National Institutes of Health Funding for Behavioral Interventions to Prevent Chronic Diseases

Abstract

Chronic non-communicable diseases (NCDs) cause the majority of premature deaths, disability, and healthcare expenditures in the U.S. Six largely modifiable risk behaviors and factors (tobacco use, poor nutrition, physical inactivity, alcohol abuse, drug abuse, and poor mental health) account for more than 50% of premature mortality and considerably more morbidity and disability. The IOM proposed that population burden of disease and preventability should be major determinants of the amount of research funding provided by the U.S. NIH. Data on NIH prevention funding between fiscal years 2010 and 2012 for human behavioral interventions that target the modifiable risk factors of NCDs were analyzed during 2013-2014. The NIH prevention portfolio comprises approximately 37% human behavioral studies and 63% basic biomedical, genetic, and animal studies. Approximately 65% of studies were secondary prevention versus 23% for primary prevention, and 71% of studies intervened at the individual and family levels. Diet and exercise were the most-studied risk factors (41%), and few studies conducted economic analyses (12%). NIH spends an estimated $2.2-$2.6 billion annually (7%-9% of the total of $30 billion) on human behavioral interventions to prevent NCDs. Although NIH prevention funding broadly aligns with the current burden of disease, overall funding remains low compared to funding for treatment, which suggests funding misalignment with the preventability of chronic diseases.

Alzheimer disease research in the 21st century: past and current failures, new perspectives and funding priorities

“…Beyond laboratory models, several lifestyle-related risk factors have been shown to play key roles in the onset and progression of AD, yet research support in theses domains remains disproportionately low, with only a 3.4% of average annual funding supported by the National Institute on Aging (NIA) for prevention in 2010-2012 [20]. Although advancing age is clearly considered the main risk factor for developing AD [21–23], nutritional factors [24], low levels of physical activity [25, 26], reduced cognitive stimulation [27], socioeconomic status and educational attainment [28–30] are all directly related to AD risk.…”

“…Understanding this complexity is clearly critical for designing intervention strategies aimed at preventing or ameliorating early symptoms of AD. Despite this knowledge and massive potential social impact, longitudinal clinical studies focused on prevention are very poorly supported in the U.S. (only ~ 7%-9% of the $30 billion NIH total discretionary budget) [20]. For all these reasons there is an urgent need to rethink current research funding strategies to directly target human relevance and disease causation.…”

Mapping public health research across the National Institute for Health Research 2006–2013

“…Interestingly, this represents a greater proportion than that identified in a review of research funded by the National Institutes of Health in the United Stated of America in a 2 year period from 2010 to 2012. That portfolio analysis estimated that almost one-fifth of its total research expenditure was allocated to disease prevention, although this difference may reflect the classification systems used [20]. …”

A Human-Based Integrated Framework forAlzheimer’s Disease Research

“…Importantly, the implementation of epidemiological, prevention, and intervention clinical studies required to unravel the role of risk factors currently associated with AD, will require increasing the level of current research funding (currently only 7%-9% of the total $30 billion NIH discretionary budget [137]). …”