push research advances in specific areas in other ways. For these reasons, this committee has been asked to evaluate the processes for setting priorities at NIH, particularly NIH's mechanisms for obtaining public input and the role of Congress in directing the allocation of funding among areas of research.

In setting priorities, NIH must also adapt to a changing policy environment. Despite having a growing budget, scientific research opportunities have grown even more rapidly, as has awareness of health problems as the population ages and as globalization exposes the U.S. population to emerging or reemerging infectious diseases.

To meet the expectations of the American people and fulfill the agency's mission, NIH's leaders must pursue many objectives. Two of the most important are (1) to identify the public's health needs, reducing the burdens of illness by developing better methods of prevention, diagnosis, treatment, and rehabilitation, and (2) to extend the basic knowledge base to lead to even better methods in the future. These two objectives are complementary and must be pursued with equal intensities if NIH is going to be successful. A third important objective is to communicate to the public and health providers the current state of scientific knowledge and the implications of research advances for improving the nation's health. Box 1 describes some of NIH's constituencies.

BOX 1 NIH Constituencies

NIH interacts with various external constituencies who have a stake in research priority setting. These include:

  • research scientists in universities, colleges, medical centers, and other research institutions outside NIH who conduct most of the research funded by NIH;
  • clinicians who apply research results and who can help identify research needs (physicians, including specialized physicians, nurses, dentists, pharmacists, social workers, psychologists, public health practitioners, and other allied health practitioners);
  • organized voluntary groups and individuals active in advocating for those with specific diseases or medical conditions;
  • organizations and individuals who represent population groups with special health problems (members of particular ethnic groups, low-income populations, women, elderly people, children, etc.);
  • Congress, which provides NIH with the authority and funding to carry out its mission, which oversees its effectiveness, and with which NIH must maintain good communication about priorities; and
  • media who communicate research results and NIH activities and who thus play an important role in helping the public understand the research enterprise.


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