Book Report "Enabling America: Assessing the Role of Rehabilitation Science and Engineering" Institute of Medicine, 1997 Copyright National Academy of Sciences A draft copy is available now by credit card only $45 + $4 S&H 800/624-6242 The final version will be available in August. Its cost is expected to be $45. National Academy Press 2101 Constitution Ave., NW Box 285 Washington, DC 20055 Discounts are available as are single review copies from the same phone / address ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ REPORT IN BRIEF Americans are living longer but experiencing more disabilities. By recognizing and boosting support for the emerging field of rehabilitation science and engineering, the federal government could improve the lives of many of the 49 million Americans who have disabling conditions. Rehabilitation science and engineering -- a multidisciplinary endeavor that encompasses basic and applied research in the health sciences, social sciences, and engineering -- is ready to assume a prominent position in America's health research agenda, according to a National Research Council committee in its new report Enabling America: Assessing the Role of Rehabilitation Science and Engineering. But funding for the field is now starkly disproportionate to the huge costs of disabilities. And research must be focused on a set of priorities that will simultaneously advance knowledge and improve the health, productivity, and quality of life for people with disabilities. A reorganization of federal efforts could help boost the field and coordinate research, the committee says. The National Institute on Disability and Rehabilitation Research (NIDRR) should be moved from the Department of Education to the Department of Health and Human Services (HHS), where it would serve as the foundation for a new Agency on Disability and Rehabilitation Research. This new agency would have enhanced authority for reviewing and coordinating the research components of the many federal programs that address the needs of people with disabling conditions. In addition, all major programs in disability and rehabilitation research should be elevated within their respective agencies or departments. Scant funding Disabling conditions range widely, from congenital disorders or spinal-cord injuries to diseases such as asthma or multiple sclerosis. Almost 10 million Americans -- or about 4 percent of the nation's population -- have a disabling condition so severe they are unable to carry out fundamental activities of life, such as attending school, working, or providing for their own care. An additional 6 percent are limited in their ability to engage in such activities, and another 4 percent are limited in social, recreational, or other pursuits. The economic costs associated with these disabilities are enormous. Medical expenditures for disabilities and the indirect costs from lost productivity exceed $300 billion each year, or more than 4 percent of the gross domestic product. These large costs stand in stark contrast to the scant funding directed toward research in rehabilitation science and engineering, the committee notes. Current expenditures of about $133 million per year in the major federal research programs amount to less than $7 annually for each person with a disability, whereas the costs of disabilities per person are almost 1,000 times greater. By providing new means of restoring function in people with disabilities, the committee says, enhanced research in rehabilitation science and engineering would substantially reduce the health care costs, loss of wages, and emotional distress caused by disabilities. Focused research Rehabilitation research in basic science, health, and engineering -- while well balanced -- is neither comprehensive nor focused on the most important priorities. Recognizing rehabilitation science and engineering more widely as an organized field of study will address these problems as well as stimulating innovations and coordinating people and ideas. For example, it will connect basic research on the function of molecules, cells, organs, and organ systems more strongly to the study of human disabilities and rehabilitation. A particular focus for research should be the physical, social, and psychological factors in the environment that affect human capabilities. Disability results from the interaction between human limitations and environmental influences such as whether adequate care is available or whether a social support network is in place. The rehabilitative process thus encompasses both the restoration of function in the individual and changes in the environment, and research must consider this entire range of factors. Health services research, focused on how best to organize, deliver, and finance interventions for people with disabling conditions, needs to be a priority, as well. This research should evaluate the cost-effectiveness of specific interventions as well as new and existing approaches to the organization and delivery of services. It should seek to understand better the health care and long-term support needs of persons with disabilities. And it should focus on the potential impact of alternative models of managed care on access to and use of services, the quality of care, costs, and outcomes. Technology transfer Many government agencies that support rehabilitation-related research have programs to help move ideas, products, and techniques from research to application. But there is no well-organized mechanism for distributing research findings in rehabilitation science and engineering to those providing services. The government should help develop and implement these connections. Such technology transfer efforts should involve consumers, assure quality, and enhance the delivery of services. Federal reorganization Moving NIDRR from the Education Department to HHS would produce a number of benefits, according to the committee. It would place the new agency in a more research-oriented environment, emphasize the importance of disability and rehabilitation as a health issue, and create an effective coordinating body for research in the field. The Agency on Disability and Rehabilitation Research should review plans for research submitted by other agencies, including the Veterans Administration, the National Science Foundation, the Centers for Disease Control and Prevention, and the National Institutes of Health. It also should have the ability both to fund interagency research and to enhance funding in areas of identified need. Creating new links The upcoming reauthorization of the Rehabilitation Act of 1973 presents Congress with a superb opportunity to make a difference in the lives of millions of people. By fostering the development of rehabilitation science and engineering, Congress can forge strong links between this vibrant field of study and the needs of Americans who have disabling conditions. The study was funded by the U.S. Department of Health and Human Services. Permission is granted to reproduce this report brief in its entirety, with no additions or alterations. 5/97