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U.S. Department of Health & Human Services
Summary
Charts
Complete List of Activities
Type Of Collaboration
Committee, Advisory Group, or Work Group
Health Survey
Meeting/Workshop
Public Education Campaign
Research Initiative
Resource Development
Training Initiative
Other
Agency Collaborations
Administration for Children and Families (ACF)
Administration for Community Living (ACL)
Agency for Healthcare Research and Quality (AHRQ)
Agency for Toxic Substances and Disease Registry (ATSDR)
Centers for Disease Control and Prevention (CDC)
Centers for Medicare & Medicaid Services (CMS)
Food and Drug Administration (FDA)
Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
Office of the Secretary (OS)
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Report on NIH Collaborations with Other HHS Agencies for Fiscal Year 2016
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Summary
Introduction
“Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” - Andrew Carnegie
This annual report captures the extent and nature of activities undertaken by the National Institutes of Health (NIH) in collaboration with the other agencies and divisions of the Department of Health and Human Services (HHS). Tasked with improving the health of the American public, HHS consists of many agencies and divisions, and synergy between these different components is vital to the success of the whole. In recognition of the important role of collaboration between HHS agencies, Congress added section 403A(a) of the Public Health Service Act, 42 U.S.C. § 283a(a),
Annual Reporting to Increase Interagency Collaboration and Coordination
, via Section 104 of the National Institutes of Health Reform Act of 2006. This law mandates that the NIH Director provide to the Secretary of HHS an annual report on NIH’s collaborations with other HHS agencies. This, our tenth report to the Secretary, covers fiscal year 2016.
Background
The HHS mission is to enhance the health and well-being of all Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. As outlined in the
HHS Strategic Plan FY 2014-2018
, the Department sets forth four interrelated, strategic goals to achieve this mission:
Strengthen Health Care;
Advance Scientific Knowledge and Innovation;
Advance the Health, Safety, and Well-Being of the American People; and
Ensure Efficiency, Transparency, Accountability, and Effectiveness of HHS Programs.
HHS accomplishes its mission and meets its strategic goals and associated objectives, strategies, and performance goals through the work of its eleven operating divisions, including eight agencies in the United States Public Health Service and three human service agencies, which administer HHS’s multifaceted programs and initiatives. In addition, staff divisions of the Office of the Secretary provide leadership, direction, and policy guidance to the Department. Together, this ‘HHS Family’ covers a vast spectrum of activities that impact health, public health, and human services outcomes. With more than 115 programs across the Department, the ultimate success of all components of the HHS family is enhanced by interagency collaborations that enable agencies to combine their knowledge and diverse expertise to accomplish their collective mission. Such cross agency teamwork is necessary to create a collaborative community within HHS that accelerates progress in medicine, health services, and public health programs.
Since its origins in 1887, as a one-room laboratory in the Marine Hospital Service, NIH has been charged with improving health through research. As the largest research arm of HHS, NIH’s mission is “to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability,” which it fulfills through its congressionally mandated
NIH-Wide Strategic Plan, Fiscal Years 2016–2020: Turning Discovery Into Health
. NIH’s collaborative efforts with other HHS agencies are vital to transforming fundamental scientific and technical information into effective, knowledge-based approaches that advance the health and safety of the public, such as disease treatments, preventive interventions, protective health policies and regulations, and public health campaigns. In turn, the information provided by other HHS agencies on public health needs informs the policies and priorities of NIH-funded research.
The interagency collaborations included in this report cover joint activities undertaken by NIH with all other components of HHS, including the
staff divisions within the Office of the Secretary (OS)
1
and the ten other operating divisions of HHS:
Administration for Children and Families (ACF)
Administration for Community Living (ACL)
Agency for Healthcare Research and Quality (AHRQ)
Agency for Toxic Substances & Disease Registry (ATSDR)
Centers for Disease Control and Prevention (CDC)
Centers for Medicare & Medicaid Services (CMS)
Food and Drug Administration (FDA)
Health Resources and Services Administration (HRSA)
Indian Health Service (IHS)
Substance Abuse and Mental Health Services Administration (SAMHSA)
FY 2016 Collaboration Themes
NIH and other HHS operating and staff divisions collaborated on 645 activities in FY 2016. These numerous examples of cross-agency collaboration demonstrate the broad spectrum of health efforts that NIH contributes to in partnership with the rest of the Department and are organized into six themes in this report:
Assessing the Public’s Health
– enabling better tracking of disease and disability
Improving Diagnostics and Treatment
– promoting research, and the translation of NIH’s research results into safe and effective diagnostics and treatments
Preventing Disease and Disability
– providing the evidence base for national disease and disability prevention efforts
Providing Evidence-Based Health Information
– equipping public health efforts and the American public with the latest research findings and best available health information
Keeping Americans Safe
– ensuring effective health policy and regulatory protections
Broad, Multi-Purpose Coordination
– coordinating complex strategic planning efforts that cut across the entire Department
Collaboration examples from each thematic area are included in
Figure 1
and described in the “FY 2016 Collaboration Highlights” section to follow.
Figure 1: Advancing the Public’s Health: Thematic Areas of NIH’s Collaborations with Other Agencies of the Department of Health and Human Services.
These examples of cross-agency collaboration demonstrate the broad spectrum of health efforts that NIH contributes to in partnership with the rest of the Department.
FY 2016 Collaborative Activities by the Numbers
In FY 2016, NIH collaborated with other HHS entities on 645 activities.
The Complete List of Activities
provides a comprehensive list of all reported activities. Over 70 new collaborations were reported in FY 2016 across a range of issues, including activities devoted to emerging infectious diseases, pediatric clinical trials, cancer, and opioid addiction. The full details for each activity, including a brief description, the year the collaboration originated, and participating HHS agencies including the participating NIH Institutes, Centers, and Offices, can be viewed by clicking on the icon next to the “Details” column of each activity.
Each collaboration has been designated a category based on the nature of the activity.
Chart 1
illustrates how the activities break down across the following categories: Committee, Work Group, or Advisory Group (316 activities); Research Initiative (131); Resource Development, e.g., developing databases, disease registries, and information clearinghouses (77); Meeting or Workshop (41); Public Education Campaign (22); Health Survey (20); Training Initiative (11); or Other (27).
Chart 2
displays the number of collaborative activities that NIH engaged in with each HHS operating or staff division.
2
As Chart 2 illustrates, the majority of NIH’s collaborations were with the CDC (407) and FDA (310). Given the complementary missions of the CDC, FDA, and NIH, the three agencies often work together closely to build on each other’s strengths and achieve shared objectives. While NIH conducts and funds basic and applied biomedical and behavioral research, the CDC engages in health promotion, prevention of disease, injury, and disability, and preparedness for new health threats, and the FDA ensures the safety of drugs, medical devices, and many other products that stem from biomedical research. There is also substantial cross-talk between NIH and the OS, especially in the coordination of multi-agency initiatives, committees, and working groups.
FY 2016 Collaboration Highlights by Thematic Area
The following summary illustrates how NIH works with its sister HHS agencies to help improve the health and well-being of the American public. Introduced in
Figure 1
(above), examples of specific collaborations in each of the six highlighted themes are described in greater detail in this section. Ultimately, these diverse collaborative efforts strengthen the HHS ecosystem, helping to foster a healthier country and healthier world.
Theme 1: Assessing the Public’s Health
An understanding of the state of the population’s health is critical for the Department to set priorities regarding current and emerging public health needs, and for NIH to refine its strategic research priorities. Cross-agency cooperation takes advantage of the knowledge and resources throughout HHS to define the scope of public health issues and enable better tracking of health outcomes, disease, and disability. NIH partners with other HHS agencies to collect and use data on disease prevalence, as well as to understand the factors that influence health within and across various parts of the population. These intra-Departmental partnerships encompass efforts to examine disease prevalence and risk factors across a range of issues, such as
cancer
,
kidney disease
, and
adolescent health behaviors
. Important collaborations also address the needs of specific groups, including
American Indian/Alaska Natives
and the
aging U.S. population
. In this section, several health surveillance efforts and national surveys are highlighted.
HHS agencies collaborate on a variety of ongoing efforts to broadly measure population health and disease. The
National Health Interview Survey (NHIS)
coordinated by the National Center for Health Statistics within the CDC, has collected data on the nation’s health since 1957 through personal household interviews. NIH provides funding for the survey and several of the NIH Institutes sponsor special supplements or help design questions for the survey, and the results provide data to track health status, health care access, and progress toward achieving national health objectives. In a similar collaborative effort, NIH also helps support the CDC’s
National Health and Nutrition Examination Survey (NHANES)
by providing assistance in developing specific sections of the survey, such as the cardiovascular, oral health, and hearing-related components. NHANES is a large program of studies designed to assess the health and nutritional status of adults and children in the U.S. The survey is unique in that it combines interviews and physical examinations to address a number of health conditions as well as nutritional status for adults and children.
There are a number of intra-Departmental surveillance efforts focusing on specific diseases and health challenges. For example, the
Population Assessment of Tobacco and Health (PATH) Study
is a large-scale FDA-NIH collaboration to conduct a national longitudinal cohort study examining tobacco use and how it affects the health of Americans. The PATH study is following about 46,000 Americans, ages 12 years and older, for at least three years to measure and accurately report the social, behavioral, and health effects associated with tobacco-product use to provide an empirical evidence base to help inform the FDA’s tobacco regulations. Similarly, the National Mental Health Field Study Test, a collaborative effort between SAMSHA and NIH’s National Institute of Mental Health (NIMH) begun in 2015, aims to develop a test that can be used to study the prevalence and patterns of specific mental disorders in the U.S.
NIH and CDC partner on several surveillance efforts related to children and young adults, such as the
Adolescent Brain Cognitive Development (ABCD) Study
, a landmark longitudinal study of brain development and child health that will increase our understanding of how diverse experiences during adolescence interact with changing biology to influence brain, cognitive and social/emotional development of youth. The study, which began in 2016, is led by NIH’s National Institute on Drug Abuse, and also involves the U.S. Department of Justice. ABCD plans to enroll 10,000 children at age 9 or 10 from diverse backgrounds and follow them through their teens and into early adulthood. To enable better tracking of sudden and unexpected death in the young, NIH and CDC launched the
Sudden Death in the Young Registry
in 2013 for cases of sudden death in people under age 24, including sudden cardiac death and sudden unexpected death in epilepsy. The registry is an expansion of the CDC's Sudden Unexpected Infant Death Case Registry, and will help researchers define the scope of unexpected death in the young and set future research priorities as well as identify children at risk and test prevention strategies.
To better understand the patterns of cancer risk among organ transplant recipients, NIH’s National Cancer Institute (NCI) has been collaborating with HRSA since 2005 on the
Transplant Cancer Match Study
, The Study, which is the largest study of cancer risk in solid organ transplant recipients in the world, uses electronically linked data from the Scientific Registry of Transplant Recipients and cancer registries to examine the epidemiology of cancer in the U.S. transplant population. A major goal of the Match Study is to determine the overall pattern of cancer in transplant recipients and identify key risk factors for individual cancer types. These findings will provide information on the role of the immune system in the development of cancer. Because cancer is an important adverse outcome of transplantation, findings from the Match Study can help identify opportunities to prevent or screen for cancer, and optimize survival following a cancer diagnosis.
Theme 2: Improving Diagnostics and Treatment
In striving to provide the best options in medical care and health practice, NIH works across the Department to help develop new, more effective ways to diagnose and treat disease and promote good health. The primary goal of NIH translational and clinical research is to improve health interventions to provide the best available care for those who need it. Cooperative efforts with other HHS agencies, such as those described in this section, help to ensure that the wealth of information gleaned from research activities can be disseminated and implemented throughout the Department and in the community.
NIH uses partnerships to leverage talents and resources to help address global pediatric health. For example, the Zika virus (ZIKV) is a growing epidemic that has been associated with numerous birth and developmental defects, such as microcephaly, as well as other pregnancy and birth-related problems, including miscarriages and stillbirths. Because of these health issues, it is imperative that the scientific community understand the effects of ZIKV on pregnancy and pregnancy outcomes. In September 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) at NIH, in collaboration with CDC and other partners, hosted the
Bridging Knowledge Gaps to Understand How ZIKV Exposure and Infection Affect Child Development Workshop
to identify optimal approaches for treating and caring for the generation of children exposed to the ZIKV in the womb. NICHD is also collaborating with the non-profit Critical Path Institute and the FDA to establish a new framework for pediatric clinical trials around the world. The
Critical Path Institute (C-Path) Global Pediatrics Trials Consortium
involves clinicians, academics, patient advocates, regulators and others working to create an independent, non-profit global pediatric trials network. The goal of this project is “to facilitate the development of innovative and quality medicines according to the highest ethical and scientific standards to help extend and enhance the lives of infants, children, and adolescents.”
The Foundation for the NIH Biomarkers Consortium
is a public-private biomedical research partnership managed by the Foundation for the National Institutes of Health that endeavors to discover, develop, and qualify biological markers (biomarkers) to support new drug development, preventive medicine, and medical diagnostics. Biomarkers are objectively measurable indicators of normal and abnormal biological states, such as, for example, hemoglobin A1C as a biomarker of blood sugar control in diabetics. The Biomarkers Consortium, with NIH, FDA, CMS, and private sector members, is looking to discover new biomarkers for assessing disease status and response to treatment. The Consortium has launched more than 20 projects in areas as diverse as Alzheimer’s disease, cardiovascular disease, diabetes, and breast cancer.
With the goal of revolutionizing our understanding of the human brain, NIH, in collaboration with several private and federal partners, including FDA, launched the
Brain Research through Advancing Innovative Neurotechnologies (BRAIN)
Initiative in 2014. By accelerating the development and application of innovative technologies, researchers will be able to produce a revolutionary new dynamic picture of the brain that, for the first time, shows how individual cells and complex neural circuits interact in both time and space. Long desired by researchers seeking new ways to treat, cure, and even prevent brain disorders, this research will fill major gaps in our current knowledge and provide unprecedented opportunities for exploring how the brain works, providing invaluable information to employ in combatting neurological and psychiatric disorders such as Parkinson’s disease, the Zika virus, and schizophrenia.
Another federal-wide initiative is the
Cancer Moonshot
to accelerate cancer research. Launched in 2016 and led by NCI, this ambitious initiative aims to make more therapies available to more patients, while also improving our ability to prevent cancer and detect it at an early stage. To inform the scientific direction for the Cancer Moonshot, a Blue Ribbon Panel of many of the nation’s top cancer experts, including representatives from FDA, Department of Defense (DoD), and Department of Veteran’s Affairs (VA), was established was to provide advice on the initiative’s vision, proposed scientific goals, and implementation. The Panel developed a
report
that provided 10 recommendations to shape the research blueprint for the Cancer Moonshot.
Theme 3: Preventing Disease and Disability
Preventing disease and disability before it starts is critical to helping people live longer, healthier lives. Poor diet, physical inactivity, tobacco use, and alcohol misuse all have been shown to have negative health consequences for Americans. Minimizing these and other risk factors can result in major public health gains, and coordinating efforts across HHS is central to the success of national prevention strategies. NIH works to expand the evidence-base for prevention strategies and partners with other HHS agencies on more than 100 prevention activities to change the way communities conceptualize and solve problems, enhance implementation of innovative strategies, and improve individual and community well-being. Examples of interagency prevention efforts include those aimed at reducing
smoking
,
underage drinking
,
women’s cancers
, and
hearing loss
, along with many others, including the following highlighted collaborations.
One important step in preventing disease is understanding risk factors for conditions that can run in families. To help individuals track their family health history, HHS teamed up with HRSA, CDC, and NIH’s National Human Genome Research Institute to develop the web-based tool,
My Family Health Portrait
. Using this tool, individuals can add and track health information to build a family tree and a chart of their family health history while exploring disease calculators. This information can also be downloaded and printed in a user-friendly format to be shared with their health care practitioner, who can recommend actions for reducing personal risk of disease and help them to identify early warning signs of disease.
To coordinate prevention research in areas with methodological challenges, NIH’s Office of Disease Prevention coordinates the
Pathways to Prevention (P2P) program
. The P2P program hosts workshops on selected topics to identify research gaps, address scientific weaknesses, suggest research needs, and move the field forward through evidence-based assessment of a complex public health issue. An evidence report, which provides an objective description of the state of the science, a summary of ongoing research, and information on research needs, serves as the foundation for each workshop. The evidence reports are prepared by one of AHRQ’s Evidence-based Practice Centers. Workshop topics have included
The Role of Opioids in the Treatment of Chronic Pain
,
Advancing the Research on Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome
,
Total Worker Health
, and, in FY16,
Advancing Research To Prevent Youth Suicide
.
In 2014, the White House and the Office of Management and Budget (OMB) created a Cross Agency Priority Goal to improve mental health outcomes for Service Members, Veterans, and their families. The VA estimates that post-traumatic stress disorder (PTSD) afflicts almost 31 percent of Vietnam War veterans and 20 percent of Iraqi War veterans.
3
NIMH, in collaboration with the OS, VA, and DoD, is supporting
research
to identify and develop more effective diagnostic and treatment methodologies and metrics to improve mental health and substance use outcomes, including for traumatic brain injury, PTSD, and related conditions. Building on the foundation of common data elements for PTSD and suicide prevention research, efforts are underway to accelerate progress through data sharing, data harmonization, and the reporting of research results.
Another major public health goal is to stem the rising rates of diabetes, the seventh leading cause of death in the U.S.
4
Type 2 diabetes, which accounts for more than 90 percent of diabetes among adults, often can be averted or delayed by lifestyle factors. NIH’s National Institute of Diabetes and Digestive and Kidney Diseases, in collaboration with CDC and the IHS, continues to support the
Diabetes Prevention Program Outcomes Study (DPPOS)
, started in 1994. This long-term outcomes study has shown that diet and exercise or the diabetes medication, metformin, can delay the onset of diabetes by ten years.
One major contributor to increasing diabetes rates is childhood obesity – nearly 17 percent of children and teens ages 2 through 19 (or 12.7 million) in the U.S. are obese.
5
To address this childhood obesity epidemic, several NIH Institutes and Centers (ICs) and the CDC, along with the U.S. Department of Agriculture (USDA) and the Robert Wood Johnson Foundation, have formed the
National Collaborative on Childhood Obesity Research (NCCOR)
. NCCOR's goals are to identify intervention needs, improve child obesity surveillance, improve research and evaluation methodologies, and provide national leadership to implement evidence-based practice and policy. NCCOR also works with many non-health partners to develop sustainable environmental design and food systems strategies to reach high risk populations and communities. This public-private collaboration spurs action, provides strategic direction, and is building a strong foundation of research to guide the nation’s efforts to prevent and reduce childhood obesity.
Theme 4: Providing Evidence-Based Health Information
The biomedical and behavioral research that NIH funds forms much of the evidence base for understanding health risks. However, to have a tangible impact on population health, this information must be effectively and broadly communicated to the American public and empower individuals to make informed personal decisions about their health. To this end, NIH works with other HHS agencies on numerous large-scale health promotion campaigns and information portals. Examples include informational websites dedicated to
diabetes
,
kidney disease
,
osteoporosis
, and
bullying
. A few other notable public health campaigns and information portals are highlighted below.
Together with CDC and CMS, NIH’s National Institute of Neurological Disorders and Stroke began the
Mind Your Risks
campaign in 2015 to educate the public about the risks of high blood pressure. While many Americans are aware that high blood pressure increases the risk of heart attack or stroke, emerging evidence is also linking uncontrolled blood pressure to cognitive impairment and dementia later in life. Mind Your Risks provides information about this research, links to resources, and encourages individuals to take steps to manage their risks by controlling high blood pressure, quitting smoking, lowering high cholesterol, eating healthy, and keeping active.
To help older individuals fit exercise and physical activity into their daily lives, the campaign
Go4Life
is led by NIH’s National Institute on Aging, in partnership with ACL, AHRQ, CDC, and OS. Motivating older adults to become physically active for the first time, return to exercise after a break in their routines, or build more exercise and physical activity into weekly routines are the essential elements of this campaign. Go4Life offers exercises, motivational tips, and free resources to help individuals get ready, start exercising, and keep going. The Go4Life campaign includes evidence-based exercise guides in English and Spanish, an exercise video, an interactive website, and national outreach activities.
Sponsored by CDC, HRSA, and NIH’s Office of AIDS Research, National Institute of Allergy and Infectious Diseases (NIAID), and National Library of Medicine (NLM),
AIDSinfo
offers access to the latest, federally approved HIV/AIDS medical practice guidelines, HIV treatment and prevention clinical trials, and other research information for health care providers, researchers, people affected by HIV/AIDS, and the general public. These English- and Spanish-language websites (
InfoSIDA
) assist in the dissemination of the Public Health Service Treatment Guidelines as well as information about both approved and investigational HIV/AIDS treatments. The site also provides mobile resources and tools, such as the
HIV/AIDS Glossary App
, an on-the-go guide to the complex terminology of HIV/AIDS with easy-to-understand definitions for more than 700 HIV/AIDS-related terms in English and Spanish, as well as fact sheets that serve as a source of readily available evidence-based information.
In response to a congressional mandate, the NIH’s Office of Dietary Supplement (ODS), in collaboration with NLM, FDA, and CDC, leads on the development and maintenance of the
Dietary Supplement Label Database (DSLD)
, which contains the full label contents from a sample of dietary supplement products – both on and off market – that can be organized and searched by users. The database now contains over 65,000 labels, with new data accumulating at the rate of 1,000 labels per month, and plans to include nearly all of the dietary supplement products in the U.S. The primary users of this database are researchers and health care providers. ODS also manages the
Dietary Supplements Ingredient Database (DSID)
, which provides basic information about the nutrient content of selected ingredients in dietary supplements, compared to label-reported ingredient levels. Currently, DSID provides estimated levels of 18 vitamin and mineral ingredients derived from analytical data for 115 adult multivitamin supplements.
Theme 5: Keeping Americans Safe
Through research, regulation, and policy development, HHS agencies are committed to protecting the health and safety of all Americans. With HHS and other federal partners, NIH works to ensure that proper policies are in place to protect the public, including confirming that medical products are safe and effective, that emerging health and biosecurity threats can be identified and addressed swiftly, that appropriate biosafety protocols are in place to prevent laboratory accidents, and that scientific information is used in responsible ways.
To improve surveillance of disease-causing bacteria and foodborne disease, NIH, in collaboration with CDC and FDA, began the
Pathogen Detection Project
in 2015. This system, hosted by NIH’s National Center for Biotechnology Information, integrates genetic sequence data for bacterial pathogens found in food, the environment, and human patients. Currently focused on sequencing and analyzing genetic material from four bacteria groups that cause foodborne illness in the U.S.: Salmonella, Listeria, Campylobacter, and Escherichia coli and Shigella, the goal of this project is to uncover potential sources of contamination and assist with investigations and outbreak responses.
Enhancing biosafety and biosecurity in health science research is a high priority and requires close collaboration between federal departments and agencies. The HHS Biosafety and Biosecurity Council – composed of OS, NIH, CDC, FDA, and other HHS representatives – advises the HHS Secretary and senior Department leadership, fosters intradepartmental coordination and collaboration, and recommends Department-wide policy on biosafety and biosecurity matters. HHS, in turn, has been working actively with interagency partners toward the development and implementation of comprehensive federal policies that support vital research and manage potential risks. The
National Science Advisory Board for Biosecurity (NSABB)
, managed by NIH; the Intragovernmental Select Agents and Toxins Technical Advisory Committee, managed by CDC; and the Federal Experts Security Advisory Panel (FESAP), co-chaired by HHS, are helping to inform federal biosafety and biosecurity policies on various issues, including
dual use research of concern (DURC)
and gain-of-function research of concern (GOFROC). DURC is research that has the potential to yield information, products, or technologies that could be directly misapplied to pose a significant threat with broad potential consequences to public health and safety, agriculture, the environment, or other aspects of national security. NIH is managing a
deliberative process
on behalf of the U.S. Government that will inform federal policy development on the funding and oversight of GOFROC—a subset of DURC studies which have the potential to generate pathogens with the potential to cause pandemic disease.
HHS must be poised to address emergency health risks, and several interagency collaborations aid this effort. Under the leadership of the HHS Office of the Assistant Secretary for Preparedness and Response, NIH participates in the
Public Health Emergency Medical Countermeasures Enterprise (PHEMCE)
, the coordinating body for federal agencies in charge of employing medical countermeasures to protect the civilian population from potential adverse health impacts from chemical, biological, nuclear, or radiological threats. Medical countermeasures are medicines, devices, or other medical interventions that can lessen the harmful effects of these threats. This preparedness effort includes representatives from the OS, NIH, FDA, and CDC, as well as the DoD, VA, USDA, and Department of Homeland Security. To provide guidance for health care providers about clinical diagnosis and treatment of radiation injury in the event of a radiological or nuclear emergency, HHS developed the web resource,
Radiation Emergency Medical Management (REMM)
, in collaboration with NIH and CDC. REMM is a comprehensive mechanism to collect, evaluate, and store just-in-time, evidence-based, usable information with sufficient background and context to make complex issues understandable to those without formal radiation medicine expertise. REMM is also available as a mobile app and all of the information available on the website can easily be saved and downloaded so that it can be available in the event that the internet is not accessible.
As noted above in Theme 2 (
Improving Diagnostics and Treatment through Research
), the Zika virus is a growing global epidemic that can cause serious birth defects, and in rare cases, lead to Guillain-Barre syndrome, an autoimmune disorder in which damaged nerve cells cause muscle weakness and sometimes partial or complete paralysis. To develop a coordinated U.S.-Government strategy to combat the Zika virus, HHS, the United States Agency for International Development (USAID), and OMB created an Interagency Coordination Group on Zika Virus. Several of NIH ICs, as well as FDA and CDC, are members of this group, which serves to facilitate information exchange across federal agencies. In addition, NIAID has established the Zika Vaccine Development Working Group, which includes representatives from CDC, FDA, and OS, to coordinate research efforts, the mobilization of domestic and international research infrastructure, and partnerships with industry to accelerate the development of a safe and effective Zika vaccine.
Theme 6: Broad, Multi-Purpose Coordination
Given the complexity of major public health challenges, there is often a need for formal cross-agency strategic planning to ensure that all of the agencies within the Department are working in concert toward larger health goals. The five-year HHS Strategic Plan described above and the interdepartmental ten-year agenda for improving the nation’s health,
Healthy People 2020
, are prime examples of strategic planning endeavors that outline pathways to achieve broad health-related objectives. Other important interagency strategic planning activities are focused on achieving better outcomes in specific health topics, such as
diabetes
,
HIV/AIDS
,
tuberculosis
, and
antimicrobial resistance
, among many others. The following interagency collaborations illustrate how NIH works with other HHS agencies and other federal departments to coordinate broad planning efforts.
The U.S. is currently in the midst of a widespread opioid addiction epidemic. According to the CDC, overdoses involving opioids were responsible for more than 28,000 deaths in 2014, over half of which were from prescription opioids.
6
In response, HHS has made addressing this problem a high priority and is focused on implementing evidence-based approaches to reduce opioid overdoses and overdose-related mortality as well as the prevalence of opioid use disorder. In 2015, the Assistant Secretary for Planning and Evaluation released an issue brief,
Opioid Abuse in the U.S. and HHS Actions to Address Opioid-Drug Related Overdoses and Deaths
, that outlined HHS’ three priority areas to guide the Department’s targeted efforts to reduce opioid-related morbidity and mortality: address opioid prescribing practices; expand the use of medication-assisted treatment to reduce opioid use disorders and overdose; and expand the use of the drug naloxone, used to treat opioid overdoses. Representatives from several NIH ICs, CDC, FDA, and CMS convene regularly to discuss agency activities and coordinate efforts surrounding HHS’ opioid addiction initiatives.
In addition to interagency coordination, interdepartmental coordinating efforts also work to achieve common goals more effectively, such as the federal government’s efforts to implement the National Alzheimer’s Project Act (NAPA). Signed into law in January 2011, NAPA established the
Advisory Council on Alzheimer’s Research, Care, and Services
to coordinate research and services across federal agencies, accelerate the development of treatments for Alzheimer’s disease and related dementias, improve early diagnosis and coordination of care, reduce ethnic and racial disparities in rates of Alzheimer’s disease and related dementias, and coordinate with international efforts to fight these conditions. In addition to the ten HHS agencies involved in this collaboration, the group further coordinates efforts across the government by partnering with the VA, the National Science Foundation, and the DoD. The Advisory Council and the Secretary of HHS update the
National Plan to Address Alzheimer’s Disease
yearly, to reflect national progress towards accomplishing the goals set forth initially, as well as new and revised action steps.
The HHS Secretary’s Initiative on Serious Mental Illness is a collaboration across all HHS agencies. To address the needs of individuals with serious mental illness and those at high risk for developing it, the collaboration has three main goals: promoting early engagement in care to reduce the duration of untreated serious mental illness; improving the quality of this care through stronger measurement and accountability; and increasing access to community-based treatment and support services.
Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.
7
To help eliminate health disparities within the U.S., HHS created the
Federal Interagency Health Equity Team (FIHET)
, a federal-wide collaboration that involves several NIH ICs and every agency within HHS. The purpose of the FIHET is to identify opportunities for federal collaboration on efforts relevant to the
National Partnership for Action to End Health Disparities
; provide leadership and guidance for national, state, tribal, and local efforts to address health equity; and infuse health disparities and health equity goals and strategies into member agency policies and practices. In 2016, the FIHET released a
Compendium
of publicly available data relevant to research and programs aiming to reduce health disparities to serve as a resource to the public and to researchers working in the field.
Animal welfare oversight is critical to NIH as well as several other Federal agencies that use animals in research. All federally funded research involving animals is evaluated, approved, and monitored by local Institutional Animal Care and Use Committees (IACUCs) to ensure that the research conducted is in accordance with all provisions of the Public Health Service Policy on Humane Care and Use of Laboratory Animals. To empower IACUCs and their institutions to increase compliance with federal standards while minimizing regulatory burden, NIH, FDA, and several other federal agencies and biomedical research institutions formed the
Interagency Collaborative Animal Research Education (ICARE)
. Launched in 2016, ICARE Academies and Train the Trainer Institutes educate participants on how to meet their responsibilities for animal welfare oversight and empower accountability for facts and conceptual understanding of Federal standards through the study of realistic problems encountered in animal care and use programs. Training modules developed by the participants of the Train the Trainer Institutes are available on the ICARE website that IACUCs can use to implement active learning training for at their institutions.
Conclusions
HHS accomplishes its mission to enhance the health and well-being of Americans through several hundred programs and initiatives that cover a wide spectrum of activities, serving the American public at every stage of life. America’s investment in NIH provides the nation with a unique resource—a scientific agency devoted to the creation of a knowledge base needed to conquer the most devastating human diseases and disabilities. In order for this rich knowledge base to improve health, the Department, as well as the entire federal government and the private sector, must work in concert to cultivate ground-breaking research and ensure that scientific knowledge is translated into sound regulations and policies, health services and medical interventions, and information that all Americans can use to lead healthier lives.
NIH appreciates the opportunity to report on its multifaceted collaborations within HHS. The policies, programs, and regulatory and service activities developed and carried out by HHS operating and staff divisions are some of the most effective means that the government can use to improve the health and well-being of its citizens. The collaborative activities detailed in this report illustrate how NIH works across the Department to cultivate partnerships, leveraging the respective strengths of all HHS agencies to support the HHS mission and strengthen the public health ecosystem.
[1]
The staff divisions of the Office of the HHS Secretary (OS) are: the Immediate Office of the Secretary (IOS), Assistant Secretary for Administration (ASA), Assistant Secretary for Financial Resources (ASFR), Assistant Secretary for Global Affairs (ASGA), Assistant Secretary for Health (ASH), Assistant Secretary for Legislation (ASL), Assistant Secretary for Planning and Evaluation (ASPE), Assistant Secretary for Preparedness and Response (ASPR), Assistant Secretary for Public Affairs (ASPA), Center for Faith-Based and Neighborhood Partnerships (CFBNP), Departmental Appeals Board (DAB), Office for Civil Rights (OCR), Office of the General Counsel (OGC), Office of Inspector General (OIG), Office of Intergovernmental and External Affairs (IEA), Office of Medicare Hearings and Appeals (OMHA), and the Office of the National Coordinator for Health Information Technology (ONC).
[2]
Individual collaborative activities can involve multiple HHS agencies. Therefore, the values displayed in Chart 2 reflect duplicate counts and add up to more than the total reported sums.
[3]
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