Outlook | A Quarterly Newsletter of the Society of Behavioral Medicine

Limited Dollars Raise Tough Questions: Is Funding for Physical Activity Research a Case of Either/Or?

As an active member of the Physical Activity (PA) Special Interest Group (SIG) and the PA SIG Assistant Editor of Outlook, Dr. David Marquez asked two funded, respected SBM researchers to take on this question. Drs. Claudio Nigg and Barbara Resnick were asked to write mock letters to a funding agency requesting that more funding be budgeted for physical activity research for youth or older adults, respectively. In a time of increasingly limited budgets for behavioral medicine research, funds are often allocated to address specific topics or to study certain subgroups of individuals. It is an unfortunate reality for researchers at the present time, and one that warrants thoughtful consideration. The purpose of this article is to encourage SBM members to think about where they stand on this issue, and to consider arguments from the opposing viewpoint. The take home message is that this is not a question of either/or: we clearly need to advocate for funding across the entire lifespan - young and old - to optimize what we know and to promote health among Americans of all ages.

Disclaimer: These mock letters to a funding agency were written to have researchers critically think about funding decisions. They are not letters that will be sent to a funding agency, nor are they meant to suggest that the authors think funding should be cut from any areas of research. Rather, both authors fully support funding for research across the lifespan. For this article, however, they were asked to take a specific side of an argument.

Dear Funder,

As the baby boomers retire in the next 15 years, a lot of attention will be drawn to this age group. They will have significant clout and will impact the political and private agenda, as they have the resources to influence these systems. However, there is a group that does not have this luxury and will not have the same resources to argue their cause. That group is our youth.

For example, Jenny, a 5-year old girl starts kindergarten already overweight. She spends about 3-4 hours each day with her handheld computer game or watching TV, snacking on chips and eating fast food or frozen dinners. The school system she is in has a focus on math, reading, and writing, and has relegated PE, health, art, and music to only once per week. Her parents have to work to afford housing and to pay off the car and university loans, and do not have time to cook fresh meals or prepare healthy snacks, let alone go outside to play for half an hour with her. Thus, the family eats out a lot at fast-food restaurants or puts frozen meals in the microwave. Jenny is actually quite common in our cities, towns, and villages across the USA. She has very little chance of growing up healthy unless more attention and resources are directed towards the health of our youth.

Today's youth will be the first generation to experience poorer health and not live as long as their parents. Unhealthy children become unhealthy adolescents and unhealthy adolescents become unhealthy adults. For example, only 30 years ago early onset diabetes meant getting diabetes around 30-40 years old. Today, as many as one in four children are overweight (95% of weight for their height) entering Kindergarten. Relatedly, we now have overweight children with diabetes who have to worry about the complications such as limb amputations and blindness in their 20s.

Increasing funding commitment to health research addressing youth will have positive impacts on a broad range of issues including:

Chronic disease (cancer, diabetes, obesity, cardiovascular disease, etc.)
Infectious disease (tuberculosis, SARS, Dengue fever, HIV/STD etc.)
Prenatal and infant health (genetics, low birth weight, SIDS, etc.)
Pro-social development (conflict resolution, bullying, cooperation, etc.)
Optimal development (gene-environment interactions, physiology, psychology, etc.)
Academic achievement (optimizing performance, focus, concentration, etc.)
Leadership development
Multi-generational involvement for health (caregiving, caretaking, family building, etc.)
Health technologies (objective and subjective assessment, intervention, etc.)

More importantly, the health care system costs are increasing at an alarming rate. By 2050 the costs will actually be larger than the gross domestic product of the U.S. Essentially the health care system as we know it will either undergo a drastic change or collapse within the foreseeable future. Therefore, the children of today will have poorer health and a broken health care system to take care of them.

I urge you to consider this as we investigate how to ensure that children and youth adopt and maintain healthy behaviors and lifestyles so they will not have to rely on a broken health care system. We must focus our resources and attention on our future - and our future is our children.

I trust you will make the right choices.

Sincerely,

Claudio Nigg, PhD
Department of Public Health Sciences
John A. Burns School of Medicine
University of Hawaii at Manoa

Dear Funder,

We are currently in a time period in which careful consideration must be given to the allocation of financial resources. I am, however, requesting that you consider the distribution of an increased percentage of funds to the National Institute of Aging (NIA) this year compared to the resources that were received in the 2007-2008 funding period. The NIA, as you well know, was established in 1974 and is one of the 27 Institutes and Centers of the National Institute of Health. NIA was developed to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people. Subsequent amendments to the initial legislation designated the NIA as the primary federal agency on Alzheimer's disease research. In 1974, the establishment of NIA was innovative and important. Today, however, the existence and viability of NIA is critical. It is estimated that in the next 25 years there will be 70 million Americans reaching retirement and the impact this will have on our economic, health care, and social systems must be addressed. Individuals are spending more years of life in older age and thus must learn how to optimize life with the subsequent changes that occur. Despite some evidence that the prevalence of disability among older adults is declining, the majority of older individuals have at least one chronic illness and a large percentage can expect to have impairments in abilities to perform basic and more advanced activities of daily living. It is essential to understand the issues that older adults face physically and cognitively and to establish solutions to the challenges encountered in this age group. Such work has an impact on every American directly as we are all aging, and indirectly as each of us are or will be a caregiver at some point in our adult lives.

Through research we have been able to establish innovative approaches to care for frail individuals and those with multiple co-morbidities. This work has helped lead the way toward decreasing disability associated with aging and optimizing quality of life. Future research in aging is geared toward such things as:

increasing the understanding of Alzheimer's disease, changes in memory and cognition, and other degenerative diseases of the nervous system, and developing interventions to prevent, diagnose early, and treat these conditions;
increasing our understanding of cardiovascular disease, cancer, and diabetes and considering personalized approaches to prevent and manage these diseases across the lifespan;
helping older adults with vision, hearing, and other sensory disorders;
addressing common bone, muscle, skin, joint, and movement disorders;
understanding the impact of nutrition and exercise;
optimizing surgical interventions;
establishing new biological and technological interventions to optimize life quality for older individuals; and
expanding our understanding of the physical, psychological, psychiatric, and social changes that occur. Without additional resources allocated to the NIA, this critical work cannot be done. Halting our discovery of knowledge in these areas at a time when greater understanding is needed to manage the aging of the baby boomers would be devastating to those of us aging as well as to the children and grandchildren who will be forced to provide care without sufficient information or direction.

Sincerely,

Barbara Resnick, PhD, CRNP, FAAN, FAANP
University of Maryland School of Nursing
Department of Epidemiology and Preventive Medicine
University of Maryland School of Medicine


Spring/Summer 2008	Return to Outlook Main page >>
Limited Dollars Raise Tough Questions: Is Funding for Physical Activity Research a Case of Either/Or? As an active member of the Physical Activity (PA) Special Interest Group (SIG) and the PA SIG Assistant Editor of Outlook, Dr. David Marquez asked two funded, respected SBM researchers to take on this question. Drs. Claudio Nigg and Barbara Resnick were asked to write mock letters to a funding agency requesting that more funding be budgeted for physical activity research for youth or older adults, respectively. In a time of increasingly limited budgets for behavioral medicine research, funds are often allocated to address specific topics or to study certain subgroups of individuals. It is an unfortunate reality for researchers at the present time, and one that warrants thoughtful consideration. The purpose of this article is to encourage SBM members to think about where they stand on this issue, and to consider arguments from the opposing viewpoint. The take home message is that this is not a question of either/or: we clearly need to advocate for funding across the entire lifespan - young and old - to optimize what we know and to promote health among Americans of all ages. Disclaimer: These mock letters to a funding agency were written to have researchers critically think about funding decisions. They are not letters that will be sent to a funding agency, nor are they meant to suggest that the authors think funding should be cut from any areas of research. Rather, both authors fully support funding for research across the lifespan. For this article, however, they were asked to take a specific side of an argument. Dear Funder, As the baby boomers retire in the next 15 years, a lot of attention will be drawn to this age group. They will have significant clout and will impact the political and private agenda, as they have the resources to influence these systems. However, there is a group that does not have this luxury and will not have the same resources to argue their cause. That group is our youth. For example, Jenny, a 5-year old girl starts kindergarten already overweight. She spends about 3-4 hours each day with her handheld computer game or watching TV, snacking on chips and eating fast food or frozen dinners. The school system she is in has a focus on math, reading, and writing, and has relegated PE, health, art, and music to only once per week. Her parents have to work to afford housing and to pay off the car and university loans, and do not have time to cook fresh meals or prepare healthy snacks, let alone go outside to play for half an hour with her. Thus, the family eats out a lot at fast-food restaurants or puts frozen meals in the microwave. Jenny is actually quite common in our cities, towns, and villages across the USA. She has very little chance of growing up healthy unless more attention and resources are directed towards the health of our youth. Today's youth will be the first generation to experience poorer health and not live as long as their parents. Unhealthy children become unhealthy adolescents and unhealthy adolescents become unhealthy adults. For example, only 30 years ago early onset diabetes meant getting diabetes around 30-40 years old. Today, as many as one in four children are overweight (95% of weight for their height) entering Kindergarten. Relatedly, we now have overweight children with diabetes who have to worry about the complications such as limb amputations and blindness in their 20s. Increasing funding commitment to health research addressing youth will have positive impacts on a broad range of issues including: Chronic disease (cancer, diabetes, obesity, cardiovascular disease, etc.) Infectious disease (tuberculosis, SARS, Dengue fever, HIV/STD etc.) Prenatal and infant health (genetics, low birth weight, SIDS, etc.) Pro-social development (conflict resolution, bullying, cooperation, etc.) Optimal development (gene-environment interactions, physiology, psychology, etc.) Academic achievement (optimizing performance, focus, concentration, etc.) Leadership development Multi-generational involvement for health (caregiving, caretaking, family building, etc.) Health technologies (objective and subjective assessment, intervention, etc.) More importantly, the health care system costs are increasing at an alarming rate. By 2050 the costs will actually be larger than the gross domestic product of the U.S. Essentially the health care system as we know it will either undergo a drastic change or collapse within the foreseeable future. Therefore, the children of today will have poorer health and a broken health care system to take care of them. I urge you to consider this as we investigate how to ensure that children and youth adopt and maintain healthy behaviors and lifestyles so they will not have to rely on a broken health care system. We must focus our resources and attention on our future - and our future is our children. I trust you will make the right choices. Sincerely, Claudio Nigg, PhD Department of Public Health Sciences John A. Burns School of Medicine University of Hawaii at Manoa Dear Funder, We are currently in a time period in which careful consideration must be given to the allocation of financial resources. I am, however, requesting that you consider the distribution of an increased percentage of funds to the National Institute of Aging (NIA) this year compared to the resources that were received in the 2007-2008 funding period. The NIA, as you well know, was established in 1974 and is one of the 27 Institutes and Centers of the National Institute of Health. NIA was developed to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people. Subsequent amendments to the initial legislation designated the NIA as the primary federal agency on Alzheimer's disease research. In 1974, the establishment of NIA was innovative and important. Today, however, the existence and viability of NIA is critical. It is estimated that in the next 25 years there will be 70 million Americans reaching retirement and the impact this will have on our economic, health care, and social systems must be addressed. Individuals are spending more years of life in older age and thus must learn how to optimize life with the subsequent changes that occur. Despite some evidence that the prevalence of disability among older adults is declining, the majority of older individuals have at least one chronic illness and a large percentage can expect to have impairments in abilities to perform basic and more advanced activities of daily living. It is essential to understand the issues that older adults face physically and cognitively and to establish solutions to the challenges encountered in this age group. Such work has an impact on every American directly as we are all aging, and indirectly as each of us are or will be a caregiver at some point in our adult lives. Through research we have been able to establish innovative approaches to care for frail individuals and those with multiple co-morbidities. This work has helped lead the way toward decreasing disability associated with aging and optimizing quality of life. Future research in aging is geared toward such things as: increasing the understanding of Alzheimer's disease, changes in memory and cognition, and other degenerative diseases of the nervous system, and developing interventions to prevent, diagnose early, and treat these conditions; increasing our understanding of cardiovascular disease, cancer, and diabetes and considering personalized approaches to prevent and manage these diseases across the lifespan; helping older adults with vision, hearing, and other sensory disorders; addressing common bone, muscle, skin, joint, and movement disorders; understanding the impact of nutrition and exercise; optimizing surgical interventions; establishing new biological and technological interventions to optimize life quality for older individuals; and expanding our understanding of the physical, psychological, psychiatric, and social changes that occur. Without additional resources allocated to the NIA, this critical work cannot be done. Halting our discovery of knowledge in these areas at a time when greater understanding is needed to manage the aging of the baby boomers would be devastating to those of us aging as well as to the children and grandchildren who will be forced to provide care without sufficient information or direction. Sincerely, Barbara Resnick, PhD, CRNP, FAAN, FAANP University of Maryland School of Nursing Department of Epidemiology and Preventive Medicine University of Maryland School of Medicine