Did A Rising Tide Lift All Boats? The NIH Budget And Pediatric Research Portfolio

Abstract

This paper examines National Institutes of Health (NIH) pediatric research spending in absolute terms and relative to the doubling of the NIH overall budget between fiscal years 1998 and 2003. Pediatric spending increased by an average annual rate of 12.8 percent during the doubling period (almost on par with the NIH average annual growth rate of 14.7 percent). However, the proportion of the total NIH budget devoted to the pediatric portfolio declined from 12.3 to 11.3 percent. We offer recommendations for implementing existing commitments to strengthen the pediatric research portfolio and to protect the gains of the doubling period.T h e a ll o c at i o n o f f e d e r a l d o ll a r s for the support of dependent populations has become a major policy concern. Much of the previous attention focused on the economic well-being of children and the elderly-in particular, the declining impoverishment of the elderly and the growing poverty among children over the past half-century. 1 Trends in federal spending on both groups, reported in absolute terms and relative to each other, show evidence of growing intergenerational inequity, leading to increased concern about whether the projected growth in federal spending on health programs for the elderly will come at the expense of credible commitments to programs for children. 2 With that broader debate in mind, we report on the status of the National Institutes of Health (NIH) pediatric research portfolio in absolute terms and relative to the overall NIH budget during the doubling period (fiscal years 1998-2003). We avoid framing NIH appropriations in terms of competition between children and adults for scarce biomedical research dollars. Instead, we ask whether a rising budgetary tide lifted all boats: How has the pediatric portfolio fared in the recent era of rapid overall NIH growth?Congress has expressed particular interest in the status of pediatric spending and specifically requested that NIH develop performance indicators to measure its progress toward achieving a stronger pediatric portfolio. This paper is a systematic effort to examine the status of the pediatric portfolio during the doubling period, when the overall NIH budget increased by an actual cumulative growth rate of 98.3 percent (75.7 percent in inflation-adjusted terms).We also highlight the status of the pediatric portfolio within four institutes: National Institute of Child Health and Human Development (NICHD); National Institute of Mental Health (NIMH); National Institute of Neurological Diseases and Stroke (NINDS); and National Human Genome Research Institute (NHGRI). We use these examples to illustrate the benefits of quantifying pediatric spending to assess progress as well as the dangers of drawing conclusions about limited pediatric spending without accounting for the benefits of biomedical research, which are often spread over subpopulations in undifferentiated ways.Pessimistic assumptions about future annual growth in federal discretionary spending will prove important for underst...

Pediatric and adult otorhinolaryngological publications: Trends over 15 years (1993–2007)

“…Using a web-based search of funding organizations in the UK, Hawkins et al have found that the overall proportion of funding devoted to children is approximately 3%, and even lower proportions of funding are devoted to government priorities such as health inequality and adolescent services [4]. By comparison the National Institutes for Health in the United States devotes only about 11-12% of its budget to pediatrics [5]. It may also be asked whether the rise in number of articles might correlate with manpower shifts in pediatric and adult ORL, and whether the increase in number of articles mirrors an increasing workforce.…”

That Sinking Feeling, Again? The State of National Institutes of Health Pediatric Research Funding, Fiscal Year 1992–2010

“…5 The NICHD was designated as the lead institute on a number of the initiatives, including establishment of a pediatric research initiative (PRI), expansion of autism-related and Fragile X syndrome research activities, and conducting a national longitudinal study of environmental influences on child health (National Children' Study or "NCS"). 6 Congress established the PRI to increase support for pediatric research, enhance collaborative efforts among ICs, speed the development of pediatric clinical drug trials, and invest in training pediatric researchers through a loan repayment program. Because a major component of the longstanding mission of the Eunice Kennedy Shriver NICHD is to improve and promote children's health and development, the NIH Director requested the NICHD Director to oversee and coordinate the PRI at the NIH and to coordinate preparation of the annual report on the status of the pediatric research portfolio (new and continuing grants and contracts).…”

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“…27 Addressing whether existing resources will be enough to address the gaps in children's health care science that impede improving children's health outcomes is beyond the scope of this commentary. Given longstanding concerns about the resources available for pediatric research, [28][29][30] more in-depth analysis could be helpful and lead to a prioritized clinical research agenda in child health. 6 Setting research priorities can be a difficult topic given the variety of criteria, but several approaches are emerging and could be adapted for use within the translational continuum.…”