Report on NIH Collaborations with Other HHS Agencies for Fiscal Year 2023

Summary

Introduction

This annual report captures the extent and nature of activities undertaken by the National Institutes of Health (NIH) in collaboration with the other agencies and divisions of the Department of Health and Human Services (HHS). Tasked with improving the health of the American public, HHS consists of many agencies and divisions, and collaborations among these different components are vital to the success of the department as a whole. In recognition of the important role of collaborations between HHS agencies, Congress added section 403A(a) of the Public Health Service Act, 42 U.S.C. § 283a(a), Annual Reporting to Increase Interagency Collaboration and Coordination, via Section 104 of the National Institutes of Health Reform Act of 2006. This law mandates that the NIH Director provide to the Secretary of HHS an annual report on NIH’s collaborations with other HHS agencies. This, NIH’s seventeenth report to the Secretary, covers Fiscal Year 2023 (FY23).

Background

The HHS mission is to enhance the health and well-being of all Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. As outlined in the HHS Strategic Plan for FY 2022-2026, the Department sets forth five interrelated, strategic goals to achieve this mission:

• Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare
• Safeguard and Improve National and Global Health Conditions and Outcomes
• Strengthen Social Well-Being, Equity, and Economic Resilience
• Restore Trust and Accelerate Advancements in Science and Research for All
• Advance Strategic Management to Build Trust, Transparency, and Accountability

HHS accomplishes its mission and meets its strategic goals, and associated objectives, strategies, and performance goals, through the activities of its thirteen operating divisions, including ten agencies in the U.S. Public Health Service and three human service agencies, which administer HHS’ multifaceted programs and initiatives. In addition, staff divisions of the Office of the Secretary provide leadership, direction, and policy guidance to the Department. Together, this ‘HHS Family’ covers a vast spectrum of activities that affect health and human services outcomes. With more than 100 programs across the Department, the ultimate success of all components of the HHS family is enhanced by interagency collaborations that enable agencies to combine their knowledge and diverse expertise to accomplish their collective mission. This cross-agency teamwork is necessary to create a collaborative community within HHS that accelerates progress in medicine, health services, and public health programs.

As the largest research arm of HHS, NIH’s mission is to seek fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to enhance health, lengthen life, and reduce illness and disability, which it fulfills through its congressionally mandated NIH-Wide Strategic Plan for FY 2021-2025. NIH’s collaborative efforts with other HHS agencies are vital to transforming fundamental scientific and technical information into effective, knowledge-based approaches that advance the health and safety of the public, such as disease treatments, preventive interventions, protective health policies and regulations, and public health campaigns. In turn, the information provided by other HHS agencies on public health needs informs NIH research policies and priorities.

The interagency collaborations included in this report cover joint activities undertaken by NIH with all other components of HHS, including the staff divisions within the Office of the Secretary¹ and the other twelve operating divisions of HHS:

• Administration for Children and Families (ACF)
• Administration for Community Living (ACL)
• Advanced Research Projects Agency for Health (ARPA-H)
• Agency for Healthcare Research and Quality (AHRQ)
• Administration for Strategic Preparedness and Response (ASPR)
• Agency for Toxic Substances & Disease Registry (ATSDR)
• Centers for Disease Control and Prevention (CDC)
• Centers for Medicare & Medicaid Services (CMS)
• Food and Drug Administration (FDA)
• Health Resources and Services Administration (HRSA)
• Indian Health Service (IHS)
• Substance Abuse and Mental Health Services Administration (SAMHSA)

FY23 Collaborations by the Numbers

NIH and other HHS operating and staff divisions reported 937 collaborative activities in FY23. These cross-agency collaborations demonstrate the complex array of efforts in which NIH contributes to enhance public health. As depicted below in Chart 1, these collaborations span a range of topics, including activities devoted to improving healthcare quality and safety, expanding knowledge, and stimulating innovation.

Each collaborative activity has been categorized based on the nature of the activity. Chart 1 illustrates how the activities break down across the following categories: Group (e.g., Committee, Work Group, Advisory Group, Task Force) (611); Research Initiative (131); Resource Development, (e.g., database, disease registry, information clearinghouse) (71); Other (47); Meeting/Workshop (35); Health Survey (16); Public Education Campaign (14); or Training Initiative (12).

Chart 2 displays the number of reported collaborative activities that NIH engaged in with each HHS operating or staff division in FY23.² As Chart 2 illustrates, most NIH’s collaborations were with CDC (404) and FDA (357). Given the complementary missions of CDC, FDA, and NIH, the three agencies often work closely together to build on each other’s strengths and achieve shared objectives. While NIH conducts and funds basic and applied biomedical and behavioral research, CDC engages in health promotion, prevention of disease, injury and disability, and preparedness for new health threats. FDA ensures the safety of drugs, vaccines, medical devices, and many other health products that stem from biomedical research. There are also substantial collaborations between NIH and the Office of the Secretary, especially in the coordination of multi-agency initiatives, committees, and working groups.

FY23 Collaboration Highlights

The HHS Strategic Plan for FY 2022-2026 describes the Department’s work to address complex, multifaceted, and evolving health and human services issues. As described above, it outlines five strategic goals. NIH works closely with its sister agencies to address each of these goals in a myriad of ways. These collaborative activities also contribute toward advancing the priorities set forth in theNIH-Wide Strategic Plan for FY 2021-2025. The following examples of collaborative NIH activities describe a few of the many efforts undertaken to achieve the Department’s strategic goal areas.

Protect and Strengthen Equitable Access to High Quality and Affordable Healthcare

To support the Department’s goals to improve equitable access to effective healthcare, NIH has joined in collaborative activities with ARPA-H, CDC, CMS, FDA, and other agencies outside of HHS. NIH participates in the Cancer Cabinet, a part of the next phase of the Cancer Moonshot with bold new goals: to reduce the cancer death rate by half within 25 years and improve the lives of people with cancer and cancer survivors. This initiative brings together departments and agencies from across the federal government including members from 20 executive branch departments, agencies, and offices. Priority actions for the Cancer Cabinet include closing the screening gap by providing access to more cancer screening opportunities and expanding equitable access to cancer early detection, expanding access to cancer-prevention approaches, and bringing cutting-edge research through the pipeline to patients and communities.

NIH has engaged in ongoing collaborations with FDA to expand healthcare access to the almost 30 million adults living in the U.S. with some degree of hearing loss. Previously, only about one-fifth of those who could benefit from a hearing aid have used one, despite the benefits, including improved social participation and a better quality of life. At the beginning of FY23, to expand access to more Americans, and supported by NIH research, FDA established a new category of over-the-counter (OTC) hearing aids for adults 18 years of age and older with perceived mild to moderate hearing loss. Following this success, NIH and FDA convened the Working Group on Accessible and Affordable Hearing Health Care for Adults to tackle topics related to hearing health care access and affordability. The goal of this working group was to gather input from subject matter experts and partners about hearing health care needs that remain, and about new work that should be conducted both in the context of OTC hearing aid availability and, more broadly, in the changing landscape of health care.

Safeguard and Improve National and Global Health Conditions and Outcomes

In FY23 NIH engaged in many new and long-standing collaborative activities to support HHS’s efforts to enhance the overall health and well-being of our nation and the world. Access to nutritious food is critical to health and resilience. HHS launched a Food is Medicine initiative in FY23, following the White House Conference on Hunger, Nutrition, and Health, and in response to a congressional directive. As a result of this directive, the Secretary of HHS, in consultation with NIH and other federal agencies including ACF, ACL, AHRQ, CDC, CMS, FDA, HRSA, IHS, IOS, OASH, Department of Transportation (DOT), Department of Education (ED), Department of Housing and Urban Development (HUD), Department of Agriculture (USDA), and the Department of Veterans Affairs (VA), have begun developing and implementing a federal strategy to reduce nutrition-related chronic diseases and food insecurity to improve health and racial equity in the U.S. This includes diet-related research and programmatic efforts that will increase access to Food is Medicine initiatives, many of which will be implemented, at least in part, by NIH. By supporting the production of and facilitating access to nutritious food across a health continuum and range of settings, Food is Medicine approaches provide immediate and long-term resources for people, communities, and systems enhancing overall health and well-being for all.

Established in 1997, the President’s Task Force on Environmental Health Risks and Safety Risks to Children is cochaired by the EPA and HHS, and it is tasked with ensuring that federal agency policies, programs, activities, and standards address disproportionate risks to children that result from environmental health risks or safety risks. This Task Force has addressed issues such as childhood asthma, unintentional injuries, lead poisoning, developmental disorders, childhood cancer, and climate change. In FY23 the Task Force supported new guidance released by the FDA titled Action Levels for Lead in Food Intended for Babies and Young Children. Working together through the Task Force, NIH, ACF, ASPR, ATSDR, CDC, FDA, SAMHSA, OASH, and other partners outside of HHS, will continue to protect current and future generations by understanding and preventing negative environmental health impacts and helping to ensure the development of healthier, more resilient children.

Strengthen Social Well-Being, Equity, and Economic Resilience

NIH is committed to working across the Department to strengthen social well-being, equity, and economic resilience in the nation. Towards this aim, in FY23 NIH joined the Task Force on Maternal Mental Health, co-led by the HHS Office on Women’s Health and SAMHSA. The Task Force aims to identify, evaluate, and make recommendations to coordinate and improve activities addressing maternal mental health conditions and co-occurring substance use disorders focusing on mental health equity as well as trauma-informed practices. A truly collaborative effort, the Task Force is made up of both federal members (representing ACF, ACL, AHRQ, ASPE, CDC, CMS, HRSA, IEA, IHS, NIH, OASH, and the Department of Energy) and nonfederal members, including those with lived experience to ensure these efforts are effective for those most impacted. The existing SAMHSA Advisory Committee for Women’s Services will be called upon to execute the recommendations from this Task Force.

Additionally, representatives from NIH, along with ACF, ACL, ASPE, CDC, HRSA, ONC, and SAMHSA, serve on the Advisory Council to Support Grandparents Raising Grandchildren. The number of grandparents and other older relatives who are caring for children in the U.S., is significant and growing, in part due to the opioid crisis. Although caregivers' lives are enhanced by the experience, providing full-time care to children can decrease caregivers' abilities to address their own health and well-being needs. This Advisory Council works to identify, promote, coordinate, and disseminate information, resources, and best practices to help grandparents and older relative caregivers of children. This will allow those caregivers to meet the health, educational, nutritional, and other needs of the children, while maintaining their own physical, mental, and emotional well-being.

Restore Trust and Accelerate Advancements in Science and Research for All

As the largest research arm of HHS, NIH works with others across the Department to support responsible, effective, and rapid scientific advances. In April 2018, NIH launched The Helping to End Addiction Long-term® Initiative, or NIH HEAL Initiative, a cross agency effort to speed scientific solutions to stem the national opioid public health crisis. This Initiative builds on extensive, well-established NIH research, including basic science to understand the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with medications for opioid use disorder. The NIH HEAL Initiative forges collaborations among research programs across NIH, HHS (including AHRQ, CDC, CMS, FDA, HRSA, OS, and SAMHSA), and the private sector to improve treatments for opioid misuse and addiction and enhance pain management. In FY23, HEAL had 314 ongoing clinical trials and 41 submissions to the FDA for clinical testing of investigational new drugs or devices.

NIH participates in the Interagency Group on Alzheimer's Disease and Related Dementias (AD/ADRD) along with ACL, AHRQ, AoA, ASPE, CDC, CMS, HRSA, IHS, NIH, OASH, SAMHSA, and additional federal partners outside of HHS to implement the National Alzheimer’s Project Act. This interagency group, established by HHS, works to coordinate research and services across agencies, accelerate the development of AD/ADRD treatments, improve early diagnosis and coordination of care, reduce ethnic and racial disparities in rates of AD/ADRD, and coordinate with international efforts to fight these conditions. Coordinating these efforts across agencies ensures more efficient and effective science, resulting in better healthcare faster.

Advance Strategic Management to Build Trust, Transparency, and Accountability

Beyond investing in health-focused policies and programs, NIH engages across the Department to advance the internal operations that build trust, transparency, and accountability. NIH participates in the HHS Evidence and Evaluation Policy Council, a Department-wide group that develops evaluation capacity by sharing best practices and promising new approaches across HHS in alignment with The Foundations for Evidence-Based Policymaking Act of 2018, P.L. 115-435. Evaluation and analysis provide essential evidence for HHS to understand how its programs work, for whom, and under what circumstances. HHS uses this evidence to inform decisions in budget, legislative, regulatory, strategic planning, program, and policy arenas. Given the breadth of work supported by HHS, many evaluations and analyses are conducted each year. These efforts range in scope, scale, design, and methodology, but all aim to understand how the effect of programs and policies and how they can be improved.

Additionally, NIH helps to promote improved federal coordination through the Federal Health IT Coordinating Council, organized by the Office of the National Coordinator for Health Information Technology. This is a voluntary group of 25 HHS agencies (including ACF, ACL, AHRQ, ASA, ASPE, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, OCR, OIG, and SAMHSA) actively implementing the national health IT agenda. Among the topics addressed at coordination meetings are: 21st Century Cures Act, P.L. 114-255 implementation, the MyHealthEData Initiative, Digital Health, and Health Insurance Portability and Accountability Act of 1996 (HIPAA) Audits and HIPAA Access Right. These important activities enhance strategic management of the Department.

Conclusions

HHS’s mission is to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services. The 937 collaborative activities that NIH engaged in with other entities across the Department in FY23 are critical for successful implementation of that mission. The American public’s investment in NIH provides the nation with a unique resource—a scientific agency devoted to the creation of the knowledge base needed to conquer the most devastating and common human diseases and to improve health for all. For this knowledge base to have impact, the Department, the entire federal government, and the private sector, must continue to work in concert to cultivate ground-breaking biomedical and behavioral research to ensure that scientific knowledge is translated into evidence-based policies, improved health services and medical intervention delivery, and reliable science-based information that all Americans can use to lead healthier lives.

NIH appreciates the opportunity to report on its collaborations within HHS. The policies, programs, and regulatory and service activities developed and carried out by HHS operating and staff divisions are some of the most effective means the government can use to improve the health and well-being of its citizens. The collaborative activities detailed in this report illustrate how NIH works across the Department to cultivate partnerships, leveraging the respective strengths of all HHS agencies to support the HHS mission, and strengthen the public health ecosystem.