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

About the National Science and Technology Council
About the Office of Science and Technology Policy
Cover Acknowledgment
Acknowledgments
The Committee on Health, Safety, and Food
Executive Summary
Background
Investing in Health, Safety, and Food Research for the 21st Century
Promoting Prevention
Sharing Information
Educating for a Healthy America
Initiatives

President Clinton established the National Science and Technology Council (NSTC) by Executive Order on November 23, 1993. This cabinet-level council is the principal means for the President to coordinate science, space, and technology policies across the Federal Government. NSTC acts as a "virtual" agency for science and technology to coordinate the diverse parts of the Federal research and development enterprise. The NSTC is chaired by the President. Membership consists of the Vice President, Assistant to the President for Science and Technology, Cabinet Secretaries and Agency Heads with significant science and technology responsibilities, and other senior White House officials.

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.

The Office of Science and Technology Policy (OSTP) was established by the National Science and Technology Policy, Organization, and Priorities Act of 1976. OSTP's responsibilities include advising the President in policy formulation and budget development on all questions in which science and technology are important elements; articulating the President's science and technology policies and programs; and fostering strong partnerships among Federal, State, and local governments, and the scientific communities in industry and academe.

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

Photomicrograph of retinoic acid, a Vitamin A derivative commonly found in green vegetables and carrots, courtesy of Michael W. Davidson, National High Magnetic Field Laboratory, Tallahassee, Florida.

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.

This policy statement is the result of a broad review and consultation undertaken by the National Science and Technology Council (NSTC) and prepared under the leadership of its Committee on Health, Safety, and Food. The member agencies of the NSTC have reviewed and concurred with this statement.

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.

The Committee on Health,
Safety, and Food

Members

Staff

In the 21st century, the expectations of an ever-growing world population coupled with competition for finite resources will create an urgent need for innovative solutions to long-standing and emerging problems. The health and security of our citizenry will remain core elements of our national interest. Achieving our national goals of improved health, environment, quality of life, national security, and economic prosperity will require continuing the nation's strong commitment and long-term investment in both research and education.

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

This document articulates the Administration's strategic goals in the areas of health, safety, and food research and development, focuses on a few cross-cutting themes, and identifies five essential initiatives. It derives from a broad consultation with leaders in academia, industry, and government who helped to shape and define the scientific goals and research priorities identified by the Committee on Health, Safety, and Food of the National Science and Technology Council (NSTC) in its 1995 Strategic Planning Document. The NSTC will pursue the initiatives listed below as the first phase of implementing the Committee's broader agenda.

• 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.

In a few short years the United States will enter a new century, a century many have characterized as The Information Age, a century that will certainly require greater science, mathematics and engineering competency than any other period in our history. As a nation, we face challenges to our health, safety, and food arising from new and re-emerging infectious diseases, population and environmental pressures on food production and agricultural sustainability, and other problems both anticipated and unforeseen.

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

In the 21st century, the expectations of an ever-growing world population coupled with competition for finite resources will create an urgent need for innovative solutions to long-standing and emerging problems. The health and security of our citizenry will remain core elements of our national interest. Achieving the national goals of improved health, environment, quality of life, national security, and economic prosperity will require continuing the nation's strong commitment and long-term investment in both basic and mission-oriented research. A scientifically trained workforce to make the break-through discoveries, to capitalize on the findings of others, to develop the applications in agriculture and medicine, and to educate and in form the public will remain an essential element in maintaining the quality of life that we enjoy as Americans.

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

Our earlier investments in research and development yield a wealth of examples illustrating the benefits of such public foresight. The blue pages in this document describe some successes that resulted from the Federal investment in research and from the policies and programs stemming from that research. Our fundamental and mission-oriented research have time and again taken on scientific and technological tasks of great national and global importance and achieved dramatic results. The worldwide eradication of smallpox, the eradication of polio in the Western Hemisphere, the Green Revolution, and improved consumer-product, workplace, and traffic safety all testify to our ability to meet a wide variety of challenges. Vaccines and antibiotics have eliminated the scourge of many infectious diseases, and new and improved surgical techniques have vastly improved the outcome for heart patients and the recipients of organ transplants, artificial prostheses, and other implanted devices. Early detection methods, preventive interventions, and effective treatments now exist for many types of cancer. Available therapies for childhood malignancies have reduced mortality from more than 95 percent in 1960 to about 50 percent today. The development of hardy, nutritionally-improved, disease-resistant crops through traditional plant breeding methods has increased food availability and quality. New genetic engineering techniques offer the promise of further improvements in safety and quality, reduced reliance on pesticides and fertilizers, and the potential for novel innovations in food plants and animals. Such advances benefit not only our physical health but also our economic well-being.

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

In supporting both fundamental and mission-oriented research, we must increase emphasis on multidisciplinary efforts. Drawing together findings from different research fields provides unlimited opportunities for new insights, technological advances, and new industries. Today's perspective on research recognizes its nonlinear, networked nature and encourages communication among scientists in diverse fields working on seemingly disparate problems. Examples of the interconnected nature of research abound. The technique known as magnetic resonance imaging (MRI), which gives a precise picture of the body's interior structure, arose from our world-class fundamental research in physics. However, MRI never could have reached its widespread use in medical diagnostics without separate but parallel developments in a number of sophisticated technologies, especially the microprocessor, the computer-in-a-chip that could be built directly into the MRI instrument.

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.

Partnerships for Future Research

Increasing the partnerships among government, industry, and academia facilitates the sharing of resources and promotes technological progress. Our fiscal realities demand flexibility and resource sharing among research-oriented groups. Traditionally, government has played a critical role by providing research monies early and by establishing the guidelines that ensure high-quality and ethical research. These efforts encourage new ideas and creative thinking while also ensuring the integrity of research, a benefit to our and future generations.

International Cooperation

Scientific cooperation among nations also stimulates collective problem-solving. International collaboration can offer new approaches to scientific challenges and societal problems faced by many nations while contributing to global understanding and good will. We can gain much through international research cooperation; through comparison of data on health, safety, and food among different nations and cultures; and through intellectual collaboration that produces new approaches to solving human problems. The global nature of infectious diseases, antibiotic resistance, food production, environmental and product hazards, malnutrition (including obesity), and the chronic diseases of adults and children suggests the great value of international partnerships in our search for solutions.

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."

Better Health Care In an era of constrained resources, research on health systems and services has begun to show how the United States can improve the return on its existing health care investment, which currently accounts for 14 percent of our Gross Domestic Product. For example, projections indicate that implementing two recent clinical practice guidelines, which address the common problems of low back pain and fluid in the middle ear of children, would reduce health care expenditures by more than $2.6 billion annually. Research on the effectiveness of the entire health care system--from clinical, preventive, and public health interventions to managerial, organizational, and financial strategies--will increase the value we receive for our health care dollars. Further return on our health care investments could result from linking of existing public health and personal care databases in the public and private sectors, an action requiring an unprecedented level of Federal-state and public-private sector cooperation.

Socioeconomic and Behavioral Research Investing in research on human development provides the cornerstone for a sound national policy that seeks to maximize the benefits derived from health, safety, and food research. To fully realize the return on our investments in health, we must further develop the collective human potential of our nation through research on the behavioral and social foundations that lead to early nurturing of children, functioning families, and safe home, school and neighborhood environments. Too often the knowledge gained, the vaccines and drugs discovered and the dietary advice given, are not acted upon because we have inadequate methods to motivate behavior change in cost-effective ways.

Summary

As the last decade of this century draws to a close, our country faces numerous challenges that will place a high premium on the sustained support of scientific research for better health, safety, and food. We are all beneficiaries of the existing highly successful system that rests on a solid foundation of trust and support from the American people. The strategic goals and research initiatives described in this document are designed to provide the American people with further benefits.

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

scientist examining a tomato 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.

"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.

Photo: computers provide access to health care information 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.

Experience has taught us that preventing problems is more cost-effective than curing them after the fact. Effective prevention of health, safety, and food problems requires research that identifies risks, determines their causes, develops preventive interventions and ways to monitor their effectiveness, and establishes the best means of applying the new knowledge gained through this research.

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

A healthy society benefits us all immensely. Healthy citizens are more productive at work and concentrate better in school. Economists have increasingly found evidence that improved health contributes to economic growth. Public health preventive initiatives such as improved sanitation, better nutrition, smoking cessation, adequate housing, and occupational safety account for approximately 85 percent of the increase in life expectancy over the past 100 years. During the 20th century, improvements in health, safety, and food choices have increased the lifespan of the United States population by more than 60 percent; and from simply delaying death, the emphasis has shifted to promoting behavior and lifestyle choices among the elderly that increase their functional capacity and quality of life.

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

While present-day prevention efforts have succeeded in some areas, new forces have appeared that require new emphasis. The increasing rate of technological change, the growing diversity of the American population, and the lengthening of our life spans all define new problems that require prevention research for new solutions.

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.

Defining the Factors that Promote
Health and Prevent Disease and Injury

Almost half of all premature deaths in the United States involve risk factors such as injuries, violence, tobacco, alcohol and illegal drugs, infectious diseases, and hazardous workplace exposures. As researchers identify new threats to health, we must focus on understanding how to change human behavior in order to mitigate these threats.

Injuries

Injuries make up almost 40 percent of all hospital emergency room visits, the majority because of accidental falls and motor vehicle crashes, events often preventable. A better understanding of the behavioral causes and biomechanics of injury will lead to improved prevention, treatment, and rehabilitation.

Violence

A second risk factor, violence, now ranks as the leading cause of death for large segments of the American population. The effects of violence extend far beyond the individual victims and their families. Violence deters economic investment in many communities, resulting in fewer jobs and services to areas most in need of opportunities. Over 100,000 children stay home from school each day because they fear violence on the way to school or in the classroom; thousands carry weapons to school with them. Research into the causes of violence and effective ways to prevent it is crucial to reducing violence and protecting our children.

Tobacco, Illegal Drugs, and Alcohol

Some of the most preventable risks to good health stem from tobacco, illegal drugs, and alcohol. Tobacco, as described in the accompanying blue page, clearly rates the title Public Health Enemy Number 1. Cigarette smoking is the leading cause of illness and death, and smokeless tobaccos--chewing tobaccos and snuff--are associated with oral cancers.

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

Rapidly expanding international travel and trade, as well as changing social and cultural patterns, emphasize the important need for research in detecting and controlling human infectious diseases. Pathogenic microbes continue to emerge or become resistant to current control measures, resulting in aggressive and unpredictable epidemics. The world has witnessed a general resurgence of infectious diseases, including significant outbreaks of cholera, malaria, tuberculosis, hemorrhagic fevers, and infections caused by antibiotic-resistant bacteria.

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.

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

Death, disease, and disability resulting from hazards in the home, school, and workplace impose an enormous national burden--on productivity, international competitiveness, the health care system, public and private insurance costs, and local, state, and Federal Government support services. On a typical day, 154 United States workers die from work-related disease or injury and an additional 9,000 workers are disabled. In 1993, the National Safety Council estimated that for injuries alone, medical costs and losses of productivity and wages totaled $112 billion. We can prevent much of this toll on United States health and productivity, but not without investing in the research needed to identify causes and develop solutions to this national problem. Such research is essential for developing cost-effective and sound regulation and for maximizing public and private investments in disease and injury prevention in the workplace, home, and community. Epidemiological and behavioral perspectives require special emphasis because population-based surveillance of exposure can lead to rational priorities for research directions. For example, the increased incidence of asthma and its association of chemical exposures and other environmental factors indicates a need for additional research emphasis. Scientifically-based public health policy depends upon such research, as does the appropriate use of risk assessment in national regulatory policies.

Establishing the role of diet in health promotion
and disease prevention

Nutrition research in the early part of the 20th century revolutionalized our understanding of the relationship between food and health. Scientists identified essential nutrients whose deficiency in the diet caused diseases such as anemia, rickets, and pellagra. These findings proved so fundamental to our understanding of human biology that their discoverers received Nobel Prizes. To eliminate these deficiency diseases, government encouraged national education programs, food fortification, and school lunch programs. In the second half of this century, nutrition research focused on understanding the role of diet in the prevention of chronic diseases, and achieved some remarkable success. The challenge for the 21st century is to apply the knowledge generated by the tools of molecular biology to the understanding of nutrient-gene interactions, to produce healthier food, and to detect and prevent disease.

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

Reducing the genetically determined risk of chronic diseases through dietary change offers one of the most promising lines of nutrition research. Eating a diet containing the appropriate levels of nutrients is essential to healthy growth and development and to avoiding the diseases of deficiency and excess. Nutrients and other substances in food can interact with developmental and hormonal factors to directly or indirectly affect gene activity. A better understanding of the molecular basis of these diseases will make it possible to tailor nutritional approaches to prevent and treat them in specific populations and individuals.

Energy Balance and Obesity

Understanding what body mechanisms control energy balance, appetite, and satiety will contribute to our ability to reverse the current epidemic of obesity, treat the eating disorders of anorexia nervosa and bulimia and correct the undernutrition associated with many chronic disorders including AIDS, endstage kidney and liver disease, cancer, and tuberculosis. Preventing obesity and its associated diseases appears possible through improved knowledge of ways to identify susceptible people through molecular or biological markers and to motivate change in their eating and activity behaviors.

Ensuring a safe, high quality, and sustainable food supply

A necessary prerequisite for a healthy, well-nourished population is an abundant, high quality, affordable, and safe food supply. We must continue to improve our ability to produce, process, and distribute sufficient high-quality food for a growing population, at a cost that people can afford and without compromising the ability of future generations to do the same. Food safety, agriculture production and sustainability, and maintaining the genetic diversity of plants and animals on land and in the sea must receive specific emphasis.

Food Safety

The safety of the wide variety of food we consume each day starts with their production on farms, ranches, ponds, lakes, and oceans and extends to the home. Further research into food-production, harvesting, and handling practices that will reduce human exposure to microbial pathogens, chemicals, and biotoxins--as well as into improved methods to detect and survey these hazards--can eliminate or significantly reduce an important cause of illness in the United States. Protecting our nation's water supply from waterborne pathogens exemplifies another growing concern, as evidenced by the 400,000 reported cases of diarrhea in Milwaukee in 1993 caused by the waterborne pathogen Cryptosporidium.

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

The long-term development and implementation of sustainable food production systems is imperative. A recent survey revealed nearly 100 new or emerging plant diseases affecting the approximately 150 crops grown in the United States. Each crop variety, each breed of farm animal, and each species of fish is vulnerable to its own unique and specialized group of infectious diseases. As agriculture in the United States becomes more intensive and compact, the chances intensify for problems from microbial pathogens. Two preventive approaches require particular attention by the research community. It must develop new plant and animal vaccines and drugs and it must advance genetic engineering for disease and pest control.

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

The agriculture-food sector remains this nation's largest industry, accounting for about 16 percent of GNP and generating a net positive balance of trade of $2 of commodities exported for every $1 of commodities imported. However, an increasing population necessitates changes in agricultural production, in this country and others. Research to raise crop yields, to optimize preservation of land and water, and to promote sustainability is more important now than ever in the past. Expanding populations promise stepped-up competition for water resources as the needs of both humans and agriculture increase.

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

Over a century of genetics research has led to many successful improvements in plants and animals. Virtually every foodstuff in our markets has benefited from such improvements. Recent developments in molecular genetics open new possibilities, from improved disease resistance, to better taste, to longer shelf life. Yet, if we fail to preserve the incredibly diverse gene pool of all plants and animals now in existence, we risk missing important future opportunities for progress. Preservation of existing genetic diversity is integral to our research efforts.

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.

Summary

Prevention strategies can improve our quality of life while also reducing the financial burdens of health care and environmental remediation. We have eliminated many diseases through vaccines and drastically reduced the occurrence of once-common illnesses and injuries through safer technology. We have made our food supply safer, more nutritious, more varied, and more accessible. New risks to our health and safety will always appear, as will new threats to our food supply, but the better our understanding, the greater our chance of reducing them. Our goal is to meet those risks and threats with strong research programs, enabling the United States to enter the 21st century in a position of strength.

As understanding of disease organisms expands, more vaccines are available to prevent the spread of new and recalcitrant diseases.

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.

Tremendous progress has marked the efforts to improve traffic safety over the past several decades. The mortality rate from motor vehicle crashes decreased from about 26 deaths per 100,000 Americans in 1966 to less than 16 per 100,000 in 1994. This improvement stemmed from a combination of strategies: 1) the application of engineering to improve vehicle design to make motor vehicles inherently safer; 2) establishment and enforcement of these new vehicle performance concepts through the promulgation of Federal Motor Vehicle Safety Standards; 3) behavioral changes realized through education, legislation, and enforcement of traffic safety laws; 4) economic incentives; and (5) improved emergency medical services.

Preventing Injuries

By analyzing information about the types and causes of injuries sustained in motor vehicle crashes, researchers initially concluded that many thousands of lives could be saved and injuries prevented by improving the inherent safety of the vehicle by designing the vehicle to absorb some of the crash energy and through the use of restraint mechanisms such as seat belts, airbags, and child safety seats. This information has led to increased research in the biomechanics of motor vehicle crash injuries funded by the Federal Government and the auto manufacturers. These efforts resulted in the promulgation of Federal Motor Vehicle Safety Standards and the increasing interest, on the part of auto manufacturers and the public, in vehicle safety.

Preventing Drinking and Driving

A need to modify the behavior of the driving public so people would use these new features and drive more responsibly also became apparent. Public education, legislation, and enforcement have greatly influenced the trend toward traffic safety by encouraging the use of seat belts and child safety seats and discouraging speeding and driving after drinking. National advocacy groups have increased awareness and changed social norms concerning alcohol-impaired driving, as well as championed stronger laws concerning drinking and driving. Groups and places that attract large numbers of people, such as professional sports teams and concert facilities, not only support public information campaigns to prevent drinking and driving, but also enforced policies that reduce the likelihood that patrons will drive alcohol-impaired following sports and other public events.

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

A similar combination of education and legislation encourages people to use their safety belts. The first mandatory child restraint law, requiring that young children be restrained in a child safety seat, won passage in 1978; by 1985 all states had passed child safety seat laws. Mandatory safety belt laws first were passed by some states in the mid 1980Õs, making failure to wear a safety belt a traffic offense. Because of the potential savings in both lives and dollars, the Federal Government encourages states to enact safety belt laws. Currently, 49 states have safety belt laws.

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

Dietary factors profoundly affect the growth and development of children and influence the diseases that we may face in adulthood. Nutrition research in the 20th century has deepened our understanding of how diet influences many chronic diseases, including diabetes, heart disease, certain cancers, hypertension, and osteoporosis. The 1988 Surgeon General's Report on Nutrition and Health stated: "For the two out of three Americans who do not smoke, and do not drink excessively, one personal choice seems to influence long-term health prospects more than any other: what we eat." To that we must add that scientific consensus now holds that our lifelong activity levels, that is, the degree to which we exercise, also profoundly influences our long-term health. Despite the tremendous health importance of sound nutrition and increased physical activity, nearly one third of the United States population suffers from poor dietary and physical activity habits; of those, some may carry a genetic predisposition that contributes to obesity. Some facts about obesity in the United States:

• 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.

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

America's food supply faces many new challenges. Consumers expect and demand higher quality foods, but at the same time, they express increasing concern about real and perceived threats to food safety. These potential threats include microbial contaminants, pesticide and drug residues, and naturally occurring toxic or anti-nutrient food constituents. Although all of these concerns are important, microbial safety is the leading issue, and will continue to be so in the future.

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.

The evolution of electronic networks and computerized databases has profoundly affected the practice of science and the communication of scientific information to the public. Researchers now routinely share data and software and analyze all types of new information, including full text, pictures, expert systems, and tutorials using online computer networks and compact disks. Online networks and other tools also help the public understand issues and make better decisions in their daily lives. Physicians can easily access a computer database to track down the latest research needed to diagnose difficult medical cases. Cotton farmers can tap into expert systems to help predict crop yields and to work out strategies for successful competition in world markets. Researchers all over the world can easily share epidemiological data collected on nuclear radiation exposures.

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.

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.

Data Acquisition and Integration

The key to real progress lies with developing up-to-date and more encompassing research databases, managing and directing the flow of information, and improving systems for data transfer. Computerized data are the fundamental building blocks of the 21st century research enterprise. Databases cover the full range of health, safety, and food research, from processing information for food production engineers to gene sequence information for molecular biologists to food and diet information for the average citizen. Although databases contain a broad expanse of knowledge, their usefulness depends on their being accessible to everyone.

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.

Data Interchange

Federal agencies must work with private sector partners to ensure the accessibility of health, safety, and food data collections via integrated systems that support the combining and analysis of the data regardless of source. Future systems, taking advantage of the Internet, will integrate tens, hundreds, or even thousands of such databases and advance research even further. Linkages among databases, and with interested parties comprising a federated information infrastructure, will prove indispensable, but we must utilize them under policies that protect the confidentiality of proprietary information and each individual's health records.

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.

Databases for Global Disease Surveillance

The international dimension of health, safety, and food issues expands every day and emphasizes the need for rapid information collection and dissemination. Recent outbreaks of HIV/AIDS, virulent strains of streptococcus, Ebola virus, and drug-resistant tuberculosis respect no geographical boundaries and reaffirm the need for up-to-date, world-wide information on infectious human diseases. Imported diseases attacking wheat and barley crops have caused major losses to these crops in the North Central states in recent years; and new strains of the potato late-blight disease, once well-managed in the United States, have become epidemic in some states since 1992. The international use of dangerous industrial and agricultural substances banned in the United States underlines the need for international surveillance of hazards and their resulting diseases. The NSTC addressed these problems in its recent report, Emerging and Re-emerging Infectious Diseases, (NSTC, 1995). The recommendations contained within that document highlight the importance of establishing international surveillance systems and databases to benefit all the research and public health communities.

Summary

The global information environment for research is constantly changing, led by the computer and telecommunications industries. Systems such as the Internet and the World Wide Web, firmly established in telecommunications today, were virtually nonexistent ten years ago. In the 21st century, maintaining our national excellence in health, safety, and food research will rely on using the scientific information revolution made possible by such systems to its fullest advantage.

Many groups have called for significantly enhanced educational efforts in science, mathematics, and engineering to adequately prepare ourselves for global competition in the 21st century. The success of our citizens in an increasingly information- and data-dependent century will derive directly from our ability to continually improve and updateboth traditional educational experiences and informal, more opportunity-oriented learning. But an equally important rationale for science education is the immediate personal returns to our citizens: improved understanding of their health and better knowledge on which to make the daily decisions that will affect their long-term health and safety.

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.

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

We must ensure the availability of the next generation of research scientists in health, safety, and food and include in their training the traditionally neglected fields with significant cost-effective community impacts such as public health. Future physicians need training in new fields of medicine, such as occupational and environmental health, or of renewed interest, such as nutrition and infectious disease. Training the next generation of scientists will be greatly enhanced by their opportunities for involvement in research related to real world problems and by training that emphasizes more flexibility, multidisciplinary cooperation, and multipurpose applications.

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

The potential contributions to society from increased scientific literacy loom large. An informed electorate is better prepared to assume the global leadership in the workforce of the next century. It is also better positioned to participate in the public debate about how society resolves a wide range of important issues in health care, regulation of environmental and health hazards, introduction of biotechnology products, traffic and product safety, and public health approaches to disease prevention. Many of these extremely complex issues have substantial economic and long-term implications.

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.

Summary

We face and must resolve two major educational challenges if we hope to continue moving toward our national goals of improved health, safety, and food. These are training the next generation of scientists to face a more demanding and multidisciplinary job market, and educating the general public to understand science, and to harness and utilize the powerful technologies of the future. Either we address these challenges immediately or they will continue to undermine our long-term success in every other area of national need. Failure to improve our scientific literacy will very directly affect the quality of life of our citizens. We need a targeted program to train the next generations of knowledge pioneers and we need new and creative ways to make scientific literacy an everyday expectation of our society.

The last half of this century has witnessed remarkable changes in the dietary patterns of the United States population and several other western industrialized nations--changes associated most notably with a decline in deaths from coronary heart disease, the leading cause of death in the United States. Research provided compelling information for dietary change, and its application to public and personal health helped in reducing heart disease.

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

Intensive study of dietary consumption across nations and among migrant groups with different prevalences of heart disease indicated that the amount of fat in the diet was related to cholesterol levels in the blood, and both correlated with cholesterol deposits in arteries and to heart attacks. Long-term studies, such as the now famous Framingham (Mass.) Heart Study left little doubt that blood cholesterol levels predicted future heart disease. Clinical trials of diet and drugs confirmed the importance of lowering cholesterol. Studies found that lowering total fat intake, decreasing the intake of saturated fat, and increasing the percentage polyunsaturated fat could lower blood cholesterol and help prevent heart attacks. Medical research has also suggested that increased consumption of fatty acids found in certain types of seafood may reduce the risk for heart disease. Concerted educational efforts by the government, the food industry, and the public health and medical communities have successfully changed food selection, lowered average blood cholesterol levels, and helped reduced deaths from heart attacks.

Dietary Guidelines for Americans

In response to the plethora of research on the relationship between diet and health, the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (DHHS) issued the Dietary Guidelines for Americans. These guidelines, updated on a five-year cycle, contain current health and nutrition advice in simple, easy-to-understand language for healthy Americans 2 years of age and older. These documents specify dietary recommendations, which include reducing the intake of fat (especially saturated fat), cholesterol, and sodium; maintaining an appropriate body weight; and consuming increased amounts of fruits, vegetables, and grains.

"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 U.S. Food and Drug Administration (FDA) began publishing proposals for new food labeling regulations in 1989 and 1990. Later in 1990, Congress passed the Nutrition Labeling and Education Act of 1990 (NLEA). That law required FDA to issue new food labeling regulations for almost all processed foods regulated by FDA. The Department of Agriculture, which regulates the meat and poultry industry, also began to create similar regulations. Both sets of regulations were intended to make the new food label a more effective tool to meet public health goals. And indeed, the Nutrition Facts label, in conjunction with the newly regulated health and nutrition label claims, translates the Dietary Guidelines for Americans into a form consumers could easily use. Furthermore, the Nutrition Facts label appears on virtually all FDA-regulated foods, whereas fewer than 70 percent of these products previously contained nutrition information. The result will yield an estimated savings of up to $26 billion in health and life over a 20-year period.

"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.

Thanks to decades of research on risk factors for chronic disease, Americans have increased their interest in nutrition, exercise, and other areas that contribute to good health and a sense of physical, emotional, and psychological well-being. Amidst this trend, the decline in tobacco use in the United States shines as a public health success story: the percentage of adults who smoke cigarettes decreased from 42 percent in 1964 to 25 percent in 1993. This reduction has saved hundreds of thousands of lives each year.

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.

The United States has a long, distinguished history as a leader in pioneering discoveries that result in improved health, safety, and food. Cost-efficient food production techniques make good nutrition available to greater numbers of people at a lower cost. Diet and lifestyle factors--smoking, alcohol and substance abuse, risk-taking behaviors, and physical activity patterns--can serve as risk factors for disease and injury and reveal strategies for prevention. While we cannot prevent all disease, new drugs, surgical procedures, and medical devices can improve the length and quality of life of those afflicted. Today, information about new drugs and treatments becomes available to clinicians, researchers, and patients almost immediately through electronic media and databases, vital products of the information revolution. Public health and food policies depend on this research base, as does the appropriate use of risk assessment in devising national regulatory policies.

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.

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