Health Promotion FIRST (Funding Integrated Research, Synthesis and Training)

Senator Lugar (R-Indiana) is the primary sponsor of Health Promotion FIRST. We are in the process of recruiting original co-sponsors and expect the bill to be introduced in the Health Education Labor and Pensions (HELP) Committee in June, 2004. If you would like to help by asking your Senator to serve as an original co-sponsor, send an email to volunteers@HealthPromotionAdvocates.org and we will send you all the information on how to approach him or her.

A summary of the legislation is below. To see a pdf of the actual legislation in discussion draft form click here.

Summary of Contents

I. Co-ordination and Planning: Section 2901 ($19 million over 5 years: 2005: $6 million; 2006: $4 million; 2007-2009: $3 million)

A. HHS will develop strategic plans for health promotion, addressing five topics:

1. How to develop the basic and applied science of health promotion.
    
2. How to utilize the authority of the Department of Health and Human Services to integrate health promotion concepts into health care and other elements of society.
    
3. How to utilize the authority of the Departments of Transportation, Education, Agriculture, Commerce, and other departments of the federal government to integrate health promotion concepts into society.
    
4. How to synthesize health promotion research into practical guidelines and disseminate these guidelines to practitioners, students, employers, policy makers and others.
     
5. How to support and develop the health promotion scientific and professional health promotional workforce.

B. HHS will develop strategies to incorporate perspectives from a wide range of disciplines in strategic and operating plans. These disciplines will include but not be limited to medicine, nursing, exercise science, nutrition, psychology, management, health education, city planning, transportation, and anthropology.

Why is this important? Lifestyle related diseases are responsible for an estimated half of all premature deaths and one quarter to one half of all medical costs in the United States. Existing efforts to develop the health promotion science base and provide programs have been very limited and have been dominated by a narrow educational and medically driven approach. People’s lifestyle practices are influenced by many factors beyond their knowledge and the services they receive from health care providers. To be successful in helping people develop and maintain healthy lifestyles, we need to create living environments that support people’s efforts to eat right, be physically active, manage stress, avoid abusive substances, and practice appropriate medical self care. To do this effectively, we need input from a diverse range of experts and we need to explore how to best engage a wide range of federal government departments in supporting these efforts.

II. Health Promotion Research at NIH: ($30 million in 2005).

Section 2911: Research Agenda and Research Funding. NIH will develop a “basic research” agenda for health promotion and allocate research funding for health promotion research based on the impact of lifestyle behaviors on disease and death relative to other causes.
Section 2912: Trans-Institute Initiative. NIH will create of a trans-institute initiative, coordinated by the Office of Behavioral and Social Sciences Research, to develop the basic science of health promotion. At least 90% of funds for this program will be distributed through grants and contracts to non-government organizations. ($30 million in 2005).

Why is this important? NIH scientists and partner organizations have the ability to make a critical contribution to helping us understand the basic mechanism of health behavior, including what motivates some people to practice healthy lifestyles and others to practice self-destructive behaviors, what motivates some to change and others to remain the same, as well as which individual, environmental and programmatic factors explain why some people are successful in changing and others are not. Given the expected growth health promotion research at NIH, it is important to develop a research agenda to identify the most important questions to address and the organizations most capable of addressing these questions. It is also important that NIH determine the appropriate amount of funds to allocate to this effort based on the relative burden of lifestyle factors on quality of life, morbidity and mortality, relative to other causes. If this planning responsibility were assigned to one or two institutes, there would be a high risk of creating research silos; a trans-institute effort has the greatest likelihood of stimulating collaborative and ultimately more effective health promotion efforts among all the institutes.

III.Health Promotion at CDC (was $152.5 million over 5 years, now 92.5 million over 5 years) Section 2921: Research Agenda. CDC will develop and revise an “applied research” agenda for health promotion.
Section 2922: Health Promotion Research Centers. CDC will create up to 30 new Health Promotion Research Centers. Eligible organizations will include schools and departments of anthropology, city planning, education, exercise science, public policy, management, nutrition, nursing, psychology, and transportation, as well as private research organizations. This program will be modelled after the existing Prevention Research Centers program at CDC. ($2.5 million in 2005, $7.5 million in 2006, $17.5 in 2007, $27.5 million in 2008, $37.5 million in 2006)

Section 2923: Extramural Research at CDC. CDC will make an effort to attract grant applications from groups with extensive health promotion programming experience but limited research experience through proactive outreach, and small pre-proposal planning grants. Some extramural research funding will be allocated to developing the applied science of health promotion in workplace, school, family, clinical and community settings.

Section 2924: Workplace Health Promotion. CDC will establish a workplace health promotion research program at CDC to include a workplace health promotion research agenda, research to address that agenda and efforts to synthesize and disseminate findings. (2005: $6 million, 2006: $8 million, 2007: $11 million, 2008: $15 million, 2009: $20 million) NOTE: ON APRIL 23 CDC ANNOUNCED PLANS TO IMPLEMENT THIS PROGRAM. THEREFORE IT WILL BE DELETED FROM THIS BILL BEFORE INTRODUCTION.

Section 2925: Developing the Health Promotion Infrastructure. At least 75% of funds for this program will be distributed through grants and contracts to non-government organizations. State and local health departments will be encouraged to contract out services to local providers in their community unless they have the basic infrastructure necessary to support programs.

Why is this important? The applied science of health promotion involves the strategies most effective in reaching all the various types of people in many settings in the community. For example, what are the most effective ways to provide health promotion in school, workplace, family, clinical, and neighborhood, settings? What are the most effective ways to reach children, teenagers, middle aged and older adults, as well as people of different education, income and cultural backgrounds, and people living in rural, urban and suburban settings? CDC is the most qualified of the federal agencies to address these questions. In recognition of the expected growth in this area, CDC should start this process by updating its current health promotion research agenda. New Health Promotion Research Centers will be created to stimulate collaborative relationships between CDC and experts from a wide range of perspectives, with the goal of making health promotion an area of study in these disciplines and gleaning innovative ways to address health promotion needs. This program is modelled after the existing successful Prevention Research Centers, which are limited to schools of public health and departments of preventive medicine. CDC’s extramural research program allows CDC to engage outside organizations in addressing topics CDC deems important, and at the same time helps to provide support to the research community. Some of these funds will be allocated to address important health promotion research questions. The health promotion field was build by practitioners, not scientists. As such, many of the most capable health promotion experts and organizations focus on providing programs, not conducting research. As a result, these providers are not experienced in applying for research grants, and CDC is thus not able to attract the most qualified health promotion experts to be involved in its research programs. CDC will therefore organize outreach efforts to attract these organizations, including providing small pre-proposal planning grants to help these organizations through the arduous process of preparing full research proposals. Workplaces provide an ideal environment to reach large portions of society with health promotion programs because people spend a large portion of their time at work and because the workplace provides a relatively stable cohesive social environment. Furthermore, employers have a financial incentive to keep employees healthy because healthy employees have lower medical costs and are more productive. Workplace programs have relatively low per person costs because they enjoy the economies of scale afforded by large cohesive populations. Research can improve the impact and efficiency of workplace programs, but most employers are not motivated to fund health promotion research because the cost is greater than the relative benefit they will receive as an individual organization, and because few employers have the technical expertise necessary to conduct rigorous research. This new program will support such research efforts.

IV. Attracting Most Qualified Experts and Developing the Health Promotion Infrastructure: Section 2931 HHS will make efforts to engage the most experienced and qualified health promotion scientists and practitioners in all grant and contract opportunities, and, rather than expanding state and federal government, insure that funds are distributed to the community in such way to empower, rather than compete with the health promotion community.

Why is this important? If the federal government were to expand its health promotion efforts by developing the internal capacity to design and provide programs, it would inadvertently be competing with existing health promotion organizations. This would result in layoffs and business failures for the health promotion community and reduced individual and corporate income tax receipts for state and federal governments. Furthermore, government support for health promotion will not last forever. The most effective strategy to create a sustainable health promotion presence will be to engage and empower the existing health promotion community of provider, research and educational organizations rather than replacing them with larger government agencies.