A summary of the FY 95 resource base for CHSF member agencies in support of CHSF priorities is attached. The purpose of this report is to highlight ongoing Federal research efforts in this science and technology field 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 science and technology community the types of research and research priorities being sponsored and considered by the Federal agencies. The Administration is committed to a broad range of high priority investments (including science and technology), as well as 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 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 other high priority Federal programs. If these programs compete successfully, they will be reflected in future Administration budgets.


Each CHSF subcommittee consulted with experts in their field inside and outside the Federal government in developing their strategies. On November 21-22, 1994, CHSF sponsored a National Forum on "Meeting the Challenge: Health, Safety and Food for America." The purpose of this forum was to obtain expert external input on CHSF strategies, to strengthen them, and to build support. CHSF plans are also reviewed by several members of the President's Committee of Advisors on Science and Technology (PCAST).

CHSF strategies have been specifically designed to focus on areas where the Federal government needs to take an active role in partnership with the private sector. Input from the National Forum was clear that the Federal government needed to focus on areas--like fundamental research--where the private sector would not or could not. Federal programs should be structured to facilitate partnership with the private sector--e.g. translating the results of fundamental research into applied research and technology applications. There are many examples of this kind of partnership in CHSF plans. In addition, in many areas, the role of the Federal government is to coordinate inter-agency and private efforts, so that data will be collected with consistent definitions and be accessible to all. This is particularly important in health systems and services R&D, where a great increase in private sector efforts to generate and collect information concerning personal care services need Federal coordination to be maximally effective. Finally, there are many public-private consortia cited in CHSF plans where ongoing research and development efforts will be pursued in specific private-public partnerships.


Each CHSF priority has significant international ramifications, and success in each will require strong international partnerships. For example, results from clinical trials that lead to improved treatment and disease prevention are disseminated internationally--e.g. the extensive records on twins in the Scandinavian countries provide a unique opportunity to examine genetic factors, and how slow virus infections in specific populations have improved understanding of fundamental neural-immune mechanisms. Data systems are currently maintained on world-wide networks, and the World Wide Web is a client- server-network-based information dissemination system available to freely exchange data in the public domain. Given the openness and exchange of scientific information, technology transfer and patent rights will continue to be significant international intellectual property issues.

In the area of personal care services, there are a vast array of problems that could benefit from international cooperation and coordination, such as developing valid and reliable measures of health outcomes. Even though Americans prefer a private, competitive health care system; there is much that can be learned from specific organizational and delivery strategies of other countries in areas such as primary care, community-based systems, cost containment, and approaches for addressing resource constraints. In addition, more research is needed on issues related to border health and migrant workers.

Many agencies collaborate with international partners to enhance their research capability and to expand the populations and environments that can be studied. For example, Africa, central Europe, and Russia provide the U. S. research community with many new opportunities for collaboration in understanding the impacts of environmental hazards and exposures. Other countries, with more homogeneous populations than the U.S., offer more promising sites in which to evaluate prevention research models and social interventions. In establishing better surveillance and data systems, the U.S. could benefit from the knowledge and experience of the international community by learning about the health and safety data collection efforts of European, Asian, and other countries. International linkages with data bases of other countries could be an ultimate goal for global information exchange.

The international implications for developing effective vaccine delivery systems are enormous. The Children's Vaccine Initiative launched at the World Summit for Children in 1990 is an international effort to harness new technologies to accelerate the transition to safe, affordable, and heat-stable vaccines that can protect children against the major infectious childhood diseases. To fulfill the global program objectives, contributions will be necessary from many government and nongovernment agencies and organizations involved in the development, technology transfer, regulation, procurement, and delivery of new vaccines, both domestically and internationally. Partnership with industry is an essential component. This global program continues to evolve as more countries and organizations participate.

In another important area of health promotion and disease and injury prevention, the Pan American Health Organization is developing a Regional Plan of Action on health and violence. Recognizing that violent behavior is a public health problem of global concern, this plan of action will develop and apply measures to prevent and control violence.

International scientific exchange and information transfer programs in food safety, security and production will enable the U.S. to benefit from research and technologies from foreign countries. International marketing and promotion will expand U.S. export opportunities. For example, to maintain and improve access to genetic resources, the transfer of agricultural products, technologies and information to developing and newly independent countries should be used to satisfy mutual terms of the Convention on Biological Diversity. Cooperative international programs leading to accepted international standards for food safety and quality will improve consumer confidence in U.S. and import products and help ensure a level playing field for U.S. producers. Another example is the International Programme on Chemical Safety of the World Health Organization, which is working with representatives from developed and developing countries to establish harmonized risk assessment methodologies that will lead to mutual acceptance and application of national governments' chemical-specific assessments and greater acceptance of standards established by the Codex Alimentarius Commission. This will raise the standard and quality of food imported in the U.S., and lower trade barriers to U.S. commodity exports.

Basic research in many aspects of nutrition is an international activity that exchanges information and insights for mutual benefit. For example, recent overseas research confirms the beneficial effects of vitamin A in reducing deaths from measles. Extensive clinical nutrition research occurs in foreign countries, in many cases providing information that complements research in the U.S.--e.g. a major Swedish clinical study is investigating the role of surgery as a treatment option for morbid obesity--or provides information that cannot be obtained in the U.S., due to the absence of centralized medical records. U.S. nutrition researchers will continue ongoing communications with other nutrition scientists around the world. Many U.S. Federal agencies will continue their working arrangements with international organizations and individual countries to promote nutrition research and the dissemination of nutrition information. Areas of emphasis include communicating the importance of preventing vitamin A malnutrition, which is the major cause of preventable blindness among children in the developing world, and improving ways to combat iron deficiency anemia on a global basis.


CHSF is committed to implementing the plans outlined above. CHSF will continue to refine its plans, pursue critical ongoing research and development activities, redirect current activities, or plan new priorities.