More than half of premature deaths in the U.S. are caused by a range of risk factors that include some controllable behaviors: tobacco use, poor nutrition, lack of physical activity. Yet new research shows the National Institutes of Health, the nation’s largest funder of biomedical research, spends less than a tenth of its total budget on prevention research aimed at changing habits.
The new analysis, reported this week in the American Journal of Preventive Medicine, is the first to take a detailed look at how much the NIH spends on studying behavioral interventions in people to prevent six leading chronic conditions among Americans: heart disease, stroke, high blood pressure, diabetes, obesity and cancer. About half of chronic diseases could be prevented if people modified risky behaviors, the researchers noted.
Between 2010 and 2012, the NIH spent an estimated $2.2 billion to $2.6 billion a year on human behavioral studies to prevent chronic diseases. That’s just 7 to 9 percent of its total $30 billion annual budget.
According to the NIH, it spends 20 percent of its overall budget on prevention. The remaining 80 percent goes to research on treatments.
“The low proportion of research funding for disease prevention and health promotion has been the trend since at least 2009,” said Chris Calitz, M.P.P., the study’s lead author and director of health programs and evaluation at the American Heart Association. “Many chronic diseases can be prevented through effective lifestyle interventions, so the federal research budget needs to address the current imbalance between prevention and treatment.”
The researchers also found that most behavioral studies focused on secondary prevention — helping people who already had chronic disease signs, such as prediabetes or obesity — rather than preventing the precursors of a disease, known as primary prevention.
Paul Jarris, M.D., executive director of the Association of State and Territorial Health Officials, said the new analysis shows that the NIH needs to reprioritize its funding.
“If we are to change the context and create a nation in which healthy choices become attractive, available, and affordable, we must invest in research on effective means of disseminating and implementing proven policy and behavioral interventions in a manner that produces favorable health and economic outcomes,” Jarris said.
The American Heart Association is among the many organizations urging Congress to fund more scientific research to fight heart disease and stroke. At the same time, Calitz and his coauthors called on the NIH to invest more in prevention science to reduce the future burden of chronic diseases, which currently cause seven in 10 deaths and account for nearly $2.3 trillion of the $2.7 trillion spent each year on health care.
The researchers also urged the NIH to partner with private healthcare companies, which are currently spending $14 billion a year on health technologies like wearable devices and other gadgets, many of which have not yet been tested in rigorous clinical trials.
“In the same way the NIH formed partnerships with the pharmaceutical industry to develop drugs, there’s an opportunity here to look at innovative partnerships with technology companies to identify successful behavioral interventions to create a viable market for prevention products and services,” Calitz said.
Partnerships with community-based organizations and nonprofits could also be leveraged to implement and scale up the most effective prevention programs, he added.
Prevention is central to the AHA’s goal to improve cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent by 2020.
To that end, the AHA awarded a $15 million grant last July to four major institutions as part of a research network to help prevent heart disease and stroke, the nation’s No. 1 and No. 5 killers.
“Of course, we want scientists to find the best treatments for heart disease, stroke and other chronic conditions,” said Eduardo Sanchez, M.D., chief medical officer for prevention at the AHA, who was not involved in the study. “But it’s even better to find the best ways to prevent those diseases from developing in the first place.”
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