Functional Area Problems. Opportunities, and Constraints 49 



Indians and Alaskan natives living on reservations. The 

 network includes 51 hospitals, 99 health centers, and 

 more than 300 health stations and satellite field health 

 clinics.^ 



There is a need for systematic evaluations of existing 

 programs over the next 5 years to provide a basis for 

 adapting or redesigning health care services to meet the 

 needs of all Americans. It is necessary to know if partici- 

 pants in government-sponsored programs receive health 

 care equal to that received by other Americans, and 

 whether health service agencies can be modified to 

 provide for preventive health services to participants. 

 Assessments of the relative merits of various delivery 

 models for the provision of care to selected populations 

 are also needed. 



CONSTRAINTS ON ADVANCES IN THE HEALTH 

 AREA 



The preceding discussion and those in the appended 

 Source Volumes highlight a large number of current and 

 emerging opportunities for science and technology to 

 have significant positive impacts on national health prob- 

 lems. The ability of the science and technology enterprise 

 to exploit fully those opportunities will depend on a 

 number of policy decisions to be made in the next few 

 years. Most of the issues about which those decisions will 

 have to be made are generic to all areas of science and 

 technology; they concern such factors as financial re- 

 sources, instrumentation, and information transfer. Two 

 types of constraints on exploiting opportunities for im- 

 proving the health of the American public are worth 

 mentioning explicitly; (1) human resource limitations, and 

 (2) effects of regulations on biomedical research. 



In the case of human resource limitations, there re- 

 mains the perennial problem of the geographic distribu- 

 tion of physicians. Additionally, there currently is a 

 decrease in the number of young physicians entering 

 careers in academic medicine, which will present prob- 

 lems in the longer term. Whereas, in the past, more than 



one third of medical students aspired to a career as clini- 

 cian-teacher-investigator, that fraction has now dimin- 

 ished significantly. It is evident in terms of both the 

 number of vacancies on medical school faculties and the 

 number of applications for research support received by 

 government agencies from persons with M.D. degrees. 

 Although the causes of that trend are not well understood, 

 it has serious implications." Much of the progress in 

 medicine during the past decade has come from academic 

 physicians. Therefore, reversing that trend will be an 

 important priority for the coming years if we are to realize 

 the full potential for improved health presented by scien- 

 tific and technological activities (NRC-Obs.). 



Federal regulations impose a second major constraint 

 on health-related scientific and technological activities. 

 Whereas in many cases regulations are imposed on the 

 products of research and development, regulations in the 

 health area are frequently imposed on the scientific ac- 

 tivities themselves (Section I-E). There is no disagree- 

 ment that some control should be placed on health-related 

 science and technology activities. Clearly, no individual 

 should be subjected to undue harm, whether physical or 

 psychological, as a result of biomedical research, what- 

 ever the potential benefits to be derived by society. 

 However, applying those regulations in specific cases to 

 determine, for example, what constitutes undue harm, or 

 undue harm relative to a certain anticipated benefit, is 

 often exceedingly difficult. Moreover, there is a growing 

 belief that some regulations of biomedical research have 

 been unduly restrictive and have unnecessarily hampered 

 health-related scientific and technological progress. That 

 concern, and the discussion surrounding it. led to revi- 

 sions in the guidelines for recombinant DNA research in 

 November 1980 and to revisions in the regulations for the 

 protection of human and animal subjects in research sup- 

 ported by the Department of Health and Human Services 

 in January 1981. Continued discussion and evaluation of 

 the regulations controlling those research activities will be 

 needed to ensure maximal use of the potential from bio- 

 medical research in the coming years. 



REFERENCES 



1. U.S. Department of Health. Education and Welfare. Healihy Peo- 

 ple. The Surf>eim General's Report on Health Promotion and Disease 

 Prevention. Washington, D.C.: U.S. Government Pnnting Office, 1979. 



2. Ibid. 



3. National Data Book. Washington, D.C.: Alcohol. Drug Abuse, 

 and Mental Health Administration. January 1980. p. 10. 



4. U.S. Department of Health and Human Services. Health Research 



Activities c^ the Department of Health anil Human Services: Current 

 Efforts and Proposed Initiatives. A report of the HHS Steering Commit- 

 tee for the Development of a Health Research Strategy. NIH Publication 

 No. 80-2053. Washington. D.C.: U.S. Government Printing Office. 

 1980. 



5. Indian Health Service, Justification for Appropriation, Fiscal Year 

 1979. pp 2-15. 



6. Personnel Needs and Training for Biomedical and Behavioral 

 Research. Washington. D.C: National Academy of Sciences. 1980. 



