The Golden Age of Health Research Funding
by Jason S. Brinkley, PhD, MA, MS
On the Brink addresses topics related to data, analytics, and visualizations on personal health and public health research. This column explores current practices in the health arena and how both the data and mathematical sciences have an impact. (The opinions and views represented here are the author’s own and do not reflect any group for which the author has an association.)
In March of this year, a major report came out that highlighted the gaps in America’s public health sector and the great need for increased funding. A Funding Crisis for Public Health and Safety: State-by-State Public Health Funding and Key Health Facts was produced by the Trust for America’s Health with funding from the Robert Wood Johnson Foundation to give a broad and approachable overview and to advocate for increased public health funding. The report is a data nerd’s dream with many great tables and figures; there are enough interesting numbers to easily memorize and throw out at dinner parties and Facebook forums in order to look very smart. But within the report there’s an interesting dichotomy playing out as there is need for health funding for research and implementation. The amount for implementation and monitoring is dwindling as funding across the board otherwise continues to increase or at least remain flat. As we look at the overall landscape, we might wonder whether we are living in a golden age of health research funding and not even know it.
Let’s start by looking at funding for US organizations that specialize in research/health research. Research!America is an advocacy group that has compiled a set of resources itemizing the overall budgets of US federal institutions that provide major funding for health research. Their budgets for 2006-2016 are in the table below. While many are mostly flat (NIH, CDC, AHRQ), FDA and NSF are exceptions with modest gains, even though their scope is beyond US public health and some of the increases included below were in areas outside of public health.
|National Institutes of Health||Centers for Disease Control and Prevention||Agency for Healthcare Research and Quality||Food and Drug Administration||National Science Foundation|
|2006||28.56 billion||6.6 billion||319 million||1.5 billion||5.58 billion|
|2007||29.18 billion||6.25 billion||319 million||1.57 billion||5.92 billion|
|2008||29.61 billion||6.38 billion||335 million||1.72 billion||6.07 billion|
|2009||30.55 billion||6.62 billion||372 million||2.06 billion||6.49 billion|
|2010||31.24 billion||6.75 billion||397 million||2.36 billion||6.87 billion|
|2011||30.92 billion||6.84 billion||372 million||2.44 billion||6.81 billion|
|2012||30.86 billion||6.88 billion||370 million||2.51 billion||7.03 billion|
|2013||29.15 billion||6.28 billion||351 million||2.39 billion||6.88 billion|
|2014||30.15 billion||6.83 billion||370 million||2.56 billion||7.17 billion|
|2015||30.08 billion||6.87 billion||363 million||2.6 billion||7.34 billion|
|2016||32.08 billion||7.23 billion||334 million||2.73 billion||7.46 billion|
While the table above shows all the major players in the field of health research, there are a number of agencies and federal funding laws that have yielded health research funding initiatives outside of these areas. Note that the America Recovery and Reinvestment Act of 2009 (also known at the time as the stimulus) provided an injection of $146 billion in funds to the US Department of Health and Human Services, much of which went out as investment grants. Likewise the Affordable Care Act of 2010 led to the creation of the PCORI trust and the Centers for Medicare and Medicaid Innovation Center, which have also provided additional funding in researching comparative effectiveness and the impact of payment models for obtaining better health outcomes. More recently, the 21st Century Cures Act of 2016 gave an additional $6 billion in funding to these same sources in specialized funds for use in specific public health crises such as cancer and opioid use disorder.
So funds come in from a lot of places, and while the major players are few, US public health also benefits from specific allocations from other sources as well. When the US Veterans’ Administration or Department of Defense explore traumatic brain injury or post-traumatic stress disorder, those innovations help victims of accidents, natural disasters, or sport-related injuries. When the US Agency for International Development provides funding for US researchers to study Malaria, West Nile virus, and Zika, those innovations help in prevention efforts at home. It’s hard to see from all this just how much combined money is spent on health research, but an estimate from another report from Research!Now puts the number for 2015 at about $36 billion for “medical and health research and development.” Beyond that, private foundations and private industry have picked up some slack in specific topic areas, and those that do health research can apply for private grants in that sector. The same report puts the total “R&D” funding budget at about $160 billion (industry investment included).
Let’s turn back to the Trust for America’s Health report, which demonstrates steady declines in state-level allocations and specifically declines in funding for state agencies, public health departments, and other sources of implementation of the nation’s health network. Putting this together, one can only conclude that if all source funding is falling flat or having only modest investments while the allocation to implementation continues to fall, then the funding that remains must be falling mostly to the health research side of public health.
For me, thought in this area started late last month when I attended the 2018 AcademyHealth Annual Research Meeting where a panel was discussing the future of health services research. The topic of potential increases in health research funding came up, and I asked a crowded room of researchers whether anyone expected funds to actually increase in the coming years. Not a hand came up. One panelist responded that perhaps we should not expect such funding to rise; perhaps we need to start demonstrating more value and stewardship with the funds that are already being allocated. To paraphrase the panelist: I’m paid as much as at least two nurses; I should be prepared to demonstrate that I have as much value to my group as having two such individuals on the ground directly impacting patient health. This line of thinking has inspired me, and it is my hope that such thinking becomes more pervasive in the health research community because it is clear that our public health infrastructure has major issues and more funds are needed. If research isn’t actively demonstrating appreciation for the position it has been given and producing useful results with value, then there is every justification to move those funds over to the implementation side of things. Maybe we actually do just need more boots on the ground, in which case the golden age of health research funding may be coming to an end.
Jason S. Brinkley, PhD, MS, MA is a Senior Researcher and Biostatistician at Abt Associates Inc. where he works on a wide variety of data for health services, policy, and disparities research. He maintains a research affiliation with the North Carolina Agromedicine Institute and serves on the executive committee for the NC Chapter of the American Statistical Association and the Southeast SAS Users Group. Follow him on Twitter. [Full Bio]
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