COMMENTARY
Enhancing the Quality of Prevention Research Supported by the National Institutes of Health As the nation’s premier biomedical research agency, the National Institutes of Health (NIH) has supported most of the research that underlies the prevention services that are provided to citizens in the United States and around the world. Within the NIH, the Office of Disease Prevention (ODP) has as its mission to improve the public health by increasing the scope, quality, dissemination, and effect of prevention research supported by the NIH. In today’s environment, the ODP needs to focus its efforts to address this mission. To do so, the ODP has developed a strategic plan for 2014 to 2018. We provide background on the ODP and key points from the strategic plan. (Am J Public Health. 2015;105: 9–12. doi:10.2105/AJPH. 2014.302057)
David M. Murray, PhD, Wilma Peterman Cross, MS, Denise Simons-Morton, MD, PhD, MPH, Jody Engel, MA, RD, Barry Portnoy, PhD, Jessica Wu, PhD, Paris A. Watson, and Susanne Olkkola, MEd, MPA
IT HAS BEEN CLEAR FOR SOME time that modifiable behavioral risk factors are among the leading causes of death in the United States.1,2 McGinnis and Foege1 reported that approximately half of all deaths among US residents in 1990 could be attributed to modifiable behavioral risk factors and called for greater investment in prevention. Mokdad et al.2 reported a similar figure for 2000 and pointed in particular to the need for interventions to prevent smoking onset and increase cessation, to improve diet, and to increase physical activity. Recent reviews have made similar arguments.3---6 The earlier reports helped set the stage for federal government attention, including the Patient Protection and Affordable Care Act (ACA) in 20107 and the release of the National Prevention Strategy in 20118; these federal efforts include major provisions to advance prevention as a priority for the nation’s health.9 The ACA requires insurers to cover services recommended by the US Preventive Services Task Force (USPSTF), vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), and services for children and adolescents based on guidelines from the Health Resources and Services Administration. Medicare covers annual wellness visits together with many of the services recommended by the USPSTF. The ACA provides matching funds to states if they eliminate cost sharing for Medicaid services recommended by the
January 2015, Vol 105, No. 1 | American Journal of Public Health
USPSTF or the ACIP. The ACA provides grants for worksite wellness programs and community prevention programs. The ACA also promotes expanded coordination between the USPSTF, the Community Preventive Services Task Force (CPSTF), and the ACIP. As the nation’s premier biomedical research agency, the National Institutes of Health (NIH) has supported most of the research that provides the evidence underlying the prevention services that are provided to citizens in the United States and around the world, including those addressed by the ACA and the National Prevention Strategy. According to NIH Research, Condition, and Disease Categorization data, NIH support for prevention research in 2012 was estimated to be 19% of the total NIH budget—almost $6 billion. When focusing on the 10 leading causes of death in the United States, NIH support for prevention research was a higher percentage and has been increasing: from 2008 to 2012, the proportion of dollars awarded for prevention research increased from 23% to 25%, whereas the proportion of awards for prevention research increased from 18% to 21%. Even with this investment, much work needs to be done, and many challenges exist.10 These challenges require the NIH Office of Disease Prevention (ODP) to be very focused in its efforts to address its mission, which is to improve the public health by increasing the scope, quality, dissemination, and
effect of prevention research supported by the NIH. To this end, the ODP developed a strategic plan to guide its activities over the next five years. We provide background on the ODP and present highlights from the ODP “Strategic Plan 2014---2018,” which was approved by the NIH director on January 3, 2014, and posted on the ODP Web site in February 2014 (https://prevention. nih.gov/docs/about/ODP_ StrategicPlan2014-2018.pdf).
THE OFFICE OF DISEASE PREVENTION The NIH established the ODP in 1986 following passage of the Health Research Extension Act, which created the position of NIH associate director for prevention. The associate director is charged with promoting and coordinating prevention research among the NIH institutes, centers, and offices and between the NIH and other public and private entities. Under the direction of the associate director for prevention, who is also the director of the ODP, the office provides leadership for the development, coordination, and implementation of prevention research in collaboration with NIH institutes and centers and other partners. The ODP leads the Prevention Research Coordinating Committee, which includes representatives from each NIH institute and center, as well as several federal partners (Agency for Healthcare Research and Quality, Centers for
Murray et al. | Peer Reviewed | Commentary | 9
COMMENTARY
Disease Control and Prevention, Office of Disease Prevention and Health Promotion), and provides a forum for trans-NIH discussion of prevention issues. The ODP serves as the NIH liaison for many federal programs and offices, including Healthy People, the National Prevention Strategy, the USPSTF, and the CPSTF. In 1995, the Office of Dietary Supplements was created within the ODP to support research that investigates potential roles of dietary supplements in promoting health and reducing the risk of chronic diseases. Since 2012, the ODP has been the home for the Tobacco Regulatory Science Program, which manages the trans-NIH collaboration with the US Food and Drug Administration’s (FDA’s) Center for Tobacco Products to conduct research to support the FDA’s regulatory authority over tobacco products. The ODP also provides cofunding for extramural and intramural prevention research and supports seminars and workshops related to prevention research.
DEFINING PREVENTION RESEARCH No consistent classification of prevention strategies exists in public health; some sources have identified as many as five levels of prevention.11 Many sources discuss primary, secondary, and tertiary prevention; some include health promotion or primordial prevention; and some discuss rehabilitation as quaternary prevention. In addition, we found no consistent definition of any of these levels; for example, some schemes include prevention of recurrent events under secondary prevention, but others do not. The Prevention Research Coordinating Committee has worked to provide a definition of prevention
research for the NIH that communicates the breadth and depth of prevention research supported by the NIH while retaining sufficient specificity to be of practical value. The Prevention Research Coordinating Committee Working Definition of Prevention Research is summarized here: Prevention research at the NIH encompasses both primary and secondary prevention. It includes research designed to promote health; to prevent onset of disease, disorders, conditions, or injuries; and to detect, and prevent the progression of, asymptomatic disease. Prevention research targets biology, individual behavior, factors in the social and physical environments, and health services, and informs and evaluates health-related policies and regulations. Prevention research includes studies for: Identification and assessment of risk and protective factors, d Screening and identification of individuals and groups at risk, d Development and evaluation of interventions to reduce risk, d Translation, implementation, and dissemination of effective preventive interventions into practice, d Development of methods to support prevention research. d
On the basis of this definition, the ODP will focus its efforts on research that involves primary and secondary prevention, because these levels are of most relevance to the public health. The ODP defines primary prevention as the prevention of a new disease, disorder, condition, or injury, hereafter referred to collectively as a health condition. Primary prevention programs target at-risk populations or the general population and are designed to prevent the development of a new health condition in individuals who do not yet have it. Primary prevention also includes identification and assessment of risk and protective factors for the onset of a new health condition.
10 | Commentary | Peer Reviewed | Murray et al.
The ODP defines secondary prevention as the early detection and treatment of an asymptomatic or early-stage health condition with the aim of preventing or slowing progression to a more serious health condition or preventing recurrence of a health condition. Secondary prevention also includes identification and assessment of risk and protective factors for recurrence of a health condition. Prevention research falls along a continuum from hypothesis development, through methods development, controlled interventions trials, defined population studies, to implementation projects. Examples of NIH-supported projects from each of these phases are available on the ODP Web site (https://prevention.nih.gov/ prevention-research/phasesprevention-research).
STRATEGIC PLAN 2014– 2018 With the arrival of a new director in September 2012, the ODP drafted a new mission and vision statement and began work on its first strategic plan. With support from the NIH leadership and guidance from a Strategic Planning Working Group, composed of NIH scientific program and strategic planning experts, representatives from other federal agencies, the extramural research community, the health care sector, and the patient community, the ODP solicited input from multiple stakeholder communities, including NIH institutes and centers, academia, public and private companies who have an interest in prevention research, health care professionals, patient advocates and advocacy organizations, scientific and professional organizations, federal agencies, and the general public.
The ODP identified six strategic priorities that provide the framework for its plan (see the box on the next page); the six priorities form an integrated approach and are not presented in order of importance. The ODP also identified measurable objectives for each priority together with detailed work plans, benchmarks, and timelines. Four of the six priorities focus on improving processes used at the NIH to support prevention research. Strategic Priority I focuses on monitoring investments that the NIH makes in prevention research to ensure that those investments are well targeted and provide a good return. Strategic Priority II focuses on identifying areas appropriate for additional investment in prevention research by drawing on input from the USPSTF, the CPSTF, the extramural community, professional societies, and other stakeholders. Strategic Priority III focuses on improving the quality of methods used in prevention research supported by the NIH, recognizing that results of that research will improve with more consistent use of state-of-the-science methods. Strategic Priority IV focuses on developing collaborative funding opportunities with multiple institutes and centers, recognizing that greater efficiency could be obtained through better coordination among institutes and centers interested in the same topics. The other two priorities seek to take optimal advantage of the results of the prevention research that the NIH supports. Strategic Priority V focuses on dissemination, in response to the mandate for dissemination that was included in the 1985 legislation that led to the creation of the ODP. Strategic Priority VI focuses on raising the profile of prevention research supported by the NIH.
American Journal of Public Health | January 2015, Vol 105, No. 1
COMMENTARY
Office of Disease Prevention Strategic Priorities for Fiscal Years 2014–2018 I. Systematically monitor NIH investments in prevention research and assess the progress and results of that research. II. Identify prevention research areas for investment or expanded effort by the NIH. III. Promote the use of the best available methods in prevention research and support the development of better methods. IV. Promote collaborative prevention research projects and facilitate coordination of such projects across the NIH and with other public and private entities. V. Identify and promote the use of evidence-based interventions and promote the conduct of implementation and dissemination research in prevention. VI. Increase the visibility of prevention research at the NIH and across the country. Note. NIH = National Institutes of Health.
The ODP “Strategic Plan 2014--2018” represents a fundamental shift in the core functions of the ODP. The ODP will develop new portfolio analysis tools to characterize the NIH investment in prevention research for the first time by topic, population, study design, setting, age group, and other factors. The ODP will work closely with the USPSTF and CPSTF to identify prevention research areas for additional effort by the NIH and to ensure that the USPSTF and CPSTF have appropriate NIH input at every step in their review of clinical preventive services and community preventive programs, respectively. The ODP will enhance the quality of NIH prevention research by improving training in prevention research methods for extramural investigators and for NIH program and review staff; by helping NIH review staff identify and recruit appropriate methodologists for their review panels; and by supporting research to develop better methods for prevention research. The ODP also will encourage and catalyze institutes and centers to join forces to address prevention research topics of common interest, such as physical activity, dietary intake, obesity, or tobacco use; by pooling resources, it will be possible to support better studies than when the studies are supported by a single institute or center. The ODP will work with institutes and
centers and other stakeholders to promote the dissemination of evidence-based programs at the individual, organizational, community, and policy levels. Through its Web site and interactions with senior NIH officials and stakeholders, the ODP will help make the NIH known not just for research on disease mechanisms and treatments but also for research on disease prevention. In addition, the ODP will strive to become a central portal for prevention researchers by providing information that will help scientists navigate the grant application and review processes as well as gain insight into the best methods for measurement, study design, intervention, evaluation, and analysis. These are just some of the new activities for the ODP specified in the “Strategic Plan 2014---2018.” Work is already under way to address several of these priorities. For Strategic Priority I, the ODP has developed a taxonomy for prevention research that is being used to classify awards as a first step in developing software to automate the classification process and support new portfolio analysis tools. For Strategic Priority II, the ODP has launched a new effort to enhance coordination of the work of the NIH with the work of the USPSTF. The ODP is working with the institutes and centers to review and comment on USPSTF reports, including all draft research
January 2015, Vol 105, No. 1 | American Journal of Public Health
plans, evidence reports, and recommendation statements for all active topics. In addition, the ODP will regularly seek input from the institutes and centers on work relevant to topics for which the USPSTF judged that the evidence was insufficient to allow a recommendation. For Strategic Priority III, the ODP is working with professional organizations with a strong interest in prevention to identify content and methods experts who are interested in service on NIH review panels. For Strategic Priority IV, the ODP is leading the development of its first funding opportunity announcement, collaborating with program staff at some of the institutes and centers. For Strategic Priority VI, ODP has completely reworked its Web site to include new sections that highlight the work of the ODP in enhancing prevention research supported by the NIH. Implementation of the “Strategic Plan 2014--2018” will continue over the next four years. The efforts of the ODP will be focused on the major causes of death in the United States. Mokdad et al.2 identified the top actual causes of death as tobacco, poor diet and physical activity, alcohol consumption, microbial agents, toxic agents, motor vehicles, firearms, sexual behavior, and illicit drug use. Danaei et al.3 identified tobacco smoking, high blood pressure, overweight to obesity,
physical inactivity, other dietary factors, and excessive alcohol consumption as major causes of death in the United States. Fisher et al.4 provided a compelling case for the role that addressing tobacco use, poor diet and physical activity, and alcohol use can play in disease prevention. These largely convergent findings provide obvious targets for ODP’s efforts to improve the public health by increasing the scope, quality, dissemination, and effect of prevention research supported by the NIH.
SUMMARY The NIH has supported much of the research that provides the evidence that the Centers for Disease Control and Prevention, the USPSTF, the CPSTF, and many other organizations use as the basis for their prevention recommendations. Support for prevention research at the NIH has increased over the last five years for the 10 leading causes of death in the United States, both in the proportion of awards and in the proportion of dollars allocated to prevention research. In the current environment, it is important to focus our efforts to make the most efficient use of available resources. The ODP “Strategic Plan 2014---2018” is a step in that direction and an important step for prevention research
Murray et al. | Peer Reviewed | Commentary | 11
COMMENTARY
at the NIH. We look forward to implementing the plan and gauging its effect at the NIH and on the nation’s health. We encourage all who are interested in prevention research at the NIH to visit the ODP Web site to learn more about the strategic plan, to monitor our progress, and to give us feedback. j
About the Authors The authors are with the Office of Disease Prevention, National Institutes of Health, Rockville, MD. Correspondence should be sent to David M. Murray, PhD, Associate Director for Prevention, and Director, Office of Disease Prevention, National Institutes of Health, 6100 Executive Blvd, 2B03, Rockville, MD 20892 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph. org by clicking on the “Reprints” link. This article was accepted April 18, 2014.
8. Benjamin RM. The national prevention strategy: shifting the nation’s healthcare system. Public Health Rep. 2011; 126(6):774---776. 9. Koh HK, Sebelius KG. Promoting prevention through the Affordable Care Act. N Engl J Med. 2010;363(14): 1296---1299. 10. Fineberg HV. The paradox of disease prevention: celebrated in principle, resisted in practice. JAMA. 2013;310(1): 85---90. 11. Mensah GA, Dietz WH, Harris VB, et al. Prevention and control of coronary heart disease and stroke---nomenclature for prevention approaches in public health: a statement for public health practice from the Centers for Disease Control and Prevention. Am J Prev Med. 2005;29(5, suppl 1):152---157.
Contributors D. M. Murray conceptualized the strategic plan, oversaw its development, and wrote the article. W. Peterman Cross managed the development of the strategic plan and edited the article. D. Simons-Morton, J. Engel, B. Portnoy, J. Wu, P. A. Watson, and S. Olkkola led one of the strategic planning teams and edited the article.
References 1. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270(18):2207---2212. 2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238---1245. 3. Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6(4): e1000058. 4. Fisher EB, Fitzgibbon ML, Glasgow RE, et al. Behavior matters. Am J Prev Med. 2011;40(5):e15---e30. 5. Kapp JM. Evaluation of the national prevention strategy in reference to historical population health. Am J Health Promot. 2013;27(5):281---283. 6. Matheson EM, King DE, Everett CJ. Healthy lifestyle habits and mortality in overweight and obese individuals. J Am Board Fam Med. 2012;25(1):9---15. 7. Patient Protection and Affordable Care Act. Pub. L. No. 111-148, 124 Stat. 119 (2010).
12 | Commentary | Peer Reviewed | Murray et al.
American Journal of Public Health | January 2015, Vol 105, No. 1
Enhancing the Quality of Prevention Research Supported by the National Institutes of Health As the nation’s premier biomedical research agency, the National Institutes of Health (NIH) has supported most of the research that underlies the prevention services that are provided to citizens in the United States and around the world. Within the NIH, the Office of Disease Prevention (ODP) has as its mission to improve the public health by increasing the scope, quality, dissemination, and effect of prevention research supported by the NIH. In today’s environment, the ODP needs to focus its efforts to address this mission. To do so, the ODP has developed a strategic plan for 2014 to 2018. We provide background on the ODP and key points from the strategic plan. (Am J Public Health. 2015;105: 9–12. doi:10.2105/AJPH. 2014.302057)
David M. Murray, PhD, Wilma Peterman Cross, MS, Denise Simons-Morton, MD, PhD, MPH, Jody Engel, MA, RD, Barry Portnoy, PhD, Jessica Wu, PhD, Paris A. Watson, and Susanne Olkkola, MEd, MPA
IT HAS BEEN CLEAR FOR SOME time that modifiable behavioral risk factors are among the leading causes of death in the United States.1,2 McGinnis and Foege1 reported that approximately half of all deaths among US residents in 1990 could be attributed to modifiable behavioral risk factors and called for greater investment in prevention. Mokdad et al.2 reported a similar figure for 2000 and pointed in particular to the need for interventions to prevent smoking onset and increase cessation, to improve diet, and to increase physical activity. Recent reviews have made similar arguments.3---6 The earlier reports helped set the stage for federal government attention, including the Patient Protection and Affordable Care Act (ACA) in 20107 and the release of the National Prevention Strategy in 20118; these federal efforts include major provisions to advance prevention as a priority for the nation’s health.9 The ACA requires insurers to cover services recommended by the US Preventive Services Task Force (USPSTF), vaccinations recommended by the Advisory Committee on Immunization Practices (ACIP), and services for children and adolescents based on guidelines from the Health Resources and Services Administration. Medicare covers annual wellness visits together with many of the services recommended by the USPSTF. The ACA provides matching funds to states if they eliminate cost sharing for Medicaid services recommended by the
January 2015, Vol 105, No. 1 | American Journal of Public Health
USPSTF or the ACIP. The ACA provides grants for worksite wellness programs and community prevention programs. The ACA also promotes expanded coordination between the USPSTF, the Community Preventive Services Task Force (CPSTF), and the ACIP. As the nation’s premier biomedical research agency, the National Institutes of Health (NIH) has supported most of the research that provides the evidence underlying the prevention services that are provided to citizens in the United States and around the world, including those addressed by the ACA and the National Prevention Strategy. According to NIH Research, Condition, and Disease Categorization data, NIH support for prevention research in 2012 was estimated to be 19% of the total NIH budget—almost $6 billion. When focusing on the 10 leading causes of death in the United States, NIH support for prevention research was a higher percentage and has been increasing: from 2008 to 2012, the proportion of dollars awarded for prevention research increased from 23% to 25%, whereas the proportion of awards for prevention research increased from 18% to 21%. Even with this investment, much work needs to be done, and many challenges exist.10 These challenges require the NIH Office of Disease Prevention (ODP) to be very focused in its efforts to address its mission, which is to improve the public health by increasing the scope, quality, dissemination, and
effect of prevention research supported by the NIH. To this end, the ODP developed a strategic plan to guide its activities over the next five years. We provide background on the ODP and present highlights from the ODP “Strategic Plan 2014---2018,” which was approved by the NIH director on January 3, 2014, and posted on the ODP Web site in February 2014 (https://prevention. nih.gov/docs/about/ODP_ StrategicPlan2014-2018.pdf).
THE OFFICE OF DISEASE PREVENTION The NIH established the ODP in 1986 following passage of the Health Research Extension Act, which created the position of NIH associate director for prevention. The associate director is charged with promoting and coordinating prevention research among the NIH institutes, centers, and offices and between the NIH and other public and private entities. Under the direction of the associate director for prevention, who is also the director of the ODP, the office provides leadership for the development, coordination, and implementation of prevention research in collaboration with NIH institutes and centers and other partners. The ODP leads the Prevention Research Coordinating Committee, which includes representatives from each NIH institute and center, as well as several federal partners (Agency for Healthcare Research and Quality, Centers for
Murray et al. | Peer Reviewed | Commentary | 9
COMMENTARY
Disease Control and Prevention, Office of Disease Prevention and Health Promotion), and provides a forum for trans-NIH discussion of prevention issues. The ODP serves as the NIH liaison for many federal programs and offices, including Healthy People, the National Prevention Strategy, the USPSTF, and the CPSTF. In 1995, the Office of Dietary Supplements was created within the ODP to support research that investigates potential roles of dietary supplements in promoting health and reducing the risk of chronic diseases. Since 2012, the ODP has been the home for the Tobacco Regulatory Science Program, which manages the trans-NIH collaboration with the US Food and Drug Administration’s (FDA’s) Center for Tobacco Products to conduct research to support the FDA’s regulatory authority over tobacco products. The ODP also provides cofunding for extramural and intramural prevention research and supports seminars and workshops related to prevention research.
DEFINING PREVENTION RESEARCH No consistent classification of prevention strategies exists in public health; some sources have identified as many as five levels of prevention.11 Many sources discuss primary, secondary, and tertiary prevention; some include health promotion or primordial prevention; and some discuss rehabilitation as quaternary prevention. In addition, we found no consistent definition of any of these levels; for example, some schemes include prevention of recurrent events under secondary prevention, but others do not. The Prevention Research Coordinating Committee has worked to provide a definition of prevention
research for the NIH that communicates the breadth and depth of prevention research supported by the NIH while retaining sufficient specificity to be of practical value. The Prevention Research Coordinating Committee Working Definition of Prevention Research is summarized here: Prevention research at the NIH encompasses both primary and secondary prevention. It includes research designed to promote health; to prevent onset of disease, disorders, conditions, or injuries; and to detect, and prevent the progression of, asymptomatic disease. Prevention research targets biology, individual behavior, factors in the social and physical environments, and health services, and informs and evaluates health-related policies and regulations. Prevention research includes studies for: Identification and assessment of risk and protective factors, d Screening and identification of individuals and groups at risk, d Development and evaluation of interventions to reduce risk, d Translation, implementation, and dissemination of effective preventive interventions into practice, d Development of methods to support prevention research. d
On the basis of this definition, the ODP will focus its efforts on research that involves primary and secondary prevention, because these levels are of most relevance to the public health. The ODP defines primary prevention as the prevention of a new disease, disorder, condition, or injury, hereafter referred to collectively as a health condition. Primary prevention programs target at-risk populations or the general population and are designed to prevent the development of a new health condition in individuals who do not yet have it. Primary prevention also includes identification and assessment of risk and protective factors for the onset of a new health condition.
10 | Commentary | Peer Reviewed | Murray et al.
The ODP defines secondary prevention as the early detection and treatment of an asymptomatic or early-stage health condition with the aim of preventing or slowing progression to a more serious health condition or preventing recurrence of a health condition. Secondary prevention also includes identification and assessment of risk and protective factors for recurrence of a health condition. Prevention research falls along a continuum from hypothesis development, through methods development, controlled interventions trials, defined population studies, to implementation projects. Examples of NIH-supported projects from each of these phases are available on the ODP Web site (https://prevention.nih.gov/ prevention-research/phasesprevention-research).
STRATEGIC PLAN 2014– 2018 With the arrival of a new director in September 2012, the ODP drafted a new mission and vision statement and began work on its first strategic plan. With support from the NIH leadership and guidance from a Strategic Planning Working Group, composed of NIH scientific program and strategic planning experts, representatives from other federal agencies, the extramural research community, the health care sector, and the patient community, the ODP solicited input from multiple stakeholder communities, including NIH institutes and centers, academia, public and private companies who have an interest in prevention research, health care professionals, patient advocates and advocacy organizations, scientific and professional organizations, federal agencies, and the general public.
The ODP identified six strategic priorities that provide the framework for its plan (see the box on the next page); the six priorities form an integrated approach and are not presented in order of importance. The ODP also identified measurable objectives for each priority together with detailed work plans, benchmarks, and timelines. Four of the six priorities focus on improving processes used at the NIH to support prevention research. Strategic Priority I focuses on monitoring investments that the NIH makes in prevention research to ensure that those investments are well targeted and provide a good return. Strategic Priority II focuses on identifying areas appropriate for additional investment in prevention research by drawing on input from the USPSTF, the CPSTF, the extramural community, professional societies, and other stakeholders. Strategic Priority III focuses on improving the quality of methods used in prevention research supported by the NIH, recognizing that results of that research will improve with more consistent use of state-of-the-science methods. Strategic Priority IV focuses on developing collaborative funding opportunities with multiple institutes and centers, recognizing that greater efficiency could be obtained through better coordination among institutes and centers interested in the same topics. The other two priorities seek to take optimal advantage of the results of the prevention research that the NIH supports. Strategic Priority V focuses on dissemination, in response to the mandate for dissemination that was included in the 1985 legislation that led to the creation of the ODP. Strategic Priority VI focuses on raising the profile of prevention research supported by the NIH.
American Journal of Public Health | January 2015, Vol 105, No. 1
COMMENTARY
Office of Disease Prevention Strategic Priorities for Fiscal Years 2014–2018 I. Systematically monitor NIH investments in prevention research and assess the progress and results of that research. II. Identify prevention research areas for investment or expanded effort by the NIH. III. Promote the use of the best available methods in prevention research and support the development of better methods. IV. Promote collaborative prevention research projects and facilitate coordination of such projects across the NIH and with other public and private entities. V. Identify and promote the use of evidence-based interventions and promote the conduct of implementation and dissemination research in prevention. VI. Increase the visibility of prevention research at the NIH and across the country. Note. NIH = National Institutes of Health.
The ODP “Strategic Plan 2014--2018” represents a fundamental shift in the core functions of the ODP. The ODP will develop new portfolio analysis tools to characterize the NIH investment in prevention research for the first time by topic, population, study design, setting, age group, and other factors. The ODP will work closely with the USPSTF and CPSTF to identify prevention research areas for additional effort by the NIH and to ensure that the USPSTF and CPSTF have appropriate NIH input at every step in their review of clinical preventive services and community preventive programs, respectively. The ODP will enhance the quality of NIH prevention research by improving training in prevention research methods for extramural investigators and for NIH program and review staff; by helping NIH review staff identify and recruit appropriate methodologists for their review panels; and by supporting research to develop better methods for prevention research. The ODP also will encourage and catalyze institutes and centers to join forces to address prevention research topics of common interest, such as physical activity, dietary intake, obesity, or tobacco use; by pooling resources, it will be possible to support better studies than when the studies are supported by a single institute or center. The ODP will work with institutes and
centers and other stakeholders to promote the dissemination of evidence-based programs at the individual, organizational, community, and policy levels. Through its Web site and interactions with senior NIH officials and stakeholders, the ODP will help make the NIH known not just for research on disease mechanisms and treatments but also for research on disease prevention. In addition, the ODP will strive to become a central portal for prevention researchers by providing information that will help scientists navigate the grant application and review processes as well as gain insight into the best methods for measurement, study design, intervention, evaluation, and analysis. These are just some of the new activities for the ODP specified in the “Strategic Plan 2014---2018.” Work is already under way to address several of these priorities. For Strategic Priority I, the ODP has developed a taxonomy for prevention research that is being used to classify awards as a first step in developing software to automate the classification process and support new portfolio analysis tools. For Strategic Priority II, the ODP has launched a new effort to enhance coordination of the work of the NIH with the work of the USPSTF. The ODP is working with the institutes and centers to review and comment on USPSTF reports, including all draft research
January 2015, Vol 105, No. 1 | American Journal of Public Health
plans, evidence reports, and recommendation statements for all active topics. In addition, the ODP will regularly seek input from the institutes and centers on work relevant to topics for which the USPSTF judged that the evidence was insufficient to allow a recommendation. For Strategic Priority III, the ODP is working with professional organizations with a strong interest in prevention to identify content and methods experts who are interested in service on NIH review panels. For Strategic Priority IV, the ODP is leading the development of its first funding opportunity announcement, collaborating with program staff at some of the institutes and centers. For Strategic Priority VI, ODP has completely reworked its Web site to include new sections that highlight the work of the ODP in enhancing prevention research supported by the NIH. Implementation of the “Strategic Plan 2014--2018” will continue over the next four years. The efforts of the ODP will be focused on the major causes of death in the United States. Mokdad et al.2 identified the top actual causes of death as tobacco, poor diet and physical activity, alcohol consumption, microbial agents, toxic agents, motor vehicles, firearms, sexual behavior, and illicit drug use. Danaei et al.3 identified tobacco smoking, high blood pressure, overweight to obesity,
physical inactivity, other dietary factors, and excessive alcohol consumption as major causes of death in the United States. Fisher et al.4 provided a compelling case for the role that addressing tobacco use, poor diet and physical activity, and alcohol use can play in disease prevention. These largely convergent findings provide obvious targets for ODP’s efforts to improve the public health by increasing the scope, quality, dissemination, and effect of prevention research supported by the NIH.
SUMMARY The NIH has supported much of the research that provides the evidence that the Centers for Disease Control and Prevention, the USPSTF, the CPSTF, and many other organizations use as the basis for their prevention recommendations. Support for prevention research at the NIH has increased over the last five years for the 10 leading causes of death in the United States, both in the proportion of awards and in the proportion of dollars allocated to prevention research. In the current environment, it is important to focus our efforts to make the most efficient use of available resources. The ODP “Strategic Plan 2014---2018” is a step in that direction and an important step for prevention research
Murray et al. | Peer Reviewed | Commentary | 11
COMMENTARY
at the NIH. We look forward to implementing the plan and gauging its effect at the NIH and on the nation’s health. We encourage all who are interested in prevention research at the NIH to visit the ODP Web site to learn more about the strategic plan, to monitor our progress, and to give us feedback. j
About the Authors The authors are with the Office of Disease Prevention, National Institutes of Health, Rockville, MD. Correspondence should be sent to David M. Murray, PhD, Associate Director for Prevention, and Director, Office of Disease Prevention, National Institutes of Health, 6100 Executive Blvd, 2B03, Rockville, MD 20892 (e-mail: [email protected]). Reprints can be ordered at http://www.ajph. org by clicking on the “Reprints” link. This article was accepted April 18, 2014.
8. Benjamin RM. The national prevention strategy: shifting the nation’s healthcare system. Public Health Rep. 2011; 126(6):774---776. 9. Koh HK, Sebelius KG. Promoting prevention through the Affordable Care Act. N Engl J Med. 2010;363(14): 1296---1299. 10. Fineberg HV. The paradox of disease prevention: celebrated in principle, resisted in practice. JAMA. 2013;310(1): 85---90. 11. Mensah GA, Dietz WH, Harris VB, et al. Prevention and control of coronary heart disease and stroke---nomenclature for prevention approaches in public health: a statement for public health practice from the Centers for Disease Control and Prevention. Am J Prev Med. 2005;29(5, suppl 1):152---157.
Contributors D. M. Murray conceptualized the strategic plan, oversaw its development, and wrote the article. W. Peterman Cross managed the development of the strategic plan and edited the article. D. Simons-Morton, J. Engel, B. Portnoy, J. Wu, P. A. Watson, and S. Olkkola led one of the strategic planning teams and edited the article.
References 1. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270(18):2207---2212. 2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238---1245. 3. Danaei G, Ding EL, Mozaffarian D, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6(4): e1000058. 4. Fisher EB, Fitzgibbon ML, Glasgow RE, et al. Behavior matters. Am J Prev Med. 2011;40(5):e15---e30. 5. Kapp JM. Evaluation of the national prevention strategy in reference to historical population health. Am J Health Promot. 2013;27(5):281---283. 6. Matheson EM, King DE, Everett CJ. Healthy lifestyle habits and mortality in overweight and obese individuals. J Am Board Fam Med. 2012;25(1):9---15. 7. Patient Protection and Affordable Care Act. Pub. L. No. 111-148, 124 Stat. 119 (2010).
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American Journal of Public Health | January 2015, Vol 105, No. 1
