CHSF strategies have been specifically designed to focus on areas where the Federal government needs to take an active role in partnership with the private sector. Input from the National Forum was clear that the Federal government needed to focus on areas--like fundamental research--where the private sector would not or could not. Federal programs should be structured to facilitate partnership with the private sector--e.g. translating the results of fundamental research into applied research and technology applications. There are many examples of this kind of partnership in CHSF plans. In addition, in many areas, the role of the Federal government is to coordinate inter-agency and private efforts, so that data will be collected with consistent definitions and be accessible to all. This is particularly important in health systems and services R&D, where a great increase in private sector efforts to generate and collect information concerning personal care services need Federal coordination to be maximally effective. Finally, there are many public-private consortia cited in CHSF plans where ongoing research and development efforts will be pursued in specific private-public partnerships.
In the area of personal care services, there are a vast array of problems that could benefit from international cooperation and coordination, such as developing valid and reliable measures of health outcomes. Even though Americans prefer a private, competitive health care system; there is much that can be learned from specific organizational and delivery strategies of other countries in areas such as primary care, community-based systems, cost containment, and approaches for addressing resource constraints. In addition, more research is needed on issues related to border health and migrant workers.
Many agencies collaborate with international partners to enhance their research capability and to expand the populations and environments that can be studied. For example, Africa, central Europe, and Russia provide the U. S. research community with many new opportunities for collaboration in understanding the impacts of environmental hazards and exposures. Other countries, with more homogeneous populations than the U.S., offer more promising sites in which to evaluate prevention research models and social interventions. In establishing better surveillance and data systems, the U.S. could benefit from the knowledge and experience of the international community by learning about the health and safety data collection efforts of European, Asian, and other countries. International linkages with data bases of other countries could be an ultimate goal for global information exchange.
The international implications for developing effective vaccine delivery systems are enormous. The Children's Vaccine Initiative launched at the World Summit for Children in 1990 is an international effort to harness new technologies to accelerate the transition to safe, affordable, and heat-stable vaccines that can protect children against the major infectious childhood diseases. To fulfill the global program objectives, contributions will be necessary from many government and nongovernment agencies and organizations involved in the development, technology transfer, regulation, procurement, and delivery of new vaccines, both domestically and internationally. Partnership with industry is an essential component. This global program continues to evolve as more countries and organizations participate.
In another important area of health promotion and disease and injury prevention, the Pan American Health Organization is developing a Regional Plan of Action on health and violence. Recognizing that violent behavior is a public health problem of global concern, this plan of action will develop and apply measures to prevent and control violence.
International scientific exchange and information transfer programs in food safety, security and production will enable the U.S. to benefit from research and technologies from foreign countries. International marketing and promotion will expand U.S. export opportunities. For example, to maintain and improve access to genetic resources, the transfer of agricultural products, technologies and information to developing and newly independent countries should be used to satisfy mutual terms of the Convention on Biological Diversity. Cooperative international programs leading to accepted international standards for food safety and quality will improve consumer confidence in U.S. and import products and help ensure a level playing field for U.S. producers. Another example is the International Programme on Chemical Safety of the World Health Organization, which is working with representatives from developed and developing countries to establish harmonized risk assessment methodologies that will lead to mutual acceptance and application of national governments' chemical-specific assessments and greater acceptance of standards established by the Codex Alimentarius Commission. This will raise the standard and quality of food imported in the U.S., and lower trade barriers to U.S. commodity exports.
Basic research in many aspects of nutrition is an international activity that exchanges information and insights for mutual benefit. For example, recent overseas research confirms the beneficial effects of vitamin A in reducing deaths from measles. Extensive clinical nutrition research occurs in foreign countries, in many cases providing information that complements research in the U.S.--e.g. a major Swedish clinical study is investigating the role of surgery as a treatment option for morbid obesity--or provides information that cannot be obtained in the U.S., due to the absence of centralized medical records. U.S. nutrition researchers will continue ongoing communications with other nutrition scientists around the world. Many U.S. Federal agencies will continue their working arrangements with international organizations and individual countries to promote nutrition research and the dissemination of nutrition information. Areas of emphasis include communicating the importance of preventing vitamin A malnutrition, which is the major cause of preventable blindness among children in the developing world, and improving ways to combat iron deficiency anemia on a global basis.
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