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Breakout Group Discussions In the final session of the workshop, participants were divided into eight discussion groups and asked to discuss five questions related to food and health integration. The discussion format provided an opportunity for every participant 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 groups' ideas and recommendations reflected many of the themes discussed earlier in the workshop, but also included fresh perspectives and suggestions. Question One: Are food and health research and education currently conducted and managed to maximize scientific progress, incentives for collaboration, and benefits to the public health? Rapporteurs for all the breakout groups reported that discussants felt that better integration, coordination, and collaboration among all the entities involved in food and health were needed. Building on this general feeling and in response to Question Two, discussants identified a number of particular issues that contribute to the problem, as well as examples of successful attempts to overcome it. 45

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46 EXPLORING A VISION Question Two: 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? INSTITUTIONAL INFRASTRUCTURE Many participants were positive about a number of new collaborative entities springing up, including research teams, centers, institutes, and various coordinating groups, mostly in the academic realm. It was discussed that there is a need to motivate the various government agencies to collaborate as much as the researchers and educators. Even so, researchers were believed to be often ahead of the universities, agencies, and corporations that employ them, and integration was often ad hoc and based on individual relationships rather than strategically planned integrated programs. Because public educational institutions are often resource-driven, faculty members are required to become entrepreneurial, responding to the opportunities presented to them. Agency interaction is often hindered by current structures to provide joint resources, some participants thought. Historically, funding institutions support particular types or topics in research, with the larger grants often going to the more traditional research models. Some institutions, such as NIH, offer large grants that provide the level of overhead support that universities require. Others agencies, such as USDA, and private associations, such as the American Heart Association, have limitations on how much of their funding can be used for overhead (sometimes no more than 10 per cent). Potentially integrative proposals presented by one agency to another, in which the originating agency would like to marry pools of funds, may be looked at by the recipient agency (often with a much larger portfolio) with suspicion. It was suggested instead that institutions try to focus on common interests. Some participants identified a need for more and better collaboration across sometimes insular agencies and institutions to overcome the "silo effect." This applies to both government agencies and the various colleges at universities that deal with these issues. As on participant stated "tInstitutional] silos are real. They are as prevalent as the silos you see on the rural landscape around America." In many cases, schools of agriculture, nutrition, or family and consumer sciences and medical and public health schools are on separate campuses, some distance apart in many cases, and some participants felt that this creates a substantial barrier to communication.

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BREAK OUT GROUP DISCUSSIONS 47 There was a perception on the part of some discussants that funding from one agency is "better than funding from another agency," and that raises some problems in getting interagency cooperation. It may be a result of differences in facilities and administration costs among agencies. It may also result from differences in probability of funding or of getting a proposal funded by different agencies, which is related to the overall amount of funds available from different agencies. There was also some concern that training programs emphasized individual investigations and reductionist methods, and not team research, which they felt is needed to address the kinds of questions that were posed during the workshop. There was a feeling among some participants that there were differences in funding-agency perspectives, among review panels, and among program leaders, who in different agencies might have more or less narrow views of their responsibilities. There was also a feeling that there were no programs to integrate across all needs and that research was looked at on a project level, rather than on a program level in terms of priorities. Some participants pointed out that it is important to look beyond food-related diseases, especially obesity, and to consider the relationship between food and wellness. Some discussants felt that promoting interdisciplinary research or bridging the gaps in different institutions was not currently a priority. One participant noted that even when institutions encourage interdisciplinary activities generally, young investigators are cautioned to be careful about getting too involved in team research, because that may not be the way to get promoted. INCENTIVES To break down the silos, some participants felt that a policy review at the federal level could play a valuable role in promoting progress. Some thought that what is needed is a single agency to volunteer to take the lead in promoting research and education in food and health: "Until the big guys fund and frame the research in the interdisciplinary area, identify funding for it and specify that is what it is for, we are not going to get very far in getting it done." Some participants suggested that the White House Office of Science and Technology Policy could play a leading role, declaring interdisciplinary food and health research to be a priority and developing cross-agency budgets. Another suggestion was the creation of a group within the federal agencies that would broker grants, allowing researchers to get advice on where to submit collaborative, integrative research programs for the greatest probability of success.

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48 EXPLORING A VISION In the academic realm, some participants identified the lack of incentives to encourage university faculties to be more interdisciplinary, particularly with respect to promotion and tenure, as a problem. Modification of the reward structure is needed, so that collaboration between different fields of research and between research and education is more straightforward. New institutional tools could be made available by institutions to foster better collaboration, such as matching funding, fellowships, and other special incentives. For investigators actively interested in crossing the divide between food and health research, low funding levels are a disincentive. That is especially true for food and agricultural scientists, given that health research has more funds available than other general research. Indirect costs were also identified as an obstacle to developing new and integrative research programs. It was suggested that it is important to look beyond single institutions and to enhance both current and new regional research efforts PRODUCER AND PUBLIC INVOLVEMENT Some participants noted that most of the health concerns revolving around food, nutrition, and health were "life-choice diseases." It was pointed out that as a nation we are not successfully educating the public to bring about substantial behavioral change for improved health even people who have a need and now get the information, do not use it properly. An improved message with regard to food and health is needed, as is improvement in how that message is used by those who receive it. One suggestion was for USDA to use its extension network to get the message out and to bring food and health research together, which might require additional funding. One group of discussants thought that an effort could be made to increase the focus on making this link in the early grades, rather than waiting to work with an adult audience, and attract new partners, such as the Howard Hughes Medical Institute and the National Science Foundation, which have innovative programs to bring science to the lower grades. Agricultural producers and food processors were also identified as important partners in improving knowledge of the relationship of food and health. EXAMPLES . Fight BAC! is a public-education campaign focused on safe food handling, whose goal is to educate consumers on steps that they can take to fight foodborne bacteria and reduce their risk of foodborne illness. Initiated in 1996, the campaign is now supported by public and

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BREAK OUT GROUP DISCUSSIONS . . . . 49 private organizations from all aspects of the food and consumer industry, including meat and produce marketers, allied trade groups, consumers, public-health organizations, and government agencies. For more information see www.fightbac.org. The Center for Science in the Public Interest has established Eating Green, a campaign to improve the public's health and the environment by advocating for a more plant-based diet through policy change and public education. The Food and Society Initiative (FAS) is a Food Systems and Rural Development program of the W. K. Kellogg Foundation. The FAS Initiative is based on a vision of a future food system that provides, for all segments of society, a safe and nutritious food supply grown in a manner that protects health and the environment and adds economic and social value to rural and urban communities. The purpose of the FAS Initiative is to support the creation and expansion of community- based food systems that are locally owned and controlled, environmentally sound, and health-promoting. For more information see www.wkkf.org/Programming/Overview.aspx?CID=l9. USDA's National Research Initiative Competitive Grants Program (NRI) is the office in the Cooperative State Research, Education, and Extension Service that is charged with funding research on key problems of national and regional importance in biologic, environmental, physical, and social sciences relevant to agriculture, food, and the environment on a peer-reviewed, competitive basis. The goals of the NRI are to increase the competitiveness of U.S. agriculture; to improve human health and well-being through an abundant, safe, and high-quality food supply; and to sustain the quality and productivity of the natural resources upon which agriculture depends. For more information see http://www.reeusda.gov/nri/. NIH's Community Based Participatory Research Program was started by the National Institute of Environmental Health Sciences in 1995. The purpose of awards in this program is to develop community- based public-health research approaches to diseases and health conditions that have an environmentally related etiology and to determine the value of the methods. Awards are intended to stimulate further advances in the design and implementation of prevention and intervention methods that are appropriately applied to environmental health; to accumulate and evaluate data, making assignments of environmental etiologies of diseases more plausible; and to develop, implement, and evaluate community-based exposure-assessment protocols. For more information see http ://www.niehs.nih.gov/translat/cbpr/cbpr.htm.

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50 EXPLORING A VISION . The mission of the Illinois Council on Food and Agricultural Research (C-FAR) is to secure additional resources to fund relevant, high-quality research, and related outreach programs that lead to profitable, consumer-sensitive, and environmentally sound food and agricultural systems in Illinois and the nation. C-FAR will foster public confidence in food and agricultural research through public participation in the planning and evaluation of the process and impact of research activities. For more information see http://www.ilcLar.org/. Question three: What potential national initiatives could be implemented to address the challenges of improved integration of agriculture and health sciences? An interdisciplinary, multi-institutional initiative was repeatedly put forward by the discussion groups as a mechanism to promote the integration of food, food- system, and health research and education. To accomplish this, some participants envisioned the federal and state governments working as a unit to create a funding program with that focus. To encourage an integrative research approach, the initiative could support programming that carried mechanistic work through public-health outcomes, requiring scientists to demonstrate from the onset of their research program how their work could be translated to other food, agriculture, and health fields. Research programs could also be combined with education and outreach. Substantial up-front funding for existing programs that demonstrated those linkages was believed to be useful, rewarding those who were creating new intellectual and organizational relationships. Some discussants suggested more diverse grant-review panels that represented a broader range of backgrounds and expertise. Academic institutions could promote integrative programming by allowing cluster hires, cross appointments, and reorganization of colleges and departments, including agriculture and medical schools, extension programs, and state health departments. The systematic evaluation of research programs at the termination of a grant to assess the success of a program in making linkages is also important, as is a planned terminal evaluation of the initiative itself. Some participants reiterated the need for more coordination and a body responsible for it, which was envisioned by different participants as either an individual, center, institute, or agency willing to take the lead and serve as champion, or as an interagency working group to provide program direction. Some participants believed that it would be useful for Congress to consider a farm bill that would be more responsive to nutrition and health needs, rather than commodity- and support-focused, to provide the push needed to develop this leadership, and that it was important to convey this message to legislators. The 2002 Farm Bill has already created a taskforce to evaluate the merits of

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BREAK OUT GROUP DISCUSSIONS 51 establishing one or more national institutes focused on disciplines important to the progress of food and agricultural science. Many participants also emphasized the need for diverse membership of the guiding bodies, including the Centers for Disease Control and the Department of Defense. Other entities that might be included in the initiative in some fashion are schools of public health, economists, private health insurers, the private sector, and, of course, the consumer. In terms of targeting a specific food and health issue, a number of participants felt that we should focus on childhood nutrition, including expanded elementary education programs. Alternative suggestions included obesity, diabetes, or other chronic diseases; food safety; and food security. Others felt that a consumer- behavior approach was needed to look at overall eating patterns rather than specific issues, such as the role of functional foods. Some felt that an initiative that would enhance the public's understanding of the agricultural system and its impact on public health was needed. The NSF's National Nanotechnology Initiative (NNI) was cited as a good model to follow. Initially funded in FY 2001, the NNI is an effort to strengthen critical scientific disciplines and encourage interdisciplinary research and education to develop a long-term vision, establish federal priorities, and coordinate the national program. President Bush's HealthierUS Initiative is based on the premise that increasing personal fitness and becoming healthier is critical to achieving a better and longer life. Extensive research has shown that making small adjustments and improvements in the activities of daily life can improve overall health and prevent disease and premature death. The HealthierUS Initiative uses the resources of the federal government to alert Americans to the vital health benefits of simple and modest improvements in physical activity, nutrition, and behavior. The initiative will encourage all Americans to be physically active every day, eat a nutritious diet, get preventive screenings, and make healthy choices to prevent diseases associated with obesity, such as heart disease, cancer, stroke, chronic obstructive pulmonary disease (for example., bronchitis, emphysema, and asthma), and diabetes. Question four: How can education and outreach contribute to improved research integration? Building on the suggestion to require demonstration of a broader scientific perspective in research proposals, discussants felt that education and outreach components also needed to be built into research programs from their initiation. In addition, there was a feeling that the effectiveness of tools for education and

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52 EXPLORING A VISION outreach needed to be the subject of research. The Food Guide Pyramid was cited as an example of a well-known public-outreach program, which is not useful if no one follows it. New technology could also be investigated to improve outreach. Discussants identified the need for greater integration and greater breadth in the primary and continuing-education programs for food and health professionals, including animal health. Professional societies and associations might be called upon to help develop more integrated and collaborative approaches. The public needs to become a partner in the effort to bring agriculture, food, and health sciences together, some discussants felt. Communities have a role in disseminating information, as well as receiving it. With the public's increased awareness and support, there would be an additional driver for better integration at the government and academic levels. The proposed expansion of the federal food and nutrition program could be used to focus integrated research and extension by reaching out to those who need information and technical assistance immediately to improve their life choices. An additional issue identified by discussants was that the consuming public does not know what is factual in food and health claims. There is no good means of identifying what is scientifically sound, so some mechanism of establishing a seal of approval for accuracy was suggested. Increased targeting of educational efforts was identified as an issue of growing importance. Extension and other outreach programs could focus on low-income audiences, because they are often at greater food and health risk. One participant identified the individualized client plan model that is being used at Alcorn State University, where outreach workers try to solve the problems of the family in totality not only economic problems, but health, education, and any other problems with which a family is afflicted At the same time, it is important to educate schoolchildren, who can take the message home to their parents, so that entire families can embrace healthy changes. Students need to have early exposure to the need for research and to what is involved. Some felt that there should be incorporation of more discussion into the whys of food choices and the bows of food production, rather than just saying that one should eat this or that food. Most young people do not see the direct connection among foods, the school lunch program, and the research associated with foods and the good outcomes associated with eating particular ways (nor do their parents with the food-stamp program). To accomplish these goals, some participants felt that state governments needed to ensure that teachers and administrators had the necessary resources.

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BREAK OUT GROUP DISCUSSIONS Question five: Which technical research fields would be most amenable or of high importance to initial integration efforts? 53 Discussants responded to this question in two ways: Some suggested a paradigm shift in food and agriculture research programming: first determine the health benefit desired or the population most susceptible to a health condition, and then work backward from there to the development of a product that is acceptable to the public. Other discussants offered up a variety of suggestions for priority topics: Behavioral psychology of food choice and health Bioactive components of foods Comparative medicine Diabetes Economics of preventing long-term chronic illness related to diet and nutrition Emerging diseases Environmental health Evaluation of research Food engineering Genomics (toxicogenomics, nutritionomics) Geography Intellectual-property rights Marketing, education, and behavior Nutraceuticals Obesity Physical exercise and physical activity Probiotics Satiety Sustainable agriculture Toxicology

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