted education efforts informed by research and development reduced the
human and financial costs of premature death from coronary heart disease.

Dietary Guidelines for Americans

"The new food label represents nothing less than an enormous public health opportunity, one that comes only rarely. Using the new label, Americans will be able to make truly informed choices about the food they eat."

--David Kessler, M.D.
Commissioner of Food and Drugs
U.S. Food and Drug Administration

Food Labeling

"The Dietary Guidelines for Americans is the result of a collaboration of the best minds in nutrition research in the Nation. The simple, easy-to-understand language of the Dietary Guidelines belies the rigorous scholarship which undergirds these recommendations. It is our desire that the public read the Dietary Guidelines along with the Food Guide Pyramid and put them into practice. The benefit to the individual and the country in terms of improved health would be enormous."

--Eileen Kennedy, Ph.D.
Executive Director
USDA Center for Nutrition Policy and Promotion

Factors other than diet have contributed to improving public health. Yet, the healthy change in the American diet provides testimony to the power of creating a scientific basis for change and harnessing the efforts of the public and private sectors to bring about the change. We have much to learn about the dietary prevention of disease, especially cancer and obesity. But the model of research and public health action provided by the progress in heart disease reduction charts a successful course.

Yet, over 46 million people still smoke and use smokeless tobacco, and young people still take up this addictive behavior at an alarming rate. In fact, the most recent surveys indicate that smoking among young people actually may have increased slightly in 1994. These statistics clearly document tobacco use as a risk for children and youths, with far-reaching implications for the Nation's future health. Nearly 3,000 children and adolescents begin regular smoking every day, and over half of all smokers become addicted to nicotine by age 18.

Since the 1950's, scientists have made major breakthroughs in understanding the relationship between tobacco and health. Cigarette smoking, the leading cause of preventable illness and death in the United States, lurks behind over 400,000 deaths each year. Biomedical researchers have determined that smoking causes lung cancer, heart disease, and other diseases, and complicates pregnancy; chewing tobacco and snuff are associated with oral cancers. Behavioral researchers have developed and tested methods and products to help people quit smoking.

Many different kinds of research studies have confirmed the relationship between smoking and ill health. For example, scientists have tracked large populations of smokers and nonsmokers, measuring the occurrence of disease in the two groups over time. Eight major studies of this type, called prospective studies, have found smokers to have death rates from all causes much higher than nonsmokers. Prospective studies also revealed the dangers of long-term and large quantity cigarette smoking, and the good news that damage done appears to decline or disappear if smokers quit smoking. Additionally, scientists have conducted more than 50 retrospective studies in which they compared the smoking patterns of lung cancer patients with those of a control group. Each retrospective study confirmed that cigarette smokers had a much higher risk of developing lung cancer than nonsmokers.

Over the past decade, research increasingly has linked secondhand smoke to lung cancer, sparking new public health concerns about this potential cause of disease in nonsmokers. Approximately 3,000 lung cancer deaths annually among United States nonsmokers stem from exposure to secondhand smoke. Furthermore, the respiratory health of children, especially those under the age of 2, can suffer from inhaling tobacco smoke. Research strongly associates such exposure with asthma. Research has also shown a clear link between prenatal smoking and low birth weight/high-risk babies. In response to the public health concern, state and local governments have enacted laws and regulations restricting smoking in public places. Research on tobacco provides important advances in our understanding of addictive behaviors. The decrease in overall smoking in the United States seems to have come from light and moderate smokers. Many current smokers smoke 25 or more cigarettes per day. Cessation among heavy smokers presents difficult challenges, and effective intervention needs the focus of biomedical, behavioral, and public health research. Successful intervention efforts will incorporate the social structures of communities, reaching out to smoking populations through channels such as mass media, primary health care facilities, workplaces, schools, places of worship, clubs, and organizations.

Research yielded several products that assist smokers as they strive to quit smoking. In the early 1980's, Department of Veterans Affairs researchers contributed to the invention of the transdermal nicotine patch, which the Food and Drug Administration has approved for use as part of a comprehensive smoking cessation program.

Research has documented a lack of progress in reducing tobacco use among young people. As such, preventing adolescents from starting to smoke is a public health priority. After adopting this addictive behavior, quitting grows increasingly difficult in adult life. Research can help guide the development of preventive strategies and public health campaigns. For example, researchers found that concern about smoking's effect on their appearance more effectively motivated teens to quit than learning about the adverse, long-term health effects associated with smoking.

Last year, only 5 percent of black U.S. high school seniors reported smoking daily--some 23 percent of white seniors smoke, according to a University of Michigan study.

Based on the overwhelming evidence of the problem of youth tobacco use, President Clinton announced an initiative to decrease youth tobacco use by one-half in the next seven years. The President's initiative includes policy changes to reduce youth access to tobacco products and to reduce the appeal of tobacco products to young people by restricting tobacco advertising and promotion.

Research, education, and prevention are critical to eliminate tobacco use as a risk factor for cancer, cardiovascular and lung diseases, and pregnancy complications. Hand in hand, science and the American people will continue to work toward improved health and well-being by eliminating the single most preventable cause of illness and premature deaths--tobacco use.

Changes in public attitudes and policies have affected the prevalence
of cigarette consumption by adults over the past century.

As we move into the 21st century, many challenges remain to achieving our national goals of a healthy and prosperous citizenry, a safe and secure society, and a sustainable food supply and environment. The Strategic Planning Document developed by the National Science and Technology Council (NSTC) and released in March 1995 articulates scientific goals and research priorities in health, safety, and food. Agency budgets developed for fiscal year 1997 will reflect these priorities. To implement the strategic goals articulated here, the following first phase research initiatives will be undertaken:

• Maintaining the United States' leadership in the sciences necessary for improving health depends on producing outstanding scientists and engineers and nurturing their development. This is necessary not only because we need to maintain a continuous pool of scientific researchers but also because young investigators often produce the most creative insights and innovative solutions. Therefore, we will recommend creating a Presidential Early Career Scientist Award combining the resources of member agencies of the NSTC to support and encourage beginning investigators.

• The advent of rapid transfer and exchange of electronic information holds the potential for revolutionary developments for both research and improving programs and policies in health, safety, and food. However, the need for better information has exceeded the construction of adequate data systems. These data systems include those used in biomedical research; worldwide disease surveillance; monitoring the nation's health, nutrition, and safety; and food safety and production. The NSTC will strengthen the domestic health, safety, and food data systems by integrating existing systems, and improving their timeliness and responsiveness to public health problems, quality, accuracy, access, and privacy.

• Nutrition plays a pivotal role in optimizing health and productivity and in reducing the risk of diet-related disease. Dietary factors profoundly affect growth, development, and the risk of developing many chronic diseases--including diabetes, heart disease, cancer, obesity, and osteoporosis. The NSTC will strengthen its integrated, multidisciplinary human nutrition research initiative to: 1) apply the new techniques of molecular biology to understanding how diet causes such profound consequences for health; and 2) stimulate healthy food, nutrition, and physical activity behaviors.

• Sound food safety policy, innovations in food production to increase safety, and consumer education to improve safe food handling depend on a scientific foundation. The NSTC, in partnership with the agricultural and food processing industries, will design and implement an integrated research agenda to develop technologies to assure the safety and quality of food for consumers.

• Improving the science base, methods, and measurements used in health promotion and disease and injury-prevention research and development will enhance our understanding of controllable factors in disease, injury, and disability and lead to more effective programs and policies. The NSTC will improve, develop, and standardize methods for assessing: 1) exposures in the home, school, workplace, and the environment; 2) the socioeconomic, behavioral, biomechanical, biomedical, and public health factors influencing health.

The purpose of this report is to highlight ongoing Federal research efforts in the areas of health, safety, and food and to identify new and promising areas where there might be gaps in Federal support. The report is intended for internal planning purposes within the Federal agencies and as a mechanism to convey to the health, safety, and food communities the types of research and research priorities being sponsored by the Federal agencies. The Administration is committed to a broad range of high priority investments, to deficit reduction, and to a smaller, more efficient Federal Government. These commitments have created a very challenging budget environment--requiring difficult decisions and a well thought-out strategy to ensure the best return for the nation's taxpayer. As a part of this strategy, this document does not represent the final determinant in an overall Administration budget decision making process. The research programs presented in this report will have to compete for resources against many other high priority Federal programs. If these programs compete successfully, they will be reflected in future Administration budgets.