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9 Department of Health, Education, and Welfare: Health Agencies Health is the second-largest social knowledge production and applica- tion policy area of the Department of Health, Education, and Welfare (HEW). More than 37 percent, or $268 million, of HEW'S total social knowledge production and application obligations in fiscal 1977 were made by health agencies. The department's health agencies are located in the Public Health Service, which consists of six operating agencies; the assistant secre- tary for health exercises direct authority over these six components. The Public Health Service tries to promote and ensure the highest level of health attainable for every individual and family in America. Table 9-1 lists the agencies of the Public Health Service and their estimated fiscal 1977 social knowledge production and application obligations. Four of the agencies obligated over $45 million for social knowledge production and application in that year. The following agencies are components of the Public Health Service: 1. The Alcohol, Drug Abuse, and Mental Health Administration supports knowledge production and application activities to try to understand and treat mental illness and the misuse of drugs and alcohol. 2. The Office of the Assistant Secretary for Health sets policy for the Public Health Service and supports evaluation research on health-related issues. 139
140 SURVEY OF FEDERAL AGENCIES TABLE 9-1 Public Health Service Agencies that Support Social Knowledge Production and Application: Profile (fiscal 1977, Smillionsj Organizational Predominant Location of Total Social Social Social Knowledge Knowledge Knowledge Production Production Production .'md and and Predominant Application Application Application Goal or Agency Obligations Activity Activity Audience" Alcohol, Drug Abuse, 79.5 Research R&D agency Provision of and Mental Health knowledge Administration for third parties National Institutes (,S.I Research R&D agency Advancement of Health of knowledge Health Resources 62.4 Research/ Mixed Provision of Administration general knowledge purpose for third statistics parties Health Services 45.4 Demonstrations Operating Provision of Administration agency knowledge for third parties Food and Drug 6.0 Research Operating Improvement Administration agency of federal program Center for Disease 4.9 Demonstrations/ Operating Mixed Control general agency purpose statistics Office of the Assistant 1.7 Research Policy-making Improvement Secretary office of federal for Health policy TOTAL 268.0 Numbers may not total due to rounding. "See Chapter 2 for a more detailed discussion. 3. The Center for Disease Control is charged with protecting the public health of the nation by providing leadership and direction in the prevention and control of disease and other preventable conditions. 4. The Food and Drug Administration is the regulatory agency con- cerned with protecting the nation's health against impure and unsafe foods, drugs, cosmetics, and other potential hazards. 5. The Health Resources Administration is responsible for identify- ing and correcting imbalances, inefficiencies, and deficiencies in thte health service delivery system.
HEW: Health Agencies 141 6. The Health Services Administration provides direct health ser- vices and other health programs to the underserved or disadvan- taged. 7. The National Institutes of Health have the mission of improving the health of Americans through the conduct, encouragement, and support of health research and development and related ac- tivities. While the above agencies are considered the "health agencies" of HEW, social knowledge production and application activities in the health policy area are also funded by other HEW agencies: the Office of the Assistant Secretary for Planning and Evaluation; the Office of Human Development Services; the Social and Rehabilitation Service; and the Social Security Administration.1 These agencies are discussed in Chapter 11. Table 9-1 also presents the predominant goal or audience for each of the HEW health agencies. The agencies fall into two major groups ac- cording to their goal or audience. The first group (the Health Resources Administration, Health Services Administration, and parts of the Al- cohol, Drug Abuse, and Mental Health Administration) is primarily concerned with the development of knowledge for third parties. In recent years, HEW has become increasingly concerned with improving health service delivery across the nation. The second major group (the National Institute of Mental Health and the National Institutes of Health) is concerned primarily with the advancement of knowledge. The classification of the National Institute of Mental Health was dif- ficult, because it is also concerned with providing knowledge for third partiesâpractitioners in the mental health communityâas well as supporting basic disciplinary research. The health policy area presented several problems for the Study Project survey. It was the intent of the survey to exclude biomedical R&D activities; only activities that either support behavioral or social research on health service delivery research were included in the defi- nition of social knowledge production and application. While there was little problem at the extremes (many activities were clearly either biomedical or social), several grey areas did emerge, and they are discussed within the individual agencies. "The March 1977 reorganization of HEW abolished the Social and Rehabilitation Service and transferred its activities to the new Health Care Financing Administration, the Social Security Administration, and the Office of Human Development Services. The reorgani- zation is discussed under the Social and Rehabilitation Service.
142 SURVEY OF FEDERAL AGENCIES For Further Information For a general discussion of health research (both biomedical and social) in the Depart- ment of Health, Education, and Welfare, see "Themes: Knowledge Development," Part iv, pp. 84-111, in Forward Plan for Health FY 1978-82, U.S. Department of Health, Education, and Welfare, U.S. Government Printing Office, Washington, D.C., August 1976. ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 57.624 16.915 1. 182 1.094 76.815 1.110 7.710 8*20 85.635 1976 59.130 16.720 1.325 1. 139 78.314 960 5.697 6.657 84.971 1977 54.450 16.337 1.334 1.111 73.232 777 5.523 6.300 79.532 The basic mission of the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA) is to assist the nation in understanding the continuing phenomena of mental illness and the misuse of drugs and alcohol. ADAMHA is the fifth-largest agency funder of social knowledge production and application in the federal government. It is composed of three institutes: the National Institute on Alcohol Abuse and Al- coholism; the National Institute on Drug Abuse; and the National Insti- tute of Mental Health. In addition to their research activities, all three institutes support training, prevention, and community service pro- grams that were not included in this survey. Determining the level of social knowledge production and applica- tion in ADAMHA proved difficult. Many activities fell on the borderline of the definition of social knowledge production and application used by the Study Project. A broad interpretation of the definition would have included all the research and related activities of ADAMHA. The distinction between "social" and "biomedical" research was often a difficult one to make. This problem was discussed with staff of all three ADAMHA institutes; their assistance was very helpful. After consulta- tion, the Study Project adopted the following definitions, which are used by ADAMHA:
HEW: Health Agencies 143 Biological research includes studies in which the primary emphasis is on a body function or process. One major area included in this category is psychopharmacological studies, at both preclinical and clin- ical levels. Such studies are generally aimed at understanding the mechanisms of drug action and how drugs affect physiological and behavioral responses. Also included in biological research are studies on drug development and synthesis, toxicology, and screening and analysis techniques. Behavioral or psychosocial research includes studies of behavior, personality, individual and group interaction, psychological responses to a variety of stimuli, etc. Included in this category are studies of the measurement and diagnostic use of personality and behavioral charac- teristics of various clinical groups, research on psychotherapy and other psychosocial forms of treatment, and studies of service delivery systems. Behavioral or psychosocial research was included in the survey, while biological research was not. The current organization of ADAMHA became effective in 1973. Dur- ing its lifetime, the National Institute of Mental Health has had many different organizational locations. The creation of ADAMHA was an attempt to provide greater visibility and independence to programs dealing with alcohol, drugs, and mental health. This organization is an attempt to recognize the differences in history, professional commit- ment, and service systems that are at work in the three areas. The goal of the Office of the Administrator in ADAMHA is to work with each of the three institutes to coordinate, facilitate, and identify major policy issues that affect each of the three fields in similar or related ways. For Further Information See Alcohol. Drug Abuse, and Mental Health Research Grant Awards. Fiscal Year 1976; The ADAMHA Publication List, or write Alcohol, Drug Abuse, and Mental Health Administration, Department of Health. Education, and Welfare, 5600 Fishers Lane, Rockville, Md. 20852.
144 SURVEY OF FEDERAL AGENCIES NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Formula- Program General Fiscal Re- tion Dem- Evalu- Purpose Year search onstrations ation Statistics Total Policy implemen- Develop- tation Dem- ment of Dissem- onstrations Materials ination Total TOTAL 1975 11.911 11.911 360 3.670 4.030 15.941 1976 11.808 11.808 160 1.000 1.160 12.968 1977 10.000 10.000 77 700 777 10.777 The National Institute on Alcohol Abuse and Alcoholism (NIAAA) serves as the focal point for federal activities on alcoholism. The mis- sion of NIAAA is to acquire a better understanding of the nature of alcoholism, its causes, and the most effective methods of treatment and prevention. NIAAA is also responsible for accumulating and disseminat- ing knowledge on the risks and dangers associated with irresponsible drinking. Research As part of its research programs, NIAAA supports research on the be- havioral and social aspects of alcohol use and abuse. Research is funded in the following areas. CLINICAL/PSYCHOLOGICAL RESEARCH This research focuses on d\ag- nosis and treatment methods aimed at increasing the efficiency and reducing the cost of alcoholism treatment. BEHAVIORAL RESEARCH This research examines the use of alcohol. It will contribute to a better definition of the alcoholic person and alcohol abuse. Research is also funded to gain an understanding of the behav- ioral determinants that induce alcohol ingestion and the factors that serve to inhibit or regulate alcohol consumption. Studies include the identification of societal influences on alcohol use, including research on subcultures, ethnic groups, social classes, and families. Research has also been funded on drinking among the elderly, women, and youth. EPIDEMIOLOGY NIAAA supports a system of surveillance of alcohol consumption that uses the most accurate and complete data sources available and develops new sources where necessary. Data are used in
HEW: Health Agencies 145 studies of the natural history and trends of alcohol use and abuse. Emphasis is placed on research to elucidate specific risk factors, pre- vention techniques, and acceptable outcomes of treatment as well as the relationship of alcohol use to illnesses such as heart disease and cancer. Dissemination In the past, NIAAA has conducted an active dissemination program. It funds the National Clearinghouse for Alcohol Information, which dis- seminates the latest research findings in the field. Support of this activ- ity has decreased in recent years. For Further Information Write National Institute on Alcohol Abuse and Alcoholism; Alcohol, Drug Abuse, and Mental Health Administration; Department of Health. Education, and Welfare; 5600 Fishers Lane; Rockville. Md. 20857. NATIONAL INSTITUTE ON DRUG ABUSE Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 18.216 16.915 700 779 36.610 750 2.125 2375 39.485 1976 19.475 16.720 â¢73 801 37.871 too 2.954 3.754 41.625 1977 20.100 16.337 834 750 38.021 700 3.050 3.750 41.771 The National Institute on Drug Abuse (NIDA) conducts a wide range of drug abuse prevention activities. NIDA'S research program is devoted to increasing knowledge of narcotics addiction and drug abuse and using that knowledge to formulate improved methods of dealing with drug problems. The agency supports research programs to gain new knowledge, ranging from fundamental research on the basic chemistry of substance abuse to applied research and development activities that have direct impact on treatment services. Research Social research in NIDA seeks to determine conditions that govern the initiation of drug abuse. The effects of societal and other environmental
146 SURVEY OF FEDERAL AGENCIES conditions on drug abuse are studied. The relationships among dif- ferent forms of substance abuse (e.g., alcoholism, drug addiction, cigarette smoking, overeating) are examined in an attempt to develop intervention techniques for the prevention and treatment of many forms of substance abuse. Social research is funded in the following programs. EPIDEMIOLOGY The goal of this research program is to determine the incidence, prevalence, and distribution of drug abuse and its effects on the individual and society. Studies, primarily employing survey meth- odology, are supported to describe drug use for the population as a whole or for special target populations. Previous surveys have focused on the use of drugs by Vietnam veterans and other young males be- tween 20 and 30 years of age. Another project surveyed nonmedical drug use, with an emphasis on the measurement of consequences. Special studies have been supported on drug use by women, elderly persons, and addicted infants. ETIOLOGY The goal of etiological studies is to determine the causal factors, including those combinations of biological, psychological, and societal conditions most closely associated with increased risk of drug abuse. Studies have been supported on personality correlates and be- havioral factors that may predispose individuals to abuse drugs; lon- gitudinal research studies concerned with medical and psychological factors that may be predictive of subsequent drug abuse; investigations of personality factors determining the choice of drug abuse as an adap- tive attempt or as a manifestation of psychopathology; and studies of familial factors and the influence of peers on the abuse of drugs. HAZARDS Another component of the NIDA research program includes studies to determine the adverse effects of drugs on the physical and mental health of the individual and the consequences of drug abuse on society. This program deals with the biological and psychological com- plications resulting from drug use, including the effects on behavior and performance. Emphasis has been placed on identifying the rela- tionships between drug dependence and such activities as criminal be- havior, addictive lifestyles, and prostitution. Policy Formulation Demonstrations NIDA supports a large program of demonstrationsâmore than $16 mil- lion. Demonstration projects are awarded to develop and evaluate
HEW: Health Agencies 147 promising new approaches relating to substance abuse treatment and rehabilitation services. Since the demonstrations are aimed at deter- mining "what works and what doesn't work," NIDA'S demonstration programs have been categorized as policy formulation demonstrations. The demonstration projects have three components: the gathering of data to define appropriate treatment and rehabilitation approaches to client groups with unique cultural, geographical, and/or psychological characteristics; the construction of innovative models to improve the quality of services based on the above data; and the evaluation of the methodologies designed to determine program effectiveness and to make possible the integration of new methods into community pro- grams. A major concern of the demonstration program is to develop pro- grams, outside the traditional treatment setting, that are responsive to the special social, psychological, and health needs of youth, minorities, women, and multiple drug users. Examples of demonstration projects are: o a demonstration project to link the community justice system with treatment resources in the community; o the development, testing, and implementation of effective treat- ment approaches to the abuse of inhalants; o vocational rehabilitation programs specifically designed for the drug user and development of outreach techniques for the multiple- drug user, women, and criminal justice clientele; and o a series of demonstration projects to identify the nature and extent of drug abuse among different Indian populations and to develop ap- propriate treatment modalities. Dissemination NIDA has supported a national data retrieval and dissemination system to provide state and local officials with essential programmatic, scien- tific, and technical information on the nature and extent of drug abuse in the United States. A resources and materials file is supported, con- taining abstracts of documents and audiovisual materials on drug abuse. A clearinghouse program file is also funded, consisting of in- formation on drug abuse programs across the nation. For Further Information See Findings of Drug Abuse Research, a publication of NIDA, or write National Institute on Drug Abuse; Alcohol, Drug Abuse, and Mental Health Administration; Department of Health, Education and Welfare; 5600 Fishers Lane; Rockville, Md. 20857.
|48 SURVEY OF FEDERAL AGENCIES NATIONAL INSTITUTE OF MENTAL HEALTH Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 27.497 482 315 28.294 1.915 1.915 30.209 1976 27.847 450 338 28.635 1.743 1.743 30.378 1977 24.350 500 361 25.211 1.773 1.773 26.984 The National Institute of Mental Health (NIMH) provides leadership, policies, and goals for the federal effort in promoting mental health and the treatment of mental disorders. Since the late 1950s, NIMH has been a major funder of the social sciences and has supported a wide range of research topics. The primary goal of NIMH research is to develop new knowledge and approaches to the causes, diagnoses, treatment, con- trol, and prevention of mental illnesses through basic, clinical, and applied research. Research As noted in the discussion of ADAMHA, the distinction between "so- cial" and "nonsocial" often proved difficult. In the case of NIMH, certain areas of research (clinical research and psychopharmacological research) fell outside the Study Project's definition of social research and were excluded from the survey. It should also be noted that only the research activities of NIMH were included in the survey; the pro- grammatic activities of NIMH, such as the Community Mental Health Center program, were excluded. Programs funding social research in NIMH are discussed below. BEHAVIORAL SCIENCE PROGRAM Research is funded on the early detec- tion of language and learning disabilities and the prevention of second- ary emotional and interpersonal problems; early emotional and person- ality development and the factors relating to maladaptive behavior; and the mental health effects of changing sexual roles, alternative family styles, and rapid cultural and social change. EPIDEMIOLOGY This program supports research on the causative fac- tors associated with mental illness. Special consideration is given to
HEW: Health Agencies 149 depression and suicide in relation to life events or environmental stress. Research also focuses on factors affecting the course and out- come of treatment and adjustment. APPLIED RESEARCH PROGRAM This program places special emphasis on infant development and prenatal attachment, adolescent behavior, changing family patterns and values, sexuality, and the mental health aspects of aging. The program supports projects designed to increase the understanding of contemporary social problems and problems re- lated to the mental health of juveniles, especially those problems as- sociated with social and environmental conditions. SERVICE DEVELOPMENT This program supports research on mental health services and delivery. Its research priorities include financing and quality standards, children's mental health services, services of the chronically and aged mentally ill, planning and evaluation technology, and capacity building for integration with other human services. CRIME AND DELINQUENCY The NIMH Center for Studies of Crime and Delinquency supports research on female crime behavior, individual violent behavior, commitment and treatment of mentally ill offenders, and the effectiveness of various types of community-based strategies for providing treatment and service to delinquents outside the criminal justice system. METROPOLITAN PROBLEMS The NIMH Center for Studies of Metropoli- tan Problems supports studies relating to the ways in which human beings function under stress and the kind of formal and informal sup- port systems available to them. Another program focuses on economic and work-related crises. Research is funded on: mental health implica- tions of urban and ethnic conflict; residential and social segregation by age, marital status, and income; the effects of residential and neigh- borhood density on individuals functioning in families; and evaluation of the community effects of neighborhood mental health facilities. MINORITY MENTAL HEALTH This program studies effective processes, procedures, and strategies for implementing research findings to im- prove the services provided to minorities by existing mental health delivery systems. RAPE This program funds research on the causes and prevention of rape.
150 SURVEY OF FEDERAL AGENCIES Throughout its history, NIMH has also funded studies on methodologi- cal developments in social science research. Dissemination NIMH has long had an active dissemination program. The National Clearinghouse for Mental Health was established to provide a central information resource on the many complex factors involved in mental illness and mental health. The computer data file includes research from all over the world. The clearinghouse provides bibliographies, consultation, publications, inquiry response, and referrals. For Further Information For a detailed discussion of research in the National Institute of Mental Health, see Research in the Service of Mental Health, Report of the Research Task Force of the National Institute of Mental Health. U.S. Government Printing Office, Washington, D.C., 1975 (summary report of this volume is also available); National Institute of Mental Health Research Support Program and Activities and Mental Health Program Reports, which are publications of NIMH, or write National Institute of Mental Health: Alcohol. Drug Abuse, and Mental Health Administration; Department of Health, Educa- tion, and Welfare; 5600 Fishers Lane; Rockville, Md. 20857. ASSISTANT SECRETARY FOR HEALTH Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- men t of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 1.043 1.043 1.043 1976 1.660 1.660 1.660 1977 1.660 1.660 1.660 The Office of the Assistant Secretary for Health provides guidance, leadership, and direction to the Public Health Service agencies on all health and health-related activities. The office coordinates all health activities of other departments and agencies and provides advice and assistance as requested. The office also does planning and policy analysis. The assistant secretary serves as the principal health adviser to the secretary of the Department of Health, Education, and Welfare.
HEW: Health Agencies 151 In September 1977, the National Center for Health Services Re- search and the National Center for Health Statistics were transferred from the Health Resources Administration to the Office of the Assist- ant Secretary for Health. (The two agencies are discussed under the Health Resources Administration.) The objective of this reorganization is to link health services research and health statistics to the policy analysis, planning, and evaluation activities of Office of the Assistant Secretary for Health. Research Prior to assuming responsibility for the National Center for Health Services Research, the Office of the Assistant Secretary did not sup- port any research programs. The office did, however, have responsibil- ity for some activities that were labeled "evaluation research" and categorized as research by the Study Project. These activities are somewhat broader than "program evaluation" and are more appropri- ately labeled "evaluation research." Examples of such activities in- clude: o a study of ambulatory surgery care with respect to quality, cost savings, and acceptability within the health care system; o an assessment of the policy analysis and evaluation research capabilities of external resource organizations in the health policy field; o an analysis of the national five-year plan for family planning ser- vices; o a study of decision making and information use in three Public Health Service regional offices. For Further Information Write Office of the Assistant Secretary for Health, Department of Health, Education, and Welfare. 5600 Fishers Lane. Rockville, Md. 20852.
152 SURVEY OF FEDERAL AGENCIES CENTER FOR DISEASE CONTROL Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 635 1.104 1976 662 1.180 l»77 694 1.278 2.336 4.075 32 1.369 3.211 35 1.600 3.572 38 873 240 933 255 1.010 274 1.145 5.220 1.223 4.434 1.322 4.894 The Center for Disease Control is the federal agency charged with protecting the public health of the nation by providing leadership and direction in the prevention and control of disease and other preventable conditions. Of the center's eight operating components, two units sup- port social knowledge production and application activities: the Bureau of Health Education and the National Institute for Occupational Safety and Health. Table 9-2 describes these agencies. For Further Information Write Center for Disease Control, Department of Health, Education, and Welfare, 1600 Clifton Road, N.E., Atlanta, Ga. 30333. TABLE 9-2 Center for Disease Control Agencies that Support Social Knowledge Production and Application: Profile (fiscal 1977, $millions) Predominant Organizational Predominant Localion of Total Social Social Social Knowledge Knowledge Knowledge Production Production Production and and and Application Application Applicalion Predominant Agency Obligations Activity Activity Goal or Audience* Bureau of Health 2.7 Policy Operating Knowledge for Education formulation agency third demonstrations parties National Institute 2.2 Statistics Operating Improvement for Occupational agency of federal Safety and programs Health TOTAL 4.9 "See Chapter 2 for a more detailed discussion.
HEW: Health Agencies 15 3 BUREAU OF HEALTH EDUCATION Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 123 1.104 1.227 32 873 213 1.118 2,345 1976 130 1.180 1.310 35 933 227 1.195 2.505 1977 141 1.278 1.419 36 1.010 246 1.294 2.713 The mission of the Bureau of Health Education is to provide leadership and direction in a comprehensive national health education program geared to the prevention of disease, disability, premature death, and undesirable and unnecessary health problems. To accomplish this mis- sion, the bureau develops and promulgates health education goals, objectives, and priorities in order to enhance the total effectiveness of the many separate federal programs involved in health education. Research A limited amount of research is funded by the bureau. Examples in- clude an examination of smoking intervention techniques, a study of hospital-based health education programs, and a longitudinal study of school health education curriculum projects. Policy Formulation Demonstrations The aim of the bureau's demonstrations is to test health education programs geared to meet the specific needs of special target populationsâminority groups, inner city and rural poor, industrial workers, etc. It is felt that these groups are not being adequately reached by current health education efforts and new delivery tech- niques are needed. A current demonstration project is testing methods for effective health education for isolated Indian and rural com- munities. Another project is introducing health education materials to be used by health workers during their daily activities. Development of Materials Most of these materials are geared to use in classrooms. The bureau has supported a broadly based elementary and junior high school
154 SURVEY OF FEDERAL AGENCIES health education curriculum that is currently used by 200 school dis- tricts in 28 states. The bureau has also funded the development of a school curriculum on smoking and health. For Further Information Write Bureau of Health Education, Center for Disease Control, Department of Health. Education, and Welfare, 1600 Clifton Road, N.E., Atlanta, Ga. 30333. NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Formula- Program tion Dem- Evalu- onstrations ation Policy Implemen- tation Dem- onstrations Fiscal Year Re- search General Purpose Statistics Develop- ment of Dissem- Materials inatton Total Total TOTAL 1975 1976 512 532 553 2.336 1.369 1.600 2.848 1.901 2.153 27 28 27 22 28 2.875 1.929 2.181 28 The mission of the National Institute for Occupational Safety and Health (NIOSH) is to ensure safe and healthful working conditions for all working people. The agency plans, directs, and coordinates the na- tional program effort to develop and establish recommended occupa- tional safety and health standards. The agency also conducts research, training, and related activities to ensure safe and healthy working con- ditions. Research NIOSH supports research projects on innovative approaches to under- standing the underlying characteristics of occupational safety and health problems and effective solutions in dealing with them. Social research is conducted on psychological and motivational factors in occupational situations, and the impact of these factors on mental health and job performance is studied. Included in this category are studies of the effects of impaired physical, mental, and emotional states on safety and effective work performance. Examples of such studies are listed below. WORK CONDITIONS, JOB SATISFACTION, AND CORONARY HEART DISEASE RISK This study tested the proposition that intrinsic job satisfaction plays an important role in the causation of coronary heart risk.
HEW: Health Agencies 155 JOB DEMANDS AND WORKER HEALTH The aim of this research is to iden- tify classes of jobs in terms of stress and discover the extent to which the relationship between job demands and strain hold within occupa- tions. General Purpose Statistics NIOSH is responsible for maintaining an occupational health surveil- lance system. Soon after its creation, NIOSH recognized that reliable statistics describing health hazards in the occupational environment were virtually nonexistent. Policy decisions, research priorities, and response to public inquiries were often based on conjecture rather than fact. NIOSH began to collect health hazard information. It currently maintains a surveillance system on occupational hazards, injuries, and illnesses resulting from the work environment. Included in the surveil- lance system is a national occupational hazard safety survey, which is intended to describe the health and safety conditions in the American work environment. For Further Information Write National Institute for Occupational Safety and Health, Department of Health, Education, and Welfare, 5600 Fishers Lane, Rockville, Md. 20857. FOOD AND DRUG ADMINISTRATION Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Formula- tion Dem- onstrations Policy Implemen- tation Dem- onstrations Fiscal Year Re- search Program Evalu- ation General Purpose Statistics Total Develop- ment of Materials Dissem- ination Total TOTAL 1975 1976 1977 2,752 2.616 3.036 159 162 225 1.230 1.185 4.141 3.963 4.421 432 605 416 1.144 1.177 1.217 1.576 1.782 1.633 5.717 1.160 5.745 6.054 The Food and Drug Administration (FDA) is a scientific regulatory agency whose mission is protecting the nation's health against impure and unsafe foods, drugs, cosmetics, and other potential hazards. While most of the agency's R&D activities are in the areas of biological and life sciences, some social knowledge production and application ac- tivities are supported.
156 SURVEY OF FEDERAL AGENCIES Research The majority of FDA'S social research is supported by the Bureau of Foods, which is responsible for conducting research and establishing standards on the composition, quality, nutrition, and safety of food, food additives, colors, and cosmetics. As part of that responsibility, the bureau supports social research on the nutritional behavior of the American public. In order to establish baseline data on consumer ex- posure to, experience with, and expectations concerning food, the FDA supported a three-year study of attitudes and knowledge about nutri- tion among food shoppers. Other social surveys have examined the food intake patterns of the American public and their attitudes toward various health practices. The latter survey investigated people's beliefs concerning fallacious or questionable health practices (such as "aids" to stop smoking, taking vitamins, etc.) and their susceptibility to these practices. Program Evaluation FDA'S evaluation efforts are currently focused on (1) the identification of the size and extent of problems and the development of ways to measure the impact of agency actions on these problems; (2) an as- sessment of alternative practices by the agency (e.g., the use of dif- ferent compliance methods); and (3) the monitoring of program per- formance and accomplishments. Other Activities The FDA also supports the development of materials. These materials are used in training courses. The agency's dissemination activities largely consist of the publication and distribution of materials concern- ing consumer protection and public health. For Further Information Write Food and Drug Administration, Department of Health, Education, and Welfare, 5600 Fishers Lane, Rockville, Md. 20857.
HEW: Health Agencies 157 HEALTH RESOURCES ADMINISTRATION Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Fiscal Year Re- search Policy Formula- tion Dem- onstrations Program Evalu- ation General Purpose Statistics Total Policy Implemen- tation Dem- onstrations Develop- ment of Materials Dissem- ination Total TOTAL 1975 1976 1977 30.103 23.285 20.933 7.132 4.090 3.656 3.590 1.612 I.1 12 21.079 25.887 24.223 61.904 54.874 49.924 8.494 7.900 7.900 2.886 1.276 1.259 2.521 3.436 3.414 13.901 12.612 12.573 75.805 67.486 62.497 The Health Resources Administration (HRA) has the responsibility for identifying and correcting current and anticipated imbalances, inef- ficiencies, and deficiencies in the distribution, supply, utilization, and costs of health care resources and services. HRA provides leadership related to the distribution of health resources in the United States. The agency carries out its mission by measuring and analyzing current status and trends; defining, testing, and evaluating alternative means of meeting problems; and promoting innovative strategies and targeted resource development designed to improve areas of imbalance and inefficiency. Table 9-3 lists agencies included within the Health Resources Admin- istration and their total social knowledge production and application obligations for fiscal 1977. As can be seen from the table, HRA attempts to fulfill its missions by the collection of statistics, health services research, and programmatic activity. The table also points out the "third party" nature of the agency, as much of its knowledge produc- tion and application is directed at the private health sector. For Further Information Write Health Resources Administration, Department of Health, Education, and Welfare, 5600 Fishers Lane, Rockville, Md. 20857.
158 SURVEY OF FEDERAL AGENCIES TABLE 9-3 Health Resources Administration Agencies that Support Social Knowledge Production and Application: Profile (fiscal 1977, Smillions) Organizational Predominant Location of Total Social Social Social Knowledge Knowledge Knowledge Production Production Production and and and Application Application Application Primary Goal Agency Obligations Activity Activity or Audience" National Center 24.0 General Statistical Collection of for Health purpose agency statistics Statistics' statistics National Center 22.2 Research R&D Agency Knowledge for for Health third parties Services Research* Bureau of Health 11.2 Policy imple- Operating Knowledge for Manpower mentation agency third parties demonstrations Bureau of Health 4.0 Dissemination Operating Knowledge for Planning and agency third parties Resources Development Office of Planning, 1.0 Evaluation Policy-making Improvement of Evaluation, and office federal Legislation policy TOTAL 62.4 "See Chapter 2 for a more detailed discussion. 'Transferred to the Office of the Assistant Secretary for Health in September 1977. BUREAU OF HEALTH MANPOWER Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- men t of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 2.041 209 1976 2.000 200 1977 2.000 200 2.250 7.932 2.200 7.900 2.200 7.900 1.031 146 1.000 150 1.000 150 9.109 11.359 9.050 11.250 9.050 11.250 The Bureau of Health Manpower is responsible for planning, develop- ing, and administering programs in support of the development and use of the nation's health manpower. Its programs are designed to strengthen state and local health manpower capacity as well as to de-
HEW: Health Agencies 159 velop new approaches to health manpower development and use. The bureau's goal is to ensure that an adequate supply, mixture, and distri- bution of health workers is available to operate the nation's health care system. Research The bureau conducts research on the nation's health manpower situa- tion. Research is geared to ascertaining the geographic and specialty distribution of health manpower, improving the manpower planning process, improving training procedures, and studying ways to increase health manpower opportunities. Research efforts have resulted in the development of new roles for nurses and dentists as well as expanded health services and improved delivery of health care services. Some of the manpower-related issues that the bureau's research ac- tivities have focused on are: the effectiveness of three-year medical schools; the status of women in the health sector; admission patterns in ten medical schools; the feasibility and potential impact of employing physician assistants; the economics of dental practice; the identifica- tion of barriers limiting entry of minority groups into health profes- sions; and the economic and noneconomic incentives needed to get nurses to work in underserved geographic areas. Policy Implementation Demonstrations The bureau supports a series of demonstration projects with the aim that they will serve as a model to be implemented by other appropriate health service organizations. One demonstration deals with the estab- lishment of a training program for registered nurses to become geriatric nurse practitioners. The demonstration project was conceived as a way to improve health care delivery for elderly persons in medically disad- vantaged areas. Another demonstration project involved a program of training nurse midwives and placing them in maternal infant care teams in six states. The aim of this demonstration was to improve the geo- graphic distribution of maternal infant services in medically deprived areas. Other demonstrations have promoted various ways in which nurses could be used to provide care in shortage areas and in ambula- tory and community settings. Development of Materials In addition to its other activities, the bureau supports the development of self-instructional and other materials to be used in the training of health workers.
160 SURVEY OF FEDERAL AGENCIES For Further Information Write Bureau of Health Manpower, Health Resources Administration, Department of Health, Education, and Welfare, 3700 East-West Highway, Hyattsville, Md. 20782. NATIONAL CENTER FOR HEALTH SERVICES RESEARCH Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 23.605 6.923 820 301 31.649 562 193 265 1.020 32.669 1976 19.802 3.890 677 251 24.620 I50 200 350 24.970 1977 17.594 3.456 602 223 21.875 133 178 311 22.186 The National Center for Health Services Research plans, develops, and administers a broad program of health services research, demon- strations, and evaluation on virtually all aspects of health services delivery in this country. The center makes awards to health service providers and researchers, conducts and coordinates health services research within the Public Health Service, and disseminates research findings and provides technical assistance to other federal programs and health service providers. The center was established in 1974 in order to make a substantial improvement in the efficiency and effectiveness of health services by expanding the knowledge of provider and consumer behavior and by testing and evaluating new approaches to producing, organizing, and delivering health services. The center is now the principal source of support in the nation for general research on the delivery of health services. In September 1977, the center was transferred from the Health Re- sources Administration to the Office of the Assistant Secretary for Health. It was felt that the center's crosscutting responsibilities as the primary source of technical and professional assistance in health policy research and in the development of a national health strategy could best be realized by locating it within the Office of the Assistant Secre- tary for Health's policy analysis staff. Research Since the center is the largest single source of funds for health services research, the development of the center's research agenda is very im- portant. Recognizing this, the center establishes its research priorities
HEW: Health Agencies 161 through intensive interaction with those who need health services information â decision makers in the executive and legislative branches of the federal, state, and local governments and researchers and providers. As an outgrowth of the agenda-setting process, the center funds research on the following selected areas. INFLATION AND PRODUCTIVITY This research has examined the factors responsible for increasing hospital costs; the effects of alternative de- livery mechanisms on health expenditures; and the critical determin- ants of wages and prices in the health sector. HEALTH INSURANCE This research has examined the price elasticity of the demand for health services; the distributional aspects of national health insurance benefits and finance; the impact of insurance on physician price and output decisions; and the potential consequences of providing catastrophic insurance benefits on a national basis. HEALTH MANPOWER This research has examined questions related to the supply of primary and specialty services and their geographic dis- tribution; increased substitution of nurses and medical corpsmen for physicians; the nonphysician labor market; and employment practices and the growth of collective bargaining in the health sector. QUALITY OF CARE This research emphasizes the improvement of tech- niques for assessing the quality of health care; the formulation of measures of health status; the evaluation of technological innovations in the delivery system that might improve care; and the identification of mechanisms to deal with malpractice insurance problems. PLANNING AND REGULATION This research emphasizes the develop- ment of better quantitative techniques for estimating resource de- mands; analysis of the social and political problems of planning; the identification of the information needed in the planning process; and development of mechanisms needed for assessing the consequences of various types of regulation. HEALTH CARE FOR THE oisA ov ANT AGE D This research has problems of access to medical care; evaluation of differences in use by subgroups; the problem of employment of the disadvantaged in the health industry; and institutional and programmatic influences on de- livery and use of health services. LONG-TERM CARE This research consists of empirical studies as well as methodological and theoretical research relevant to such policy ques-
162 SURVEY OF FEDERAL AGENCIES tions as the demand for long-term care, the supply and access effects of existing insurance and regulatory policies, and the costs and distribu- tion implications of alternative assistance strategies. In addition to funding individual projects in the seven priority areas, the center also supports six regional health service research centers. These centers are expected to carry out the following activities: design and implementation of research, evaluation, and demonstration proj- ects; education of health service researchers drawn from relevant pro- fessions and disciplines; and consultation and technical assistance to interested individuals and organizations in a specific region or local area. A key function of these regional centers is the development of a research agenda that is responsive to regional and local needs. Two of the centers will be designated as National Special Emphasis Centers: o Health Care Technology Center, to focus on assessing the poten- tial impacts of existing or proposed technologies on the health service delivery system. o Health Care Management Center, to focus on improving the man- agement, organization, and productivity of the health sector. The cen- ter will provide training and retraining for health administrators and will attempt to develop leaders, planners, and policy analysts for the health sector. Policy Formulation Demonstrations Another major activity of the center is the support of demonstrations to learn about alternative methods of health care delivery. It has sup- ported a "community-based primary health care unit" to test an alter- native way of organizing and delivering health services by creating a delivery team geared to service a definite population. Another demon- stration project created "chronic disease service modules" to test the feasibility of a module approach for providing care for chronically ill patients. One project tested and evaluated alternative mechanisms for reimbursing physicians for the care of hospitalized patients. All dem- onstrations contribute to the center's mission to learn more about im- proved methods of health care delivery. For Further Information The following publication series provide more information on the activities of the center: The Research Management Series describes programmatic rather than technical aspects of the center's research effort. Specific reports in the series are The Program in Health
HEW: Health Agencies 163 Services Research, Research on the Priority Issues of the National Center for Health Services Research, Grants and Contracts Active, and Recent Studies in Health Services Research, CY 1976. The Policy Research Series describes findings from the research program of major significance for policy issues of the moment. The Research Digest Series provides overviews of significant research supported by the center. The Research Proceedings Series extends the availability of new research through conferences, sym- posia, and seminars sponsored or supported by the center. The Research Summary Series provides rapid access to significant results of center-supported research projects. The Research Report Series produces significant research reports in their entirety upon the completion of a project. To obtain these publications or information concerning the various publication series, write National Center for Health Services Research, Department of Health, Education, and Welfare. Room 8-50, 3700 East West Highway, Hyattsville, Md. 20782. NATIONAL CENTER FOR HEALTH STATISTICS Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 1.521 20.339 21.860 21.860 1976 265 25.636 25.901 25.901 1977 24.000 24.000 24.000 The National Center for Health Statistics is responsible for providing timely and accurate statistical information on the status of the nation's health and providing its official vital statistics. The national center is one of the five major general purpose statistical agencies in the federal government. The objectives of the center are many. It provides a national descrip- tive baseline of health statistics that serves to identify and measure problems and trends in health status. The data are also used for iden- tifying efficiencies and inefficiencies in the distribution, supply, use, and costs of health care resources and services. The center's health and related social data are also used by a variety of governmental and nongovernmental users. A major activity of the center is to develop and implement a cooperative system of data collection with states and local areas to produce comparable and reliable health data at the na- tional, state, and local levels without duplication of effort. The center also provides technical assistance to other federal agencies working in the health field. Along with the National Center for Health Services Research, the National Center for Health Statistics was transferred in September
164 SURVEY OF FEDERAL AGENCIES 1977 from the Health Resources Administration to the Office of the Assistant Secretary for Health. It was felt that the transfer would result in more effective use of the center as the agent responsible for the collection and analysis of general purpose health statistics and for coordinating those statistics that involve cooperation with state and local agencies. In addition, it was felt that health data collection efforts would become more systematic and uniform, enhancing the ability of the assistant secretary for health to obtain data needed for policy mak- ing and to resolve data policy issues. General Purpose Statistics The center provides two main clusters of statistics. They are listed below. VITAL STATISTICS Data are collected on births, deaths, marriages, and divorces. Annual and decennial life tables and related actuarial tables are prepared. HEALTH STATISTICS Data are collected on: o illnesses, injuries, impairments, and disabilities; o costs and uses of health services (including hospital and nursing homes); o nutritional status, prevalence of chronic disease, physiological measurements, and patterns of physical and intellectual growth; o characteristics, supply, and geographic distribution of health manpower and facilities. Vital statistics are reported on both a monthly and an annual basis. Statistical data are published by the center in its Vital and Health Statistics Publication Series. The principal periodic reports of the cen- ter are presented in Table 9-4. For Further Information For a discussion of health statistics in general, including the statistics collected by the National Center for Health Statistics, see Health Statistics Plan. Fiscal Years 1978- 1982, Department of Health. Education, and Welfare, Washington, D.C., February 1977 (document can be obtained from the Office of the Assistant Secretary for Health). For more information on the statistical activities of the center, see Current Listing and Topical Index to the Vital and Health Statistics Series, a publication of the National Center for Health Statistics, or write National Center for Health Statistics, Department of Health. Education, and Welfare, Room 2-19. 3700 East-West Highway, Hyattsville, Md. 20782.
HEW: Health Agencies 165 TABLE 9-4 Principal Periodic Reports of the National Center for Health Statistics General and Health Statistics Publication Series General Reports Series 1 Programs and Collection Procedures Series 2 Data Evaluation and Methods Research Series 3 Analytical Studies Series 4 Documents and Committee Reports Health Statistics Series 10 Data from Health Interview Survey Series 11 Data from Health Examination Survey Series 12 Data from Health Record Survey Series 13 Data from Hospital Discharge Survey Series 14 Data on Health Resources: Manpower and Facilities Vital Statistics Series 20 Data on Mortality Series 21 Data on Natality, Marriage, and Divorce Series 22 Data from the National Natality and Mortality Surveys HEALTH RESOURCES ADMINISTRATION: OTHER AGENCIES Bureau of Health Planning and Resources Development Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 2.171 262 2.433 1.662 2.110 3.772 6.205 1976 849 849 126 3.086 3J12 4.061 1977 849 849 126 3.086 3.212 4.061 The Bureau of Health Planning and Resources Development provides leadership and administration to a program of federal, state, and areawide health planning and health delivery system development. The goal of the bureau is to assist state and local agencies in developing and implementing health planning in accordance with the National Health Planning and Resources Development Act of 1974. Research During fiscal 1975, the bureau supported research projects on ways to improve planning methodology for health services. A sounder knowl- edge base concerning health planning was deemed essential to carry
166 SURVEY OF FEDERAL AGENCIES out the bureau's technical assistance activities. Research in the bureau is now a minor activity, as more emphasis is placed on providing plan- ning assistance. Development of Materials During fiscal 1975, the bureau also supported the development of mate- rials for state and local organizations on planning methodology and the development of agency plans. Dissemination A major activity of the bureau is dissemination. It provides technical assistance to state and local governments for planning. Technical as- sistance is provided on how best to plan for health services at the community level; how medical care affects people's health status; how data can be used to plan health services effectively; and how to meas- ure the relative effectiveness of different health programs. A large portion of the technical assistance information is knowledge-based. For Further Information Write Bureau of Health Planning and Resources Development, Health Resources Admin- istration, Department of Health. Education, and Welfare, 3700 East-West Highway. Hyattsville, Md. 20782. Office of Planning, Evaluation, and Legislation Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 2.286 987 439 3.712 3.712 1976 634 670 1.304 1.304 1977 490 sio 1.000 1.000 The Office of Planning, Evaluation, and Legislation serves as the prin- cipal adviser to the administrator of the Health Resources Administra- tion on long- and short-range planning to meet the health resources needs of the nation. The office develops plans, establishes evaluation requirements, and designs legislative proposals to support departmen- tal goals. In support of its missions, the office funds a variety of re-
HEW: Health Agencies 167 search and program evaluation activities concerning Health Resources Administration programs. Emphasis is placed on providing objective measurements on program performance and the total effectiveness of agency efforts. For Further Information Write Office of Planning, Evaluation, and Legislation, Health Resources Administration, Department of Health, Education, and Welfare, 3700 East-West Highway, Hyattsville, Md. 20782. HEALTH SERVICES ADMINISTRATION Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 14.683 4.213 1*13 20.739 16.757 346 2.655 19.758 40.497 1976 15.273 3.397 2,264 20.934 27.621 472 3.183 31.276 52,210 1977 9.440 500 3.862 2.315 16.117 25.769 350 3.178 29.297 45.414 The primary objectives of the Health Services Administration (HSA) are to provide health services for the underserved or disadvantaged; to build health services delivery capacity in medically underserved areas; to ensure the quality of health care; to foster effective and efficient health services delivery; and to provide services to populations defined by statute. HSA is also expected to provide national leadership in the area of health services delivery. Table 9-5 presents the agencies within HSA that fund social knowl- edge production and application activities. All the agencies are operat- ing agencies, as all administer programmatic activities. The Bureau of Community Health Services is the largest unit within the agency; it funds social knowledge production and application for state and local governments that administer local health services. Over 90 percent of the agency's social knowledge production and application activities is geared to these third parties. For Further Information Write Health Services Administration, Department of Health, Education, and Welfare, 5600 Fishers Lane, Rockville, Md. 20857.
168 SURVEY OF FEDERAL AGENCIES TABLE 9-5 Health Services Administration Agencies that Support Social Knowledge Production and Application: Profile (fiscal 1977, Smillions) Organizational Predominant Location of Total Social Social Social Knowledge Knowledge Knowledge Production Production Production and and and Application Application Application Primary Goal Agency Obligations Activity Activity" or Audience* Bureau of 40.2 Policy Operating Knowledge for Community implementation agency third parties Health Services demonstralions Office of Planning. 1.6 Program Operating Improvement of Evaluation, and evaluation agency federal policy Legislation Bureau of Quality 1.5 Program Operaling Improvement of Assurance evaluation agency federal program Bureau of Medical 1.1 Research Operating Knowledge for Services agency third parties Indian Health 1.0 Policy Operating Improvement of Service implementation agency federal program demonstrations TOTAL 45.4 "See Chapter 2 for a more detailed discussion. BUREAU OF COMMUNITY HEALTH SERVICES Social Knowledge Production and Application Obligations (Sthou sands) Knowledge Production Activities Knowledge Application Activities Policy Formula- Program General Fiscal Re- tion Dem* Evalu- Purpose Year search onstrations ation Statistics Total Policy 1 -Hi -1. in. 1ii Develop- tation Dem- ment of Dissem- onM rat ions Materials ination Total TOTAL 1975 7.893 975 1.512 10.380 15.869 227 2.602 18.698 29.078 1976 7.932 1.262 1.879 1 1 .073 26.706 350 3.128 30.184 41.257 1977 8.353 1.262 1.929 1 1 .544 25.106 350 3.153 28.609 40.153 The Bureau of Community Health Services supported nearly 90 per- cent of the social knowledge production and application activities of the Health Services Administration in fiscal 1977. The bureau is re- sponsible for assisting communities in finding the best way of meeting their health needs and resolving problems of access to health care. The bureau also serves as a national focus for improving the organization
HEW: Health Agencies 169 and delivery of health care. Its mission is accomplished by (1) initiating activities to provide alternatives in health care service delivery and (2) administering programs that support health services to specific popula- tion groups that lack adequate health care. The following programs are administered by the bureau: Neighborhood Health Centers (which provide maternal and child health programs and comprehensive family planning), Migrant Health Clinics, and the National Health Service Corps. The bureau also administers loans to health maintenance or- ganizations. In fiscal 1977 the bureau's social knowledge production and applica- tion activities were funded in five programmatic areas. Table 9-6 lists those programs and their total social knowledge production and appli- cation obligations for fiscal 1977. Rural Health The bureau encourages integrated health care delivery in rural areas through the support of policy implementation demonstrations, which show new approaches and concepts directed at combining, coordinat- ing, and strengthening health service delivery in rural areas. The bureau spent over $23 million on two demonstration programs in fiscal 1977. Both programs were geared to demonstrating a solution to in- adequate and inaccessible health services in rural areas. The largest demonstration program ($16.5 million in fiscal 1977) is the Rural Health Initiative. This demonstration seeks to combine exist- TABLE 9-6 Bureau of Community Health Services Programs that Obligated Social Knowledge Production and Application Funds (fiscal 1977, $millions) Total Social Knowledge Production and Application Program Obligations Rural Health 26.5 Maternal and Child Health 7.8 Family Planning 3.1 International Health Research 1.7 Agency wide Statistics 1.0 TOTAL 40.1
170 SURVEY OF FEDERAL AGENCIES ing elements of rural health care into integrated units that demonstrate how local comprehensive rural health care systems can be formed that not only are self-sufficient but also provide career opportunities to attract and retain physicians and other health professionals in rural communities. The second demonstration is the Health Underserved Rural Areas project, which obligated $8.5 million in fiscal 1977. This demonstration is geared toward improving primary health care in rural areas. Its aim is to show how primary care services can be integrated into a complete system of health care delivery that is financially viable, professionally attractive, and self-sustaining. A secondary goal is to integrate Medicaid patients into a single care system. Maternal and Child Health The bureau administers grants to states for the provision of services to high risk mothers and children. The program enables each state to extend and improve services for promoting the health of mothers and children, reducing infant mortality, and preventing morbidity. The bureau funds mental retardation clinics, maternal and child health ser- vices, crippled children clinics, intensive infant care projects, etc. Approximately 10 percent of the program's total budget is devoted to research and training. In fiscal 1977, the program obligated $5.3 million for research. The basic purpose of the research program is to contrib- ute to the objective of improving the health of mothers and children. It is an applied research program that attempts to bridge the gap between research and the variety of health service projects administered by the bureau. The program funds research on the following topics: the nonuse of existing health services by mothers and children; habilitation and rehabilitation needs of handicapped children; specific disease and health problems of mothers and children (e.g., perinatal mortality, nu- trition and pregnancy, child abuse); health needs of adolescent preg- nant girls; and mental retardation and learning disorders. In addition to its research activities, the program also obligates ap- proximately $2.5 million for a variety of dissemination activities con- cerning maternal and child health. Family Planning The bureau administers grants for family planning services. In support of that program, the bureau funds a variety of knowledge production
HEW: Health Agencies 171 and application activities. The development of materials is supported to assist local clinics. Technical assistance is provided to local family planning clinics on the most effective ways of reaching the target popu- lation. The program also funds program evaluation concerning the ef- fectiveness of the family planning clinics. A small amount of research is funded. International Activities The bureau administers the international health research program of HEW. Individual projects are selected by the Public Health Service agencies on the basis of scientific merit and relevance to domestic program priorities. Work is carried out by foreign investigators in cooperation with research staff from the United States. Agencywide Statistics The bureau also collects and analyzes statistics concerning its target population. Statistics are published concerning the health of mothers and children, number of children served in mental retardation clinics, family planning services, etc. For Further Information Write Bureau of Community Health Services, Health Services Administration, Depart- ment of Health, Education, and Welfare, 5600 Fishers Lane, Rockville, Md. 20857. BUREAU OF MEDICAL SERVICES Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL l»75 6.446 438 331 7.215 250 119 53 422 7.637 1976 6.991 450 385 7.826 265 122 55 442 8,268 1977 730 38« 1.116 25 25 1.141 The Bureau of Medical Services administers the largest direct medical care program in the Public Health Service. Direct health care is pro- vided to merchant seamen and other designated federal beneficiaries.
172 SURVEY OF FEDERAL AGENCIES Occupational health services are provided to federal employees. The bureau administers public health service hospitals, public health ser- vice outpatient clinics, and federal prison hospitals. Prior to fiscal 1977, the bureau was the second-largest funder of social knowledge production and application within the Health Ser- vices Administration. In fiscal 1977, the Ford administration an- nounced plans to close public health service hospitals and hence did not request any research funds for the bureau. The Study Project's figures are based on the President's fiscal 1977 budget request. Con- gress, however, did not agree to close the hospitals, and final appropri- ations for the bureau reflect higher research obligations that are not reported here. The bureau's research activities are administered in two programs: patient care and special health services, and emergency medical services. Both received cuts in the President's fiscal 1977 budget. Research Research is funded by the bureau to study the improvement of the quality, efficiency, and economy of the delivery of federal health ser- vices. Bureau health service research is carried out by interdisciplinary teams of physicians, dentists, nurses, pharmacists, industrial en- gineers, social scientists, and computer programmers. Their efforts are directed to applying modern technology to the problems of planning, organizing, and managing the delivery of federal health services. In addition to health services research, the bureau conducts clinical re- search. The bureau is responsible for providing national leadership for the development, improvement, expansion, and integration of comprehen- sive area emergency medical service systems. Prior to fiscal 1977, this program had a significant research component. The bureau funded studies that examined the following aspects of emergency medical care: o the development of measures of effective system performance; o the testing and evaluation of emergency medical service data sys- tems and the analysis of data concerning time between injury occur- rence and medical treatment and the disability and mortality conse- quences of system failure; and o the study of the manpower and technical combination that could be used as alternative means of delivering health care to rural isolated communities.
HEW: Health Agencies 173 For Further Information Write Bureau of Medical Services, Health Services Administration. Department of Health, Education, and Welfare, 6525 Belcrest Road, Hyattsville, Md. 20782. HEALTH SERVICES ADMINISTRATION: OTHER AGENCIES Health Standards and Quality Bureau Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fisca1 Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1977 500 1.000 1.500 1.500 The Health Standards and Quality Bureau, formerly the Bureau of Quality Assurance, provides national leadership and direction to ef- forts to ensure that health care services provided under the Medicare, Medicaid, and other federal programs are medically necessary and furnished in the most economic manner consistent with recognized professional standards of care. The bureau is currently administering professional standards review organizations (PSROS). In fiscal 1977, a program evaluation of the PSRO program was funded. Two small policy formulation demonstrations are also being funded. The bureau was transferred to the newly created Health Care Financing Administration in March 1977. For Further Information Write Health Standards and Quality Bureau, Health Care Financing Administration, Department of Health, Education, and Welfare. 5600 Fishers Lane, Rockville, Md. 20857.
174 SURVEY OF FEDERAL AGENCIES Indian Health Service Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Devetop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 344 344 638 638 982 1976 350 350 650 650 1.000 1977 357 357 663 663 1.020 The Indian Health Service operates a program of comprehensive health services for eligible American Indians and Alaskan natives. In addition to providing direct service, the Indian Health Service develops innova- tive health delivery systems for Indian groups. Research is supported in that area. The service is now supporting a policy implementation demonstra- tion. A Health Program Systems Center is being funded to develop, test, define, and demonstrate optimal ways of planning, budgeting, implementing, and evaluating the service's comprehensive health pro- gram. As the effectiveness of these planning and analysis procedures and methodologies is demonstrated, it is hoped that they will be used throughout the Indian Health Service. For Further Information Write Indian Health Service. Health Services Administration. Department of Health. Education, and Welfare. 5600 Fishers Lane, Rockville. Md. 20857. Office of Planning, Evaluation and Legislation Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 2.800 2.800 2.800 1976 1.685 1.685 1.685 1977 1.600 1.600 1.600 The Office of Planning, Evaluation and Legislation reports directly to the administrator of HSA. It is responsible for both long-range program
HEW: Health Agencies 175 planning and operational planning as well as evaluation and legislative development. The following evaluations have been supported by the office: o an analysis of HSA program potential under alternative health care financing strategies; o an evaluation of the barriers to implementation of the program and projects in maternal and child health; and o a cost and utilization evaluation of the migrant hospital program. For Further Information Write Office of Planning, Evaluation and Legislation, Health Services Administration, Department of Health, Education, and Welfare, 5600 Fishers Lane, Rockville, Md. 20857. NATIONAL INSTITUTES OF HEALTH Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 36.782 8.086 467 1976 34.557 6.750 526 1977 37.065 6.648 490 45.335 59 6 1.642 18.993 21.231 66.566 41.833 1.182 1.846 19.218 22.246 64.079 44.203 1.182 1.795 20.912 23.889 68.092 The National Institutes of Health (NIH) is the sixth-largest funder of research and development in the feder-al government. (The five largest funders of research and development are: the Department of the Air Force, the Department of Energy, the National Aeronautics and Space Administration, the Department of the Army, and the Department of the Navy.) In fiscal 1977, NIH obligated $1.95 billion for research and development. Of that total, $68 million was found to be social. The mission of NIH is to improve the health of the American people. To carry out this mission, NIH conducts, encourages, and supports health research and development and related activities. Table 9-7 lists the institutes that support social knowledge production and application activities.
176 SURVEY OF FEDERAL AGENCIES TABLE 9-7 National Institutes of Health (fiscal 1977, Smillions) Agency Social Knowledge Production and Application Obligations National Library of Medicine National Cancer Institute National Institute of Child Health and Human Development National Heart, Lung, and Blood Institute National Institute of Neurological and Communicable Diseases and Stroke National Institute of Environmental Health Sciences National Institute of Allergy and Infectious Diseases Fogarty International Center for Advanced Study in the Health Sciences Office of the Director National Eye Institute National Institute of Dental Research National Institute of Arthritis, Metabolism, and Digestive Diseases National Institute of General Medical Sciences National Institute on Aging TOTAL 20.9 18.7 11.1 7.5 3.8 1.5 0.9 0.9 0.8 0.6 0.4 0.3 0.3 0.1 68.1 For Further Information See A Guide to N1H Programs and Awards; National Institutes of Health, Research Grants; and National Institutes of Health, Research Development Contracts, which are publications of NIH, or write National Institutes of Health, Department of Health, Educa- tion, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014. NATIONAL CANCER INSTITUTE Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstralions ation Statistics Total onstrations Materials ination Total TOTAL 1975 12.289 6.468 204 1976 12.289 4.913 227 1977 12,289 4.913 208 18.961 596 17.429 1.182 17.410 1.182 81 89 82 677 19.638 1471 18.700 1.264 18.674
HEW: Health Agencies 177 The National Cancer Institute (NCI) is the federal government's princi- pal agency for cancer research and control. The National Cancer Act of 1971 directed NCI to "plan and develop an expanded, intensified, and coordinated research program encompassing the programs of the Na- tional Cancer Institute, related programs of other research institutions and other federal and nonfederal programs." A major part of that pro- gram is the cancer control program, which demonstrates and com- municates to both the medical community and the general public the latest advances in cancer prevention and management. The Cancer Control and Rehabilitation Program was the only pro- gram in NCI found to support social knowledge production and applica- tion activities. The goal of the cancer control program is to "identify, field test, evaluate, demonstrate and promote the widespread applica- tion of available and new, proven and practical knowledge about the technologies for reducing the incidence, morbidity and mortality from cancer." The total cancer control budget was $55 million in fiscal 1977. Of that total, $18 million was obligated for social knowledge production and application activities. The cancer control program presented a major dilemma for the Study Project: how much of the cancer control program should be included in the survey? On one hand, the cancer control program could be clas- sified as a health service delivery demonstration and the entire program included in the survey. On the other hand, the survey had decided to exclude "biomedical R&D." The definition used by the Study Project was to exclude "research on diseases, syndromes, injuries or condi- tions, whether mental or physical, affecting human beingsâtheir cause, occurrence, prevention, detection, treatment, cure or rehabilita- tion." The dilemma was made more difficult by the fact that conflicting opinions exist on the goals of the cancer control program. Is the pri- mary objective of the breast cancer control demonstrations to deter- mine and compare the relative efficiencies of physical examination, mammography, and thermography in the early detection of breast cancer (with strong emphasis on pretreatment evaluation of persons diagnosed as having breast cancer)? Or is the emphasis on evaluating the cost effectiveness and management issues concerning mass screen- ing programs? The dilemma was never fully resolved. It was decided, however, that biomedical demonstrations would be excluded from the survey. Only demonstration projects or research projects that had a clear behavioral component would be included. Demonstration projects that were primarily geared to testing innovative service delivery programs (with- out a heavy biomedical component) were included in the survey. The decision was made in order to achieve consistency with the remainder of the Study Project survey. By and large, biomedical R&D was
178 SURVEY OF FEDERAL AGENCIES excluded throughout the entire survey. Instances were found, such as the cancer control program, where biomedical demonstrations could have been categorized as service delivery demonstrations and included in the survey. Biomedical demonstrations represent a grey area that the Study Project was never able to clarify fully. The remainder of this section will discuss those parts of the cancer control program that were included in the Study Project survey. It should be noted that dollar figures were not available for fiscal 1977. It was estimated by the cancer control program that the level of obliga- tions would remain steady between fiscal 1976 and fiscal 1977. Thus, the dollar figures are constant for those years. Research The cancer control and rehabilitation program supports several dif- ferent types of research. A small behavioral research program is funded. This program has held conferences on such topics as cancer control and the behavioral sciences. The program funded a history of the cancer control programs from 1946 to 1971. Research is also sup- ported that looks at health personnel issues. One project identified the number and types of personnel needed to conduct cancer control pro- grams in the future. A survey of cancer control laws and review of cancer education programs in medical and dental schools has been supported. Research is funded on community-based cancer control planning techniques. Multidisciplinary groups receive planning re- search grants to develop community-based programs. Another major area of research is cancer rehabilitation. These proj- ects attempt to develop the means, techniques, and methods of re- habilitation and to assess ways in which they can be applied. The following research programs are supported by the cancer control re- habilitation program. PSYCHOLOGICAL ASPECTS OF BREAST CANCER The gOal Of thJS program is to improve the psychological well-being of breast cancer patients and their families and to enhance their readaptation to a nor- mal and satisfactory way of life. PSYCHOSOCIAL REHABILITATION OF CANCER PATIENTS RCSCafCh fo- cuses on ways to improve the ability of the patient and his or her family to deal with inherent psychosocial problems involved in cancer. One aspect of this research focuses on developing means for preventing or treating emotional complications.
HEW: Health Agencies 179 SUICIDE AND OTHER COPING BEHAVIOR OF CANCER PATIENTS is funded to identify coping strategies, types of vulnerability, predomi- nant concerns, and effectiveness of resolution. An index of vulnerabil- ity was developed on the basis of common traits found among patients subject to suicidal thoughts. PSYCHOLOGICAL ADAPTATIONS TO CHILDHOOD LEUKEMIA Increased survival rates for children with leukemia have resulted in growing con- cerns about the effects of diagnosis and treatment upon the psychologi- cal well-being of the child and his or her family. Research has focused on the development of reliable and valid methods for the early identifi- cation of psychologically "high-risk" children and parents. Policy Formulation Demonstrations As noted above, a decision was made to include only demonstrations that had a clear behavioral component or that were primarily aimed at demonstrating a new service delivery mechanism. Thus, the following demonstration programs were included in the survey. DEMONSTRATION OF A CANCER REHABILITATION FACILITY ThJS 5C11C5 of demonstrations developed model patient rehabilitation service sys- tems that provided medical, psychological, and social support covering the entire course of a cancer patient's illness. INTEGRATED CANCER REHABILITATION SERVICE This SCt Of prOJCCtS fo- cused on rehabilitation and continuing care approaches for a multiple institutional approach. The projects provide the medical, psychologi- cal, and social support required to return cancer patients to a normal and productive life. DEVELOPMENT AND IMPLEMENTATION OF AT-HOME REHABILITATION PROGRAMS This demonstration program supported innovative service delivery projects that provide cancer patients with at-home care. A multidisciplinary health team was supported. This project identified the physical, psychological, occupational, nutritional, and continuing needs of discharged patients. EARLY IDENTIFICATION OF PSYCHOSOCIAL PROBLEMS The ODJCCtive Of this program is to test and demonstrate the benefits of early identifica- tion of psychosocial problems and early intervention toward rehabilita-
180 SURVEY OF FEDERAL AGENCIES tion of cancer patients. An experimental group was given selected psychological and social support for improving their overall emotional status and managing selected, known crises, such as reentry into school and work, reestablishment of home and work functions, re- moval of negative attitudes toward use of supportive devices, etc. MODIFICATION OF EMPLOYER'S ATTITUDES TOWARD THE EMPLOYMENT OF WORK-ABLE CANCER PATIENTS These projects attempted to detect barriers to employment, both attitudinal and policy, that are prevalent among employer groups. The goal of the projects was to modify em- ployer attitudes in an effort to improve the employment and/or reem- ployment of cancer patients. Policy Implementation Demonstrations The cancer control and rehabilitation program supports a limited number of "social" policy implementation demonstrations. They in- clude the following. SMOKING EDUCATION These projects were aimed at promoting preven- tive methods for lung cancer. The demonstration contained a compo- nent that demonstrated smoking cessation techniques. Another aspect of the demonstration was aimed at preventing junior high school stu- dents from starting to smoke. PSYCHOSOCIAL REHABILITATION OF CANCER PATIENTS ThCSC prOJCCtS were aimed at demonstrating the effectiveness of individual and group intervention techniques in improving the level of psychosocial func- tioning of cancer patients and their families. In contrast to some of the more experimental programs classified as policy formulation demon- strations, this demonstration was intended to "show off' a successful technique that could be implemented in other cancer treatment pro- grams. For Further Information Write National Cancer Institute, National Institutes of Health, Department of Health, Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014.
HEW: Health Agencies 181 NATIONAL HEART, LUNG, AND BLOOD INSTITUTE Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Impletnen- Develop- Fiscal Re- tion Dem- Evalu- Purpose Ution Dem- men t of Dissem- Year search onstrations ation Statistics Total onstrations Materials inauon Total TOTAL 1975 2.501 1.618 263 4.382 1.142 1.555 2.697 7.079 1976 2.351 1.837 299 4.487 1.29 6 1.765 3.061 7.548 1977 2.632 1.735 822 4.649 1.225 1.668 2.893 7.542 The National Heart, Lung, and Blood Institute provides leadership for a national program on diseases of the heart, blood vessels, lungs, and blood. The institute plans, fosters, and supports a coordinated program of research, investigation, clinical trials, and demonstrations relating to the causes, prevention, diagnosis, and treatment of heart, blood vessel, lung, and blood diseases. Research The institute's social research activities are concentrated in the area of hypertension and coronary heart disease. Research is funded to de- velop social and behavioral instruments for identifying behavioral fac- tors in coronary heart disease. Specific population groups are analyzed for the psychological, socioeconomic, and life situation factors that may lead to heart disease. Racial and socioeconomic factors related to hypertension are analyzed. The institute funds behavioral research on family behavior to see whether the family can be used as an instrument to assist patients in coping with the stress of adhering to post-illness medical regimens. Policy Formulation Demonstrations The institute supports several comprehensive sickle-cell disease cen- ters. The centers combine research and demonstration projects to launch a coordinated attack on the disease. A major component of the centers is a community education and counseling program. The "community" aspects of this demonstration have been included, while the "treatment" aspects have been excluded from the above totals.
182 SURVEY OF FEDERAL AGENCIES Development of Materials A major activity of the institute is supporting educational activities that emphasize the prevention of heart and lung disease. A series of educa- tional materials has been developed concerning hypertension. The Na- tional Research and Demonstration Center for Heart and Vessel Dis- ease has supported the development of materials on smoking. Dissemination The major dissemination activity of the institute is the National High Blood Pressure Education Program. This is a nationwide media and literature dissemination program aimed at creating and enhancing the awareness of both health professionals and the general public to the dangers of untreated high blood pressure and the benefits of treatment. For Further Information See National Heart, Lung, and Blood Institute Catalog of Information and Educational Materials, a publication of the institute, or write National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health, Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014. NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 12.137 12.137 140 140 12.277 1976 10.336 10.336 135 135 10.471 1977 10.956 10.956 130 130 11.086 The mission of the National Institute of Child Health and Human De- velopment is to contribute to the health of citizens through efforts to understand the many factors, both biological and behavioral, related to the adaptation of the world's population to available resources and the expansion of knowledge on family planning, child health, maternal health, and human development. The institute serves as a focal point for major scientific research
HEW: Health Agencies 183 directed toward family planning and improved health for mothers and children. The goals of the institute that are accomplished through re- search are to ensure a pregnancy and subsequent infancy of maximum health and to provide conditions for the optimum development of the child so that full physical and mental potential can be attained by the adult. These objectives are interdependent with a broad understanding of family structure, the dynamics of human population, and the reason- able regulation of its growth. The institute is interested in all problems affecting human development. Research The institute's social research is conducted in two centers: the Center for Population Research and the Center for Research on Mothers and Children. CENTER FOR POPULATION RESEARCH The Center for Population Re- search has responsibility for understanding the forces affecting popula- tion growth, the development and evaluation of contraceptive methods, and the discovery of factors that determine acceptability of contraceptive methods and how they influence fertility patterns. With regard to social research, the center's objective is to develop scien- tifically valid findings on the causes and effects of population growth. It is hoped that these findings will provide the basis for rational decisions by both individuals and governments in matters affecting population growth and distribution. Social research is supported on: o interrelationships between social change and population size, structure, and distribution, with particular emphasis placed upon so- cial, economic, and other determinants and consequences of popula- tion change. o trends in fertility as affected by age at marriage, divorce, and abortion. o interrelationships among family structure, sexual behavior, fertil- ity, illegitimacy, and abortion. o social, economic, and psychological consequences on both par- ents and children of various childbearing patterns. o analysis of policies aimed at regulating population and which indi- rectly affect population growth and distribution. CENTER FOR RESEARCH ON MOTHERS AND CHILDREN The Center for Re- search on Mothers and Children has as its goal the advancement of knowledge on pregnancy, infancy, and childhood. The problems of
184 SURVEY OF FEDERAL AGENCIES human development from both psychosocial and biological standpoints are studied with special reference to the causes, prevention, and amelioration of the problems of mentally retarded children and the developmentally disabled. Social research is supported in the following areas. Growth and Development This program is concerned with human growth and development from birth through adolescence to maturity. The program supports fundamental research to broaden the under- standing of the complex interplay of factors that determine and affect the proper emergence and development of the biological, intellectual, and social characteristics of the individual. Research is supported on: nutrition, learning and cognitive development, human communica- tions, adolescent development, intellect development, and adolescent socialization. Mental Retardation Social research focuses on optimizing the in- tellectual and social performance of those already handicapped and reducing the impact of dysfunction on the family and community. Re- search is supported on: studies of family interaction patterns; patterns of care and service delivery; and the impact of public and professional attitudes on the behavior of retarded persons. For Further Information Write National Institute of Child Health and Human Development, National Institutes of Health, Department of Health. Education, and Welfare. 9000 Rockville Pike, Bethesda, Md. 20014. NATIONAL INSTITUTE OF NEUROLOGICAL AND COMMUNICATIVE DISORDERS AND STROKE Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 3.457 3/57 259 259 3.716 1976 3.284 3.284 271 271 3.555 1977 3.547 3.547 279 279 3.826 The mission of the National Institute of Neurological and Communica- tive Disorders and Stroke is the identification, stimulation, and support
HEW: Health Agencies 185 of essential research activities aimed at improving diagnosis, treat- ment, and prevention of disorders of the nervous system, the neuromuscular apparatus, the ear, human communication, and the senses of taste, smell, touch, and pain. The institute is concerned with certain disorders of the young (cerebral palsy, epilepsy), of adulthood (head and spinal cord injury, multiple sclerosis), and of the aged (stroke, Parkinson's disease). Research Social research is primarily focused on communication. Studies are funded to develop models of linguistic performance and analyze lan- guage acquisition. The institute supports research to measure chil- dren's language performance. The major objective of this research is to improve the understanding of language impairments in neurologically damaged children. The study of memory codes and sentence com- prehension in children is also funded by the institute. For Further Information Write National Institute of Neurological and Communicative Disorders and Stroke, Na- tional Institutes of Health, Department of Health, Education, and Welfare, 9000 Rockville Pike. Bethesda, Md. 20014. NATIONAL LIBRARY OF MEDICINE Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fisca1 Re- tion Dem- Evalu- Purpose ution Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 1.321 1,321 500 16.887 17.387 18,708 1976 1421 1.321 550 16.945 17.495 18.816 1977 1.585 1.585 570 18.740 19.310 20.895 The National Library of Medicine (NLM) is the world's largest research library in a single scientific and professional field. The library has a statutory mandate from Congress to apply its resources broadly to the advancement of medical and health-related sciences. It collects, orga- nizes, and makes available biomedical information to investigators, educators, and practitioners and carries out programs designed to
186 SURVEY OF FEDERAL AGENCIES strengthen and develop new medical library services in the United States. It is also the central resource of the existing national biomedical information system. The Health Services Research Act of 1974 authorized a number of new programs for the National Library of Medicine leading to better access and utilization of health information. The programs assist the health community in finding ways for more rapid and widespread communication of biomedical information. Research The National Library of Medicine supports two types of research proj- ects. The first consists of historical studies of the medical sciences and public health practices. Examples include the history of mental hospi- tals in the United States to 1900; the early history of public health in Western Europe; the diagnosis and treatment of asylum inmates 1824-1860; the development of anatomical sciences (Galen to Ves- alius); the conceptual background of eighteenth century medicine; and science, medicine, and modernization in East Africa. The second type of research support focuses on library and informa- tion technology. Examples of this research include a study of informa- tion needs of practicing physicians; a new approach to organizing med- ical knowledge; the establishment of an information system for the study of bioethics in universities; and the development of new models for medical information communication systems. Dissemination The dissemination of biomedical research represented another grey area for the Study Project survey. After consultation with library staff, it was decided to include the information retrieval systems of the li- brary and their dissemination network activities. Library staff noted that recent legislation had emphasized the health service delivery role of the library. Thus, the dissemination activities of the library were viewed as part of the health service delivery system and hence its activities were classified as "social." The library supports the follow- ing dissemination activities. NATIONAL MEDICAL AUDIOVISUAL CENTER TTlC CCHtCI' JS TCSpOnsible for the development of a national program to improve the quality and use of biomedical audiovisuals in schools of health professionals. The center operates an audiovisual distribution system; compiles catalogs
HEW: Health Agencies 187 and indices of audiovisual materials; assists schools in planning and designing audiovisual facilities; and designs, develops, tests, and eval- uates audiovisual instructional materials. MEDLARS (MEDICAL LITERATURE ANALYSIS AND RETRIEVAL SYS- TEM) This is an information retrieval system developed to achieve rapid bibliographic access to NLM'S vast store of information. MEDLINE (MEDLARS ON-LINE) This system provides an on-line biblio- graphic search capability through terminals in libraries at universities, hospitals, and research institutions. REGIONAL MEDICAL LIBRARY PROGRAM This program supports the de- velopment of a dissemination network. A major goal of this program is to use and build upon existing health institutions and networks for improved information access. LISTER HILL NATIONAL CENTER FOR BIOMEDICAL COMMUNI- CATIONS The center has the responsibility within NLM for improv- ing health care delivery, medical education, and biomedical research through new applications of computer and communication technology. The center also serves as a focal point within HEW for coordination of biomedical communications systems and network projects. For Further Information Write National Library of Medicine, National Institutes of Health, Department of Health, Education, and Welfare, Bethesda. Md. 20014.
188 SURVEY OF FEDERAL AGENCIES NATIONAL INSTITUTES OF HEALTH: OTHER AGENCIES Fogarty International Center for Advanced Study in the Health Sciences Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 191 i 673 673 673 1976 652 652 6?2 1977 900 no 900 The Fogarty International Center for Advanced Study in the Health Sciences was created to advance knowledge in the biomedical and allied sciences and to relate new knowledge to current society. The center was created to study problems in fundamental science, to achieve a greater understanding of the biological and behavioral sci- ences through advanced study, and to identify the legal, ethical, social, and economic problems that may arise from new findings in biomedical research. The center has sponsored conferences in such fields as human genetics, population and family planning, and environmental health problems. Through the exploration of such undertakings at the center, ideas and syntheses may have an impact upon the future devel- opment of medical and biological sciences and the nature of health action in the future. For Further Information Write Fogarty International Center for Advanced Study in the Health Sciences, National Institutes of Health, Department of Health, Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014.
HEW: Health Agencies 189 National Eye Institute Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 578 578 578 1976 578 578 m 1977 «M 614 614 The National Eye Institute conducts and supports research related to the prevention, etiology, diagnosis, and treatment of eye disease and disorders of the visual system. Behavioral research is funded to study sensory processes, mechanisms, and systems of sensation and percep- tion. Much of the behavioral research is geared toward better under- standing of sensorimotor disorders. For Further Information Write National Eye Institute, National Institutes of Health, Department of Health, Edu- calion, and Welfare. 9000 Rockville Pike, Bethesda. Md. 20014. National Institute on Aging Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstralions ation Statistics Total onstrations Materials ination Tota! TOTAL 1975 110 110 110 1976 110 110 110 1977 179 179 179 The National Institute on Aging was created in 1974 to conduct and support biomedical and behavioral research to increase knowledge of the aging process. The diseases and other special problems and needs of the elderly are studied. Research is funded on the psychosocial problems of the elderly. This area includes research on probable future age structures of the population and studies of cognitive functioning during the aging process. Other studies examine the health impact of
190 SURVEY OF FEDERAL AGENCIES interpersonal relations, worklife, and retirement in the aging and aged. Studies are conducted on the impact of housing and institutional care on health. For Further Information Write National Institute on Aging, National Institutes of Health, Department of Health. Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014. National institute of Allergy and Infectious Diseases Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose t.inon Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 806 806 806 1976 806 MK M6 1»77 919 919 919 The National Institute of Allergy and Infectious Diseases conducts and supports research that will contribute to a better understanding of the causes of allergic, immunologic, and infectious diseases and to the development of better means of preventing, diagnosing, and treating these illnesses. The institute is concerned with the following infectious diseases: venereal diseases, hepatitis, influenza, and other viral respi- ratory infections. Social research is concerned with the study of "hu- man ecology." These studies examine social systems as modes of ad- aptation of human population to environmental conditions. The rela- tionship between infectious diseases and environmental conditions is analyzed. For Further Information Write National Institute of Allergy and Infectious Diseases, National Institutes of Health. Department of Health, Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014.
HEW: Health Agencies 191 National Institute of Arthritis, Metabolism, and Digestive Diseases Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 296 1976 275 1977 308 29 6 m 308 29 6 275 3tt The National Institute of Arthritis, Metabolism, and Digestive Dis- eases conducts and supports research related to a broad array of dis- eases that are characterized by chronicity and long-term disabling ef- fects rather than by mortalityâillnesses such as arthritic disease, dia- betes, liver disease, blood disease, and kidney disease. Social research in the institute is primarily concerned with the relationship between human behavior and biological correlates. For Further Information Write National Institute of Arthritis, Metabolism, and Digestive Diseases, National Insti- tutes of Health, Department of Health, Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014. National Institute of Dental Research Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 397 1976 385 1977 412 397 385 412 397 385 412 The National Institute of Dental Research conducts research on the causes, prevention, diagnosis, and treatment of oral and dental dis- eases and conditions. The institute has a small program of pain control and behavioral studies. In addition to behavioral studies directly re- lated to pain, research is supported on the psychological aspects of a variety of oral-facial problems. The program also supports studies con-
192 SURVEY OF FEDERAL AGENCIES cerning the psychological factors related to accepting dental health care. For Further Information Write National Institute of Dental Research, National Institutes of Health, Department of Health, Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014, National Institute of Environmental Health Sciences Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- ment of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 1.189 1.189 1.189 1976 1.154 1.154 1.154 1977 1.569 1.569 I.5W The National Institute of Environmental Health Sciences serves as a national resource and focal point for environmental health research. Its mission is to develop an understanding of the factors and biological mechanisms involved in human disease and disorders of environmental origins. A major goal is to develop understanding of the interrelation- ships between chemical and physical factors in the environment and human disease and to translate that knowledge into action to relieve human problems of environmental origin. In addition to the general contribution to biomedical and clinical knowledge, institute research is intended to provide health criteria for the establishment of standards by those federal agencies charged with regulatory response. A small amount of research is devoted to the social and legal aspects of environmental health. For Further Information See National Institute of Environmental Health Sciences Research Programs. 1976- 1977, a publication of the institute, or write National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health, Education, and Welfare, P.O. Box 12233, Research Triangle Park, N.C. 27709.
HEW: Health Agencies 193 National Institute of General Medical Sciences Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- men t of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 341 Ml 12 12 353 1976 3M 13 13 313 1977 346 346 13 13 359 The National Institute of General Medical Sciences supports research and training in basic or general biomedical sciences that have signifi- cance for two or more NIH institutes and are outside the general area of responsibility of any other institute. The institute supports behavioral science research related to the study of trauma and burns. This type of research includes the study of the effectiveness of cognitive strategies in reducing pain. For Further Information Write National Institute of General Medical Sciences, National Institutes of Health, Department of Health, Education, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014. Office of the Director Social Knowledge Production and Application Obligations (Sthousands) Knowledge Production Activities Knowledge Application Activities Policy Policy Formula- Program General Implemen- Develop- Fiscal Re- tion Dem- Evalu- Purpose tation Dem- meni of Dissem- Year search onstrations ation Statistics Total onstrations Materials ination Total TOTAL 1975 665 665 59 59 724 1976 705 705 705 1977 797 191 797 The director of the National Institutes of Health provides overall lead- ership to NIH activities and maintains close liaison with the assistant secretary for health on matters related to medical research, research training, health professional education and training, manpower re- sources, and biomedical communications. The office is also responsi-
194 SURVEY OF FEDERAL AGENCIES ble for assessing the growth of medical research nationally and apply- ing those findings to future program planning. In connection with its responsibilities, the office has funded the following projects: a study of the economic return for training in bioscience; a study of how the employment market absorbs new biomedical scientists; a study of the need for biomedical and behavioral research personnel; and research on the trends in cost of diseases related to biomedical research. For Further Information Write Office of the Director, National Institutes of Health, Department of Health, Edu- cation, and Welfare, 9000 Rockville Pike, Bethesda, Md. 20014.
