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1
Introduction
America's abundant food supply has been both a blessing and a curse to the
nation's health throughout its history. The hard physical labor that was required
to found and forge the nation was fueled by the plentiful, safe, and diverse
offerings of American agriculture, providing energy and nutrients for growth
and health. Science over the centuries has served to increase the quantity,
quality, and variety of the food supply. New technologies have allowed us to
determine that chemical compounds found in some foods, such as antioxidants,
can promote good health and combat disease. Agricultural biotechnology has
allowed the extension of traditional crop-improvement practices to the
molecular level, and further increased the nutrient quality and overall
productivity of food plants and animals. Advances in food processing and
storage techniques have reduced the incidence of foodborne illness.
Economically, national and global market unification has introduced new foods
and new cuisines into the American diet, and seasonal foods, such as fresh
vegetables and fruits, have become available year-round.
While these changes have allowed malnutrition and hunger to be a concern of
the past for most Americans and the average caloric intake has been increasing
(see Figure 1-1), the nation has become increasingly sedentary. The very
abundance of food and traditional eating habits that were so beneficial now
1
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[NTRODUCTION
3
contribute to an epidemic of overweight and obesity. Rates of overweights in
adults in the United States increased from 33 to 37 percent and the rate of
obesity3 increased from almost 12 to over 22 percents (see Table 1-1 for U.S.
Obesity trends in 1991-2001~. Diet and overweight have been linked to
secondary health consequences, including heart disease, stroke, diabetes, and
some cancers of the colon and rectum, breast, endometrium, prostate,
esophagus, and kidney.5 The medical cost of overweight and obesity has been
estimated at $92.6 billion in 2002 dollars, and annual medical spending
attributable to overweight and obesity now rivals that attributable to smoking.6
Although data indicate that American diets are becoming healthier and
Americans are becoming more active (see Figure 1-2), the average diet still fails
to meet the U. S. Department of Agriculture (USDA) recommendations for daily
alcohol, fruit and vegetable, and fat consumption. Activity and diet remain the
personal choice of consumers, but programs to expand and disseminate
knowledge for better health fall in the public and private sector. Whether we see
food as medicine or as the cause of disease, medical and agricultural research
have the potential to come together in innovative ways to help consumers and
producers understand and face the challenges of following a healthful diet.
Government, universities, foundations, and industry can support such efforts
through the research infrastructure they provide and the priorities they set.
Research is needed on foods (both beneficial and detrimental to health) on
consumer knowledge and behavior, and its motivation, and on the economics of
food- and health-related activities, including food pricing, health-care costs, and
agricultural support programs.
Agricultural research has traditionally focused on improving production
quantities and quality, usually of single crops or animal species. USDA, with its
mission to support American agriculture and a safe and affordable food supply
Defined as a Body Mass Index (BMI) between 25.0 and 29.9 in adults 18 and older. BMI is defined
as weight in kilograms divided by height in meters squared (w/h**2).
3 Defined as a Body Mass Index (BMI) of 30.0 or more in adults 18 years old and older.
4 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and
Health Promotion. (n. d.). Behavioral Risk Factor Surveillance System, Trends Data Nationwide.
Available on-line at i,
~ [January 2004].
5 World Cancer Research Fund in association with American Institute for Cancer Research. 1997.
Food, nutrition and the prevention of cancer: a global perspective. Washington, DC: American
Institute for Cancer Research. Available on-line at ~L~ [January
2004]
6 Finkelstein, E. A., Fiebelkorn, I. C., and G. Wang. 2003. National medical spending attributable
to overweight and obesity: how much, and who's paying? Health Affairs Web Exclusive, May 14,
2003. Available on-line at ~df [January
2004].
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4
EXPLORING A VISION
Table 1-1. Percentages of adults in the United States who are obese, by gender,
age, race, education, and smoking status, based on Behavioral Risk Factor
Surveillance System data (Obesity defined as a Body Mass Index (BMI =
Kg/m2) greater than or equal to 30.~. 738393~0
Characteristics
Fraction Obese, NO (BMI, kg/m)
1991 1995 1998 1999 2000 2001
12.0 15.3 17.9 18.9 19.8 20.9
Total
Gender
Men
Women
Age groups, years
18-29
30-39
40-49
50-59
60-69
>70
Race ethnicity
White, non-Hispanic
Black, non-Hispanic
Hispanic
Other
Educational level
Less than high school
High-school degree
Some college
College or above
Smoking status
Never smoked
Ex-smoker
Current smoker
11.7 15.6
12.2 15.0
7.1 10.1
11.3 14.4
15.8 17.9
16.1 21.6
14.7 19.4
11.4 12.1
11.3 14.5
19.3 22.6
11.6 16.8
7.3 9.6
16.5
13.3
10.7
8.0
17.7
18.1
12.1 12.1
16.9 18.6
21.2 22.4
23.8
21.3
14.6
16.6
26.9
20.8
11.9
20.1 24.1
16.7 19.4
15.1 17.8
11.0 13.1
12.0 15.2 17.9
14.0 17.9 20.9
9.9 12.3 14.8
19.1 20.2
18.6 19.4
13.5
24.2
22.3
16.1
15.5
17.7 18.5
27.3 29.3
21.5 23.4
12.4 12.0
26.1
21.7
19.5
25.3
20.6
18.1
14.3 15.2
21.0
20.8
14.0
20.2 20.5
22.9 24.7
25.6 26.1
22.9
25.3
17.1
19.6
31.1
23.7
15.7
27.4
23.2
21.0
15.7
19.0 19.9 20.9
21.5 22.7 23.9
15.7 16.3 17.8
19.9
22.7
7 Mokdad AH, Serdula M, Dietz W. et al. 1999. The spread of the obesity epidemic in the United
States, 1991-1998. Journal ofthe American Medical Association 282:1519-1522.
Modkad AH, Serdula M, Dietz W. et al. 2000. The continuing obesity epidemic in the United
States. Journal ofthe American Medical Association 284:1650-1651.
9 Mokdad AH, Bowman BA, Ford ES, et al. 2001. The continuing epidemics of obesity and
diabetes in the United States. Journal of the American Medical Association 286(10): 1195-1200.
A Mokdad AH, Bowman BA, Ford ES, et al. 2003. Prevalence of obesity, diabetes, and obesity
related health risk factors, 2001. Journal of the American Medical Association 289:76-79.
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INTRODUCTION
Figure 1-2. Trends in diet and activity levels in the United Statesmen
Percent of Adults (Ages 18+) Reporting
NO Physical Activity in Their Leisure Time
—1 9gO-1998
Per Łapita Alcohol Consumption (Ages 14+)
—1990-1 998
1 999
Average Daily Servings of Fruits
and \/dgetables (Ages 2+)
—1989-1991 to 1994-1996
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—1989-1991 to 1994-1996
990 1 ~~a 1 9~ 1~ gag 1 9gO l 99~
mat mar
1996 1999
National Cancer Institute. 2001. 2001 Cancer Progress Report. Available on-line at
[January 2004].
5
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6
EXPLORING A VISION
for the American public, is a primary sponsor of agricultural research, both
intramural through the USDA Agricultural Research Service, and extramural
through the National Research Initiative (NRI). The NRI focuses on research
that bridges the basic and applied sciences, including nutrition, food safety, and
health; it has begun to encourage multidisciplinary and interagency efforts in
recognition of the added value of interdisciplinary science. Competition for NRI
support is open to scientists at all academic institutions, federal research
agencies, and private and industrial organizations. In FY 2001, the NRI
awarded a total of $99 million to the top 597 proposals submitted. The average
grant award for new standard research projects was $188,116 for 2.4 years.
USDA expects that about $120-150 million will be available for new awards for
the FY 2004 award cycled (see Table 1-2~.
The National Institutes of Health (NIH) is the primary sponsor of biomedical
research in the United States, and has traditionally operated with a disease-
combating paradigm, rather than a health-promotion one. This has resulted in
exploration of individual diseases and treatments, not of possibly shared
etiologies. Obesity, with a role in many serious chronic illnesses, received only
about $274 million of the FY 2000 NIH research budget of over $27 billion. In
contrast, heart disease and diabetes, known outcomes of overweight and obesity,
each received over $1 billion.~4
The National Academies brought together representatives of USDA and NIH,
along with the other public and private funding institutions, in the hope of
sparking exploration of a more efficient and effective system for conducting
food and health research geared to improving, maintaining, and promoting
health. A discussion of new structures, policies, programs, and roles may
encourage research and education into these novel, interdisciplinary avenues.
STRUCTURE OF THE MEETING
To address the need for a better understanding of the linkages between food and
health, the National Academies invited leaders in agriculture and public health
to gather at a workshop in Washington, DC, on June 9, 2003. In her
|2 U.S. Department of Agriculture, Cooperative State Research, Education, and Extension Service.
n.d. NRI Annual Report: Fiscal Year 2001, National Research Initiative Competitive Grants
Program. Available on-line at tiff [January 2004].
|3U.S. Department of Agriculture, Cooperative State Research, Education, and Extension Service.
n.d. National Research Initiative Competitive Grants Program. Available on-line at
[January 2004].
|4 NIH Computer Retrieval of Information on Scientific Projects (CRISP) System n.d. Available
on-line at ~ r~ [January 2004].
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INTRODUCTION 7
Table 1-2. NRI Funding Allocationsa, FY 200115
Research Area/Program Number Total Dollars
of Grants Awardedb
Natural resources and environment
Plant responses to the environment 18 $3,090,000
Watershed processes and water resources 18 4,124,049
Soils and Soil Biology 23 4,380,600
Total 59 $11,594,649
Nutrition, food safety, and health
Improving human nutrition for optimal health 22 4,774,458
Food safetyc 31 5,976,378
Epidemiological approaches to food safetyc 6 5,486,155
Total 59 $16,236,991
Animals
Animal reproduction 22 3,888,726
Animal health and well-beingd 55 10,988,912
Animal genome and genetic mechanisms 15 2,700,000
Animal growth, development, and nutrient utilizatione 26 3,928,146
Total 118 $21,505,784
Biology and management of pest and beneficial organisms
Entomology and nematologyf 33 5,593,143
Biology of plant-microbe associationsg 26 5,349,010
Biologically based pest managementh 17 2,494,593
Biology of weedy and invasive plants 11 2,630,000
Total 87 $16,066,746
Plants
Plant genetic mechanismsi 34 4,833,571
Plant growth and developmentj 28 3,646,000
Agricultural plant biochemistryk 34 3,914,847
Total 96 $12,394,418
Markets, trade, & rural development
Markets and tradel 21 1,984,000
Rural developmentm 14 1,483,333
Total 35 $3,467,333
(continues)
15U.S. Department of Agriculture, Cooperative State Research, Education, and Extension Service.
n.d. NRI Annual Report: Fiscal Year 2001, National Research Initiative Competitive Grants
Program. Available on-line at http://www.reeusda.gov/nri/pubs/annreport/2001.pdf [January 2004].
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8 EXPLORING A VISION
Table 1-2. (continued)
Research Area/Program Number Total Dollars
of Grants Awardedb
Enhancing value and use of agricultural and forest products
Food characterization/process/product research 21 3,367,883
Non-food characterization/process/product research 16 2,453,217
Improved utilization of wood and wood fibern 16 2,025,166
Total 53 $7,846,266
Other
Agricultural systems 11 2,535,289
Strengthening programso 75 3,514,458
Metabolic engineering program interagencyp 2 250,000
U.S. rice genome project interagency 2 2,000,000
Total 90 $8,299,747
Awards to be determinedq $1,620,267
Grand total 597 $99,032,201
aThe content of this table varies slightly from tables provided in documents supporting the President's budget to
Congress each year in the following ways: 1) while the documents supporting the President's budget include data
only for funds from the 2001 appropriation, this table includes data on all awards from proposals submitted to the
2001 proposal cycle, regardless of the year the funds were appropriated (as noted in the table) and 2) awards are
arranged in this table under program area (to which proposals are submitted and reviewed) as opposed to
relationship to appropriated budgetary lines.
bIncludes awards still in process.
cIncludes $304,672 in funds from the FY 2000 appropriation.
dIncludes $13,239 in funds from the FY 1996 appropriation, $6,759 in funds from the FY 1997 appropriation,
and $2 in funds from the FY 1999 appropriation.
eIncludes $1,000 in funds from the FY 1996 appropriation and $5,000 in funds from the FY 2000 appropriation.
fIncludes $2,132 in funds from the FY 1996 appropriation, $21,981 in funds from the FY 1997 appropriation, and
$4,030 in funds from the FY 1998 appropriation.
gIncludes $30,000 in funds from the FY 1997 appropriation and $479,010 in funds from the FY 2000
appropriation.
hIncludes $3,974 in funds from the FY 1997 appropriation.
iIncludes $10,864 in funds from the FY 1996 appropriation, $498 in funds from the FY 1997 appropriation,
$2,638 from the 1998 appropriation, and $114,571 in funds from the FY 2000 appropriation.
jIncludes $5,000 in funds from the 1997 appropriation.
kIncludes $2,298 in funds from the 1997 appropriation and $549 in funds from the FY 1998 appropriation.
lIncludes $2,293 in funds from the 1996 appropriation, $5,596 in funds from the FY 1997 appropriation, $1 in
funds from the FY 1998 appropriation, and $2,110 in funds from the FY 1999 appropriation.
mIncludes $12,666 in funds from the FY 1996 appropriation, $47 in funds from the FY 1997 appropriation, $21
in funds from the FY 1998 appropriation and $2,646 in funds from the FY 1999 appropriation.
nIncludes $4,308 in funds from the FY 1996 appropriation and $37,666 in funds from the FY 1998 appropriation.
oIncludes $88,187 in funds from the FY 1996 appropriation, $41,133 in funds from the FY 1997 appropriation,
$54,702 from the FY 1998 appropriation, and $6 from the FY 1999 appropriation.
pIncludes $100,000 in funds from the FY 2000 appropriation.
qAs of December 17, 2001.
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INTRODUCTION
9
introductory remarks to the participants, Moderator Barbara Glenn, a member of
the National Academies Board on Agriculture and Natural Resources, tasked the
roughly 100 decision-makers in agricultural and health research, education
policy, and industry to meet this challenge. Their mission was to share and
build upon their scientific and organizational backgrounds, with the goal of
developing innovative means of improving the integration of the nation's food
system with its health system to promote better health. Meeting participants
drew on their past experiences with other integration attempts and their future
needs in research and education fields where food and the food supply intersect
with health, such as food biotechnology, nutrition, cancer, obesity, diabetes,
food safety, food-animal health, and zoonotic diseases. These contributions
served as a springboard for a broader examination of the education and research
infrastructure in agricultural colleges, medical schools, and funding institutions.
To provide background for an exploration of these challenges, the opening
keynote address was followed by plenary presentations by key government
scientists. Two panels were then introduced to begin the discussions; the
presentations of the first focused on academic, industrial, and philanthropic
infrastructure for food and health research, and those of the second on the
experience of researchers at the nexus of these topics. Each presentation session
was interspersed with audience questions. In the final session of the workshop,
participants were divided into groups and asked to discuss five questions related
to food and health integration. The discussion format provided an opportunity
for participants to respond to earlier presentations and to offer their own ideas
and recommendations on the subject. A rapporteur in each group took notes and
presented a summary of the group's discussion to the entire gathering.
The five questions for discussion were:
Are food and health research and education currently conducted and
managed to maximize scientific progress, incentives for collaboration,
and benefits to the public health?
What activities, programs, or initiatives currently exist in your
institution, organization, or agency to address the challenges of
improved integration of agriculture and health sciences? What gaps
remain?
What potential national initiatives could be implemented to address the
challenges of improved integration of agriculture and health sciences?
How can education and outreach contribute to improved research
integration?
Which technical research fields would be most amenable or of high
importance to initial integration efforts?
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10
EXPLORING A VISION
WORKSHOP SUMMARY
This workshop summary extracts the key technical issues from the presentations
and discussions. Many issues were touched upon repeatedly by several speakers
in different sessions, and this format is intended to allow readers who did not
attend the workshop to gain an understanding of the discussions in the context of
the entire workshop.
The workshop was intended to illuminate issues, not to resolve them. By its
nature, any workshop is necessarily incomplete, and a workshop summary can
report only on what was said. All the information reported here emerged from
presentations and discussions during the workshop. This summary is intended
to reflect the variety of opinions expressed by the speakers. The contributors
have reviewed it and affirmed that it accurately reflects the events and
discussions at the workshop.
Representative terms from entire chapter:
health research
