Perhaps Dickens said it best: “It was the best of times, it was the worst of times.” America’s current economic crisis has many citizens and lawmakers feeling negative pressure and uncertainty about feasible solutions to recovery. America has long been hailed a leader in innovation in science and technology, but with the debt ceiling collapsing and unemployment rates remaining steadily high, the viability of the country’s strength and health hang in the balance. Within the Chinese culture, the word crisis is synonymous with the word opportunity. What opportunity then does the economic crisis that began in 2007 and still reaches into today hold for the US economy?
According to Research America: An Alliance for Discoveries in Health, over 50 percent of U.S. economic growth since WWII has been attributed to advances in scientific discovery. The group contends that strengthening investments in scientific research and innovation is the best way to improve health, enhance the nation’s security and encourage growth in the economy. Lawmakers agree. Understanding the critical importance of scientific innovation and discovery, President Barack Obama has called for an increase in federal funding in medical and scientific research from programs such as the National Institutes of Health (NIH). In 2012, he proposed that NIH receive $31.8-billion, up 2.4 percent from its fiscal-2010 levels.
NIH is the largest funder of research in the nation. The NIH drives the economy by directly supporting jobs in all 50 states that are essential to innovations in health. Once the NIH fund limit is set, hospital systems, universities, private practitioners and research intuitions must prove themselves worthy of grant giving by completing a very competitive application process. To qualify for funds, institutions must show that the funding will be used to transform health care by improving the quality of care received, extending healthy life, and reducing the burdens of illness and disability on the economy. NIH awards grants specifically for research and also those that support research-related activities such as fellowship and training, career development and scientific conferences. Systems must have in place the appropriate “health innovation technology” or HIT to be considered for federal funds. HIT includes the use of electronic health records instead of paper medical records to maintain people’s health information. All proposals must be of high scientific caliber, relevant to public health needs and fall within NIH priorities set for the given time period. Research projects typically focus on the following disease states and conditions: cancer, genetics & genomics, cardiovascular health, reducing health disparities in certain socioeconomic groups, autism, mental health, aging and substance abuse. NIH uses a multiple-step process to fund projects. After submission, the proposal is sent to one of many committees for peer review where it is scored and, if deemed worthy of consideration, forwarded to a body called the Council at the Institute. Councils are arranged by disease state. The appropriate Council then ranks each proposal and decides which proposals will be funded until funds are depleted.
In 2010, the State of South Carolina received a total of 388 awards from the NIH totaling $145,108,261. Over $98,000,000 went to the Medical University of South Carolina who received 261 awards. The next largest granted institution was the University of South Carolina in Columbia where 85 awards were granted totaling $31,604,341. The only hospital in the state to get NIH monies was the Spartanburg Regional Medical Center. Clemson University was awarded 23 grants totaling $6,920,000.
Below is a partial breakdown of the $1.4 billion in stimulus funding from the ARRA act in 2009 from the U.S. Department of Health and Human Services in the State of South Carolina for Community Health Centers, universities and other institutions in the State. The monies were designed to “provide fiscal relief, improve and expand access to health care, provide child care and other social services for its most vulnerable citizens, establish the infrastructure for health information technology, and conduct scientific research” according to the Department.
- $1 billion for the increased Federal share (FMAP) of State Medicaid costs.
- $70.3 million for health information technology (IT)
- $55.5 million for scientific research and facilities
- $36.4 million for the Child Care and Development Fund to increase access to child care and improve quality.
- $34.8 million for Community Health Center services, construction, renovation, equipment, and health IT.
- $19 million for Temporary Assistance for Needy Families (TANF), including $1.9 million for subsidized jobs programs.
- $13.4 million for the Community Services Block Grant for community action agencies to reduce poverty and help low-income residents become self-sufficient.
- $2.7 million to support 57 National Health Service Corps clinicians providing primary health care in Health Professional Shortage areas.
- $1.9 million for immunization programs.
- $1.4 million for meals and nutrition services for the elderly.
- $272,000 through the Indian Health Service, including EPA funds, for health care and sanitation facilities construction, maintenance and improvements, equipment, and health IT.
Dr. Brenda Thames, Vice President of Academic Development at Greenville Hospital System University Medical Center, says that since competition for federal awards is very steep on both the national and local levels, as shown above, larger research and academic hospitals such as MUSC often receive the lionshare of funding from not only the NIH but also from private funders in research, based primarily on name recognition. She adds that this trend of favoritism allows for many populations in need of advanced healthcare to suffer due to lack of exposure. Associate Provost for Research at MUSC, Stephen M. Lanier, Ph.D., suggests that other obstacles exist to potentially obstruct funding for research in certain areas such as lack of infrastructure, poor research capacity and economic sustainability found in many rural areas, particularly in the South. For example, he states that the area of South Carolina that extends into Georgia is known as the “stroke belt” in the medical profession because of the high incidence of heart attack and stroke among residents. Many times advanced treatments which are potentially life saving are not available in areas such as this due to lack of funding.
In order to counter these potential threats, both research professionals suggest that smaller hospital systems and those without teaching and research components seek outside funding from private corporations and foundations and most importantly form strategic partnerships and collaborations with other institutions to fund research. Legislators in South Carolina have strategic partnering as a high priory on their agendas to remain competitive as a state in the research realm. Examples of these collaborations include: the Health Sciences South Carolina (HSSC), a statewide collaborative formed in 2004 comprised of researchers from Clemson University, the Greenville Hospital System University Medical Center, the Medical University of South Carolina, Palmetto Health System, and the Spartanburg Regional Healthcare System; the South Carolina Bioengineering Alliance (SCBA), a collaborative effort formed in 1985 among Clemson University, MUSC, and University of South Carolina with a mission to promote, strengthen, and develop bioengineering research, education, and technology transfer across the state; and the Institute for Translational Oncology Research (ITOR) of Greenville Hospital System University Medical Center which partners with USC, Clemson University and the University of Minnesota along with the Cancer Center of the Carolinas and other partners in the research field.
Forming collaborations increases the chance that projects will be considered for national funding from rigorous agencies such as NIH and ensures that money is fairly distributed throughout the state. Without research funding citizens are not able to properly compete in the national and global economic system. Research America has estimated that a one percent reduction in cancer deaths could save the national economy $500 billion. While budget cuts in all areas show a decrease in economic strength, the lack of investment in health and scientific discovery is potentially harmful for all Americans. The insight shown by South Carolina policy makers and hospital systems choosing to partner to increase funding opportunities appears to be the correct choice for ensuring that the state remains competitive and its residents healthy.