INTRODUCTION OF HEALTH PROMOTION FIRST (FUNDING INTEGRATED RESEARCH SYNTHESIS AND TRAINING) IN THE UNITED STATES SENATE

On September 14, 2004, Senator Richard Lugar (R-IN) introduced Health Promotion FIRST (Funding Integrated Synthesis, Research and Training) (S2798), in the United States Senate with original co-sponsorship by Senators Jeff Bingaman (D-MN), Jim Bunning (R-KY), Maria Cantwell (D-WA), Hillary Clinton (D-NY) Thad Cochran (R-MS, Ben Nighthorse Campbell (R-CO) Lindsey Graham (R-SC). and James Jeffords (I-VT). Health Promotion FIRST was conceived and championed by Health Promotion Advocates (www.HealthPromotionAdvocates.org). I have written about some of the details of this legislation previously and will focus on its overall contents in this column. Health Promotion FIRST will be reintroduced in 2005 and Health Promotion Advocates will work to pass it before the end of the 109th Congress (2005–2006).

The purpose of Health Promotion FIRST is to develop the basic and applied science of health promotion, and to lay plans to integrate health promotion into all aspects of society. The bill has four major components: coordination and planning, health promotion research at the National Institutes of Health (NIH), health promotion at the Centers for Disease Control and Prevention (CDC) and attracting the most qualified experts to federal health-promotion efforts while empowering the existing health-promotion infrastructure. Each of these major components is discussed below.

CO-ORDINATION AND PLANNING

Section 2901 of the bill directs the United States Department of Health and Human Services (HHS) to develop strategic plans to enhance the basic and applied science of health promotion.¹ Specifically, these enhancements include, how to utilize the authority of the HHS to integrate health promotion concepts into health care and other elements of society; how to utilize the authority of other departments of the federal government to integrate health promotion concepts into society² ; how to synthesize health promotion research into practical guidelines and disseminate them to practitioners, students, employers, policy makers, and others³ ; and how to support and develop the scientific and professional health promotion workforce. This section also directs the HHS to seek input from many disciplines in developing this plan including medicine, nursing, exercise science, nutrition, psychology, management, health education, city planning, transportation, anthropology, and others.

Section 2901 is important because it lays the foundation for what we expect to be significant growth in federal policy related to health promotion. It starts with the presumption that solutions should not be limited to those from “traditional” health experts and programs offered by the HHS.

Health Promotion Research at the National Institutes of Health

Sections 2911 and 2912 direct the NIH to develop an institute-wide health promotion research agenda, allocate funds for health promotion research regarding the burden of lifestyle on disease and death relative to other causes, and create a trans-institute initiative for health promotion. It also specifies that at least 90% of these programs’ funds would be distributed through grants and contracts to non-government organizations.

These sections are important for providing the research funds necessary to fully reveal the basic mechanisms of health behavior, to provide coordination for the growing number of health promotion research efforts at the NIH, and to ensure that funds flowing into this area flow to the research community instead of being retained by the NIH.

Health Promotion at the Centers for Disease Control and Prevention

 Section 2921 directs the CDC to update its "applied research" agenda for health promotion. Section 2922 directs the CDC to create up to 30 new Health Promotion Research Centers based in schools and departments of anthropology, city planning, education, exercise science, public policy, management, nutrition, nursing, psychology, transportation and private research organizations. Section 2923 directs the extramural research program to attract grant applications from groups with extensive health promotion programming experience but limited research, and to allocate some funds for developing the applied science of health promotion in work, school, family, clinical, and community settings. Section 2925 specifies that at least 75% of the program funds be distributed through grants and contracts to non-government organizations, and encourages state and local health departments to hire local providers unless the basic infrastructure necessary to support programs already exists.

These four sections are important because they provide direction and funding for refining the most effective strategies to reach diverse populations through school, work, family, clinical and neighborhood settings, among others; to integrate health promotion concepts into the thinking of many academic disciplines; to engage the most qualified experts in health promotion applied research efforts; and to ensure that new funds flow to the applied research community instead of being retained by the CDC.

Attracting the Most Qualified Experts and Empowering the Health Promotion Infrastructure

Section 2931 of Health Promotion FIRST specifies that the HHS will make efforts to engage the most experienced and qualified health promotion scientists and practitioners in all grant and contract opportunities. Rather than expanding state and federal government, this section would ensure that funds are distributed to the health promotion community to empower, rather than compete with, it.

Section 2931 is important to ensure that federal funds are used in the most efficient way for developing the basic and applied science of health promotion, and that the existing health promotion infrastructure is not cannibalized by increased federal investment in health promotion.

The introduction of Health Promotion FIRST in the United States Senate is an important milestone both for health promotion advocacy and for stimulating the evolution of the basic and applied science of health promotion. Nearly five years were devoted to identifying the gaps in health promotion research and planning, surveying the existing health promotion work of federal agencies, meeting with hundreds of members of Congress, building support within the health promotion community, and writing this legislation.⁴ During this time, Health Promotion Advocates evolved from a loosely defined idea of building health promotion into the national agenda among a handful of people to a non-profit corporation with a clear vision and mission over 70 active committee members, 700 grass roots advocates, dozens of organizational collaborators, working relationships with dozens of Congressional offices, and the commitment to continue work to integrate health promotion concepts into all aspects of society.

To pass Health Promotion FIRST we need to build our team so we have a visible presence in Washington, D.C. To succeed in integrating health promotion concepts into all aspects of society, we need to build our team until we are as powerful as the other major advocacy groups in Washington, D.C. We will do this through collaborative efforts with existing powerful health advocacy groups and by working to engage all health promotion professionals across academic disciplines in the advocacy process. Call me today, or tomorrow, or next week to get involved!

References

1. O’Donnell, M. How to develop the basic and applied science of health promotion. Am J Health Prom. 2004:18:vi– vii.
2. O’Donnell, M. Harnessing the full power of the federal government to promote good health. Am J Health Prom. 2004;18:iv–vi.
3. O’Donnell, M. Synthesis and dissemination of research findings: a critical next step in the evolution of health promotion. Am J Health Prom. 2004;18:iv–v.
4. O’Donnell, M. Building health promotion in the national agenda. Am J Health Prom. 2000;14:iv.
 

Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion