TY - BOOK AU - Institute of Medicine AU - National Research Council A2 - Gerald T. Keusch A2 - Marguerite Pappaioanou A2 - Mila C. González A2 - Kimberly A. Scott A2 - Peggy Tsai TI - Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases SN - DO - 10.17226/12625 PY - 2009 UR - https://nap.nationalacademies.org/catalog/12625/sustaining-global-surveillance-and-response-to-emerging-zoonotic-diseases PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Agriculture KW - Conflict and Security Issues AB - H1N1 ("swine flu"), SARS, mad cow disease, and HIV/AIDS are a few examples of zoonotic diseases-diseases transmitted between humans and animals. Zoonotic diseases are a growing concern given multiple factors: their often novel and unpredictable nature, their ability to emerge anywhere and spread rapidly around the globe, and their major economic toll on several disparate industries. Infectious disease surveillance systems are used to detect this threat to human and animal health. By systematically collecting data on the occurrence of infectious diseases in humans and animals, investigators can track the spread of disease and provide an early warning to human and animal health officials, nationally and internationally, for follow-up and response. Unfortunately, and for many reasons, current disease surveillance has been ineffective or untimely in alerting officials to emerging zoonotic diseases. Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases assesses some of the disease surveillance systems around the world, and recommends ways to improve early detection and response. The book presents solutions for improved coordination between human and animal health sectors, and among governments and international organizations. Parties seeking to improve the detection and response to zoonotic diseases—including U.S. government and international health policy makers, researchers, epidemiologists, human health clinicians, and veterinarians—can use this book to help curtail the threat zoonotic diseases pose to economies, societies, and health. ER - TY - BOOK AU - Institute of Medicine TI - Review of the DoD-GEIS Influenza Programs: Strengthening Global Surveillance and Response SN - DO - 10.17226/11974 PY - 2008 UR - https://nap.nationalacademies.org/catalog/11974/review-of-the-dod-geis-influenza-programs-strengthening-global-surveillance PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The influenza pandemics of 1918, 1957, and 1968 offer a warning to the world about the potential dangers of the influenza virus. In 2006, after a series of cases and clusters of the highly pathogenic H5N1 avian virus made clear the threat of a possible pandemic, the U.S. Congress allocated $39 million to the Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS) to increase and improve its worldwide influenza surveillance network through upgrades to its domestic and overseas laboratories' capabilities. An Institute of Medicine (IOM) committee was subsequently formed to evaluate the effectiveness of these laboratory-based programs in relation to the supplemental funding, and the report that follows details the committee's findings. The committee that prepared this report, the Committee for the Assessment of DoD-GEIS Influenza Surveillance and Response Programs, was convened at the request of DoD-GEIS management to evaluate the execution of the fiscal year 2006 supplemental funding for avian influenza/ pandemic influenza (AI/PI) surveillance and response. The committee was tasked with evaluating the DoD-GEIS AI/PI surveillance program for the worth of each funded project's contribution to a comprehensive AI/PI surveillance program; the adequacy of the program in view of the evolving epidemiologic factors; responsiveness to the intent of Congress as expressed in Sec. 748, H.R.1815, Pandemic Avian Flu Preparedness; consistency with the DoD and national plans; and coordination of efforts with CDC, WHO, and local governments. Review of the DoD-GEIS Influenza Programs: Strengthening Global Surveillance and Response reviews the development of conclusions and recommendations with long-term, program-level relevance as well as conclusions and recommendations regarding the improvement of specific DoD-GEIS projects. ER - TY - BOOK AU - Institute of Medicine AU - National Research Council A2 - Alexandra Beatty A2 - Kimberly Scott A2 - Peggy Tsai TI - Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin: Workshop Summary SN - DO - 10.17226/12522 PY - 2008 UR - https://nap.nationalacademies.org/catalog/12522/achieving-sustainable-global-capacity-for-surveillance-and-response-to-emerging-diseases-of-zoonotic-origin PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Agriculture AB - One of the biggest threats today is the uncertainty surrounding the emergence of a novel pathogen or the re-emergence of a known infectious disease that might result in disease outbreaks with great losses of human life and immense global economic consequences. Over the past six decades, most of the emerging infectious disease events in humans have been caused by zoonotic pathogens--those infectious agents that are transmitted from animals to humans. In June 2008, the Institute of Medicine's and National Research Council's Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin convened a workshop. This workshop addressed the reasons for the transmission of zoonotic disease and explored the current global capacity for zoonotic disease surveillance. ER - TY - BOOK AU - Institute of Medicine A2 - Philip S. Brachman A2 - Heather C. O'Maonaigh A2 - Richard N. Miller TI - Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review SN - DO - 10.17226/10203 PY - 2001 UR - https://nap.nationalacademies.org/catalog/10203/perspectives-on-the-department-of-defense-global-emerging-infections-surveillance-and-response-system PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - Perspectives on the Department of Defense Global Emerging Infections Surveillance and Response System: A Program Review describes the capacity, quality, and effectiveness of the international and domestic facilities and programs that are a part of a DoD system to monitor and address emerging infectious diseases globally. The committee concludes that the goals of the system are in U.S. military, U.S. civilian, and global public health interests and that substantial progress has been made toward achieving system goals. ER - TY - BOOK AU - Institute of Medicine A2 - Stanley M. Lemon A2 - Margaret A. Hamburg A2 - P. Frederick Sparling A2 - Eileen R. Choffnes A2 - Alison Mack TI - Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary SN - DO - 10.17226/11996 PY - 2007 UR - https://nap.nationalacademies.org/catalog/11996/global-infectious-disease-surveillance-and-detection-assessing-the-challenges-finding PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Conflict and Security Issues AB - Early detection is essential to the control of emerging, reemerging, and novel infectious diseases, whether naturally occurring or intentionally introduced. Containing the spread of such diseases in a profoundly interconnected world requires active vigilance for signs of an outbreak, rapid recognition of its presence, and diagnosis of its microbial cause, in addition to strategies and resources for an appropriate and efficient response. Although these actions are often viewed in terms of human public health, they also challenge the plant and animal health communities. Surveillance, defined as "the continual scrutiny of all aspects of occurrence and spread of a disease that are pertinent to effective control", involves the "systematic collection, analysis, interpretation, and dissemination of health data." Disease detection and diagnosis is the act of discovering a novel, emerging, or reemerging disease or disease event and identifying its cause. Diagnosis is "the cornerstone of effective disease control and prevention efforts, including surveillance." Disease surveillance and detection relies heavily on the astute individual: the clinician, veterinarian, plant pathologist, farmer, livestock manager, or agricultural extension agent who notices something unusual, atypical, or suspicious and brings this discovery in a timely way to the attention of an appropriate representative of human public health, veterinary medicine, or agriculture. Most developed countries have the ability to detect and diagnose human, animal, and plant diseases. Global Infectious Disease Surveillance and Detection: Assessing the Challenges—Finding Solutions, Workshop Summary is part of a 10 book series and summarizes the recommendations and presentations of the workshop. ER - TY - BOOK AU - National Academy of Medicine A2 - Laura Harbold DeStefano A2 - Elena Fuentes-Afflick A2 - Eve Higginbotham A2 - Mary Woolley A2 - Keith Yamamoto TI - Transforming Human Health: Celebrating 50 Years of Discovery and Progress SN - DO - 10.17226/26722 PY - 2022 UR - https://nap.nationalacademies.org/catalog/26722/transforming-human-health-celebrating-50-years-of-discovery-and-progress PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The past half-century has been an era of astonishing progress for biomedical science, health, and health care in the United States and worldwide. This volume, commissioned to mark the occasion of the 50th anniversary of the founding of the U.S. National Academy of Medicine (NAM; formerly the Institute of Medicine [IOM]), tells the story of that progress across five major fields: biomedical science and technology, diseases and conditions, public health, U.S. health care, and global health. Since the NAM was founded in 1970, the nation and the world have seen multitudes of remarkable "firsts"—including the dawn of targeted gene therapies, the near eradication of polio, revolutionary treatments for cancers and cardiovascular disease, and many more. NAM members were the architects of many of these breakthroughs, alongside countless dedicated scientists, clinicians, educators, and public health leaders worldwide. The milestones chronicled in this volume are a testament to their remarkable work, which has saved and improved innumerable lives. ER - TY - BOOK A2 - Scott P. Layne A2 - Tony J. Beugelsdijk A2 - C. Kumar A2 - N. Patel TI - Firepower in the Lab: Automation in the Fight Against Infectious Diseases and Bioterrorism SN - DO - 10.17226/9749 PY - 2001 UR - https://nap.nationalacademies.org/catalog/9749/firepower-in-the-lab-automation-in-the-fight-against-infectious PB - The National Academies Press CY - Washington, DC LA - English KW - Explore Science KW - Conflict and Security Issues AB - Today's world poses a triple threat to the American population: infectious diseases, contamination of food and water, and bioattacks (biowarfare or bioterrorism). At least 17 countries are producing weapons of mass destruction using viruses, bacteria, or their toxins. AIDS, E. coli contamination, drug-resistant tuberculosis, and virulent flu strains are perhaps the best known of a host of disease threats. What these dangers have in common is the amount of data required to achieve solutions; in some cases, as much as a petabit (1 followed by 15 zeros) of data is required to study large numbers of samples from widespread locations. Firepower in the Lab examines how the nation can combat this triple threat by improving our ability to detect, measure, and monitor harmful biological agents. It explores the potential of today's exciting new laboratory automation and computer technologies as well as the emerging tools of molecular biology--how we can generate and analyze more data quickly and reduce human hands-on involvement, which inevitably introduces errors. The book discusses how to improve and apply technologies such as robotics, laboratory automation, "lab-on-a-chip," bioinformatics, and Internet control innovations. It reviews lessons learned from our experience with pandemic flu viruses. It also presents strategies for developing new high-throughput technologies, including how to address the lack of public funding for critical research undertakings. ER - TY - BOOK AU - Institute of Medicine A2 - Eileen R. Choffnes A2 - Alison Mack TI - The Influence of Global Environmental Change on Infectious Disease Dynamics: Workshop Summary SN - DO - 10.17226/18800 PY - 2014 UR - https://nap.nationalacademies.org/catalog/18800/the-influence-of-global-environmental-change-on-infectious-disease-dynamics PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Conflict and Security Issues AB - The twentieth century witnessed an era of unprecedented, large-scale, anthropogenic changes to the natural environment. Understanding how environmental factors directly and indirectly affect the emergence and spread of infectious disease has assumed global importance for life on this planet. While the causal links between environmental change and disease emergence are complex, progress in understanding these links, as well as how their impacts may vary across space and time, will require transdisciplinary, transnational, collaborative research. This research may draw upon the expertise, tools, and approaches from a variety of disciplines. Such research may inform improvements in global readiness and capacity for surveillance, detection, and response to emerging microbial threats to plant, animal, and human health. The Influence of Global Environmental Change on Infectious Disease Dynamics is the summary of a workshop hosted by the Institute of Medicine Forum on Microbial Threats in September 2013 to explore the scientific and policy implications of the impacts of global environmental change on infectious disease emergence, establishment, and spread. This report examines the observed and potential influence of environmental factors, acting both individually and in synergy, on infectious disease dynamics. The report considers a range of approaches to improve global readiness and capacity for surveillance, detection, and response to emerging microbial threats to plant, animal, and human health in the face of ongoing global environmental change. ER - TY - BOOK AU - Institute of Medicine A2 - David A. Relman A2 - Eileen R. Choffnes A2 - Alison Mack TI - Infectious Disease Movement in a Borderless World: Workshop Summary SN - DO - 10.17226/12758 PY - 2010 UR - https://nap.nationalacademies.org/catalog/12758/infectious-disease-movement-in-a-borderless-world-workshop-summary PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine KW - Conflict and Security Issues AB - Modern transportation allows people, animals, and plants--and the pathogens they carry--to travel more easily than ever before. The ease and speed of travel, tourism, and international trade connect once-remote areas with one another, eliminating many of the geographic and cultural barriers that once limited the spread of disease. Because of our global interconnectedness through transportation, tourism and trade, infectious diseases emerge more frequently; spread greater distances; pass more easily between humans and animals; and evolve into new and more virulent strains. The IOM's Forum on Microbial Threats hosted the workshop "Globalization, Movement of Pathogens (and Their Hosts) and the Revised International Health Regulations" December 16-17, 2008 in order to explore issues related to infectious disease spread in a "borderless" world. Participants discussed the global emergence, establishment, and surveillance of infectious diseases; the complex relationship between travel, trade, tourism, and the spread of infectious diseases; national and international policies for mitigating disease movement locally and globally; and obstacles and opportunities for detecting and containing these potentially wide-reaching and devastating diseases. This document summarizes the workshop. ER - TY - BOOK TI - PY - UR - PB - The National Academies Press CY - Washington, DC LA - English ER - TY - BOOK AU - National Research Council TI - New Research Opportunities in the Earth Sciences SN - DO - 10.17226/13236 PY - 2012 UR - https://nap.nationalacademies.org/catalog/13236/new-research-opportunities-in-the-earth-sciences PB - The National Academies Press CY - Washington, DC LA - English KW - Earth Sciences AB - The 2001 National Research Council (NRC) report Basic Research Opportunities in Earth Science (BROES) described how basic research in the Earth sciences serves five national imperatives: (1) discovery, use, and conservation of natural resources; (2) characterization and mitigation of natural hazards; (3) geotechnical support of commercial and infrastructure development; (4) stewardship of the environment; and (5) terrestrial surveillance for global security and national defense. This perspective is even more pressing today, and will persist into the future, with ever-growing emphasis. Today's world-with headlines dominated by issues involving fossil fuel and water resources, earthquake and tsunami disasters claiming hundreds of thousands of lives and causing hundreds of billions of dollars in damages, profound environmental changes associated with the evolving climate system, and nuclear weapons proliferation and testing-has many urgent societal issues that need to be informed by sound understanding of the Earth sciences. A national strategy to sustain basic research and training of expertise across the full spectrum of the Earth sciences is motivated by these national imperatives. New Research Opportunities in the Earth Sciences identifies new and emerging research opportunities in the Earth sciences over the next decade, including surface and deep Earth processes and interdisciplinary research with fields such as ocean and atmospheric sciences, biology, engineering, computer science, and social and behavioral sciences. The report also identifies key instrumentation and facilities needed to support these new and emerging research opportunities. The report describes opportunities for increased cooperation in these new and emerging areas between EAR and other government agency programs, industry, and international programs, and suggests new ways that EAR can help train the next generation of Earth scientists, support young investigators, and increase the participation of underrepresented groups in the field. ER - TY - BOOK AU - Institute of Medicine A2 - Jonathan R. Davis A2 - Joshua Lederberg TI - Emerging Infectious Diseases from the Global to the Local Perspective: A Summary of a Workshop of the Forum on Emerging Infections SN - DO - 10.17226/10084 PY - 2001 UR - https://nap.nationalacademies.org/catalog/10084/emerging-infectious-diseases-from-the-global-to-the-local-perspective PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - In October 1999, the Forum on Emerging Infections of the Institute of Medicine convened a two-day workshop titled “International Aspects of Emerging Infections.” Key representatives from the international community explored the forces that drive emerging infectious diseases to prominence. Representatives from the Americas, Africa, Asia and the Pacific, and Europe made formal presentations and engaged in panel discussions. Emerging Infectious Diseases from the Global to the Local Perspective includes summaries of the formal presentations and suggests an agenda for future action. The topics addressed cover a wide range of issues, including trends in the incidence of infectious diseases around the world, descriptions of the wide variety of factors that contribute to the emergence and reemergence of these diseases, efforts to coordinate surveillance activities and responses within and across borders, and the resource, research, and international needs that remain to be addressed. ER - TY - BOOK TI - PY - UR - PB - The National Academies Press CY - Washington, DC LA - English ER - TY - BOOK TI - PY - UR - PB - The National Academies Press CY - Washington, DC LA - English ER - TY - BOOK AU - Institute of Medicine AU - National Research Council TI - Countering Bioterrorism: The Role of Science and Technology SN - DO - 10.17226/10536 PY - 2002 UR - https://nap.nationalacademies.org/catalog/10536/countering-bioterrorism-the-role-of-science-and-technology PB - The National Academies Press CY - Washington, DC LA - English KW - Conflict and Security Issues KW - Biology and Life Sciences AB - The attacks of September 11 and the release of anthrax spores revealed enormous vulnerabilities in the U.S. public-health infrastructure and suggested similar vulnerabilities in the agricultural infrastructure as well. The traditional public health response—surveillance (intelligence), prevention, detection, response, recovery, and attribution—is the paradigm for the national response not only to all forms of terrorism but also to emerging infectious diseases. Thus, investments in research on bioterrorism will have enormous potential for application in the detection, prevention, and treatment of emerging infectious diseases that also are unpredictable and against which we must be prepared. The deciphering of the human genome sequence and the complete elucidation of numerous pathogen genomes, our rapidly increasing understanding of the molecular mechanisms of pathogenesis and of immune responses, and new strategies for designing drugs and vaccines all offer unprecedented opportunities to use science to counter bioterrorist threats. But these same developments also allow science to be misused to create new agents of mass destruction. Hence the effort to confront bioterrorism must be a global one. Countering Bioterrorism makes the following recommendations: Recommendation 1: All agencies with responsibility for homeland security should work together to establish stronger and more meaningful working ties between the intelligence, S&T, and public health communities. Recommendation 2: Federal agencies should work cooperatively and in collaboration with industry to develop and evaluate rapid, sensitive, and specific early-detection technologies. Recommendation 3: Create a global network for detection and surveillance, making use of computerized methods for real-time reporting and analysis to rapidly detect new patterns of disease locally, nationally, and ultimately— internationally. The use of high-throughput methodologies that are being increasingly utilized in modern biological research should be an important component of this expanded and highly automated surveillance strategy. Recommendation 4: Use knowledge of complex biological patterns and high-throughput laboratory automation to classify and diagnose infections in patients in primary care settings. Recommendation 5: USDA should create an agency for control and prevention of plant disease. This agency should have the capabilities necessary to deal effectively with biothreats. ER - TY - BOOK AU - Institute of Medicine A2 - Elizabeth Haytmanek A2 - Katherine McClure TI - Mitigating the Nutritional Impacts of the Global Food Price Crisis: Workshop Summary SN - DO - 10.17226/12698 PY - 2010 UR - https://nap.nationalacademies.org/catalog/12698/mitigating-the-nutritional-impacts-of-the-global-food-price-crisis PB - The National Academies Press CY - Washington, DC LA - English KW - Food and Nutrition KW - Agriculture AB - In 2007 and 2008, the world witnessed a dramatic increase in food prices. The global financial crisis that began in 2008 compounded the burden of high food prices, exacerbating the problems of hunger and malnutrition in developing countries. The tandem food price and economic crises struck amidst the massive, chronic problem of hunger and undernutrition in developing countries. National governments and international actors have taken a variety of steps to mitigate the negative effects of increased food prices on particular groups. The recent abrupt increase in food prices, in tandem with the current global economic crisis, threatens progress already made in these areas, and could inhibit future efforts. The Institute of Medicine held a workshop, summarized in this volume, to describe the dynamic technological, agricultural, and economic issues contributing to the food price increases of 2007 and 2008 and their impacts on health and nutrition in resource-poor regions. The compounding effects of the current global economic downturn on nutrition motivated additional discussions on these dual crises, their impacts on the nutritional status of vulnerable populations, and opportunities to mitigate their negative nutritional effects. ER - TY - BOOK AU - Institute of Medicine A2 - Joshua Lederberg A2 - Robert E. Shope A2 - Stanley C. Oaks, Jr. TI - Emerging Infections: Microbial Threats to Health in the United States SN - DO - 10.17226/2008 PY - 1992 UR - https://nap.nationalacademies.org/catalog/2008/emerging-infections-microbial-threats-to-health-in-the-united-states PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - The emergence of HIV disease and AIDS, the reemergence of tuberculosis, and the increased opportunity for disease spread through international travel demonstrate the critical importance of global vigilance for infectious diseases. This volume highlights risk factors for the emergence of microbial threats to health, warns against complacency in public health, and promotes early prevention as a cost-effective and crucial strategy for maintaining public health in the United States and worldwide. The volume identifies infectious disease threats posed by bacteria and viruses, as well as protozoans, helminths, and fungi. Rich in information, it includes a historical perspective on infectious disease, with focuses on Lyme disease, peptic ulcer, malaria, dengue, and recent increases in tuberculosis. The panel discusses how "new" diseases arise and how "old" ones resurge and considers the roles of human demographics and behavior, technology and industry, economic development and land use, international travel and commerce, microbial adaptation and change, and breakdown of public health measures in changing patterns of infectious disease. Also included are discussions and recommendations on disease surveillance; vaccine, drug, and pesticide development; vector control; public education and behavioral change; research and training; and strengthening of the U.S. public health system. This volume will be of immediate interest to scientists specializing in all areas of infectious diseases and microbiology, healthy policy specialists, public health officials, physicians, and medical faculty and students, as well as anyone interested in how their health can be threatened by infectious diseases. ER - TY - BOOK AU - National Research Council A2 - Christopher D. Wickens A2 - Anne S. Mavor A2 - Raja Parasuraman A2 - James P. McGee TI - The Future of Air Traffic Control: Human Operators and Automation SN - DO - 10.17226/6018 PY - 1998 UR - https://nap.nationalacademies.org/catalog/6018/the-future-of-air-traffic-control-human-operators-and-automation PB - The National Academies Press CY - Washington, DC LA - English KW - Earth Sciences KW - Transportation and Infrastructure KW - Behavioral and Social Sciences AB - Automation in air traffic control may increase efficiency, but it also raises questions about adequate human control over automated systems. Following on the panel's first volume on air traffic control automation, Flight to the Future (NRC, 1997), this book focuses on the interaction of pilots and air traffic controllers, with a growing network of automated functions in the airspace system. The panel offers recommendations for development of human-centered automation, addressing key areas such as providing levels of automation that are appropriate to levels of risk, examining procedures for recovery from emergencies, free flight versus ground-based authority, and more. The book explores ways in which technology can build on human strengths and compensate for human vulnerabilities, minimizing both mistrust of automation and complacency about its abilities. The panel presents an overview of emerging technologies and trends toward automation within the national airspace system—in areas such as global positioning and other aspects of surveillance, flight information provided to pilots an controllers, collision avoidance, strategic long-term planning, and systems for training and maintenance. The book examines how to achieve better integration of research and development, including the importance of user involvement in air traffic control. It also discusses how to harmonize the wide range of functions in the national airspace system, with a detailed review of the free flight initiative. ER - TY - BOOK TI - Conference on Human Health and Global Climate Change: Summary of the Proceedings DO - 10.17226/9100 PY - 1996 UR - https://nap.nationalacademies.org/catalog/9100/conference-on-human-health-and-global-climate-change-summary-of PB - The National Academies Press CY - Washington, DC LA - English KW - KW - Environment and Environmental Studies ER - TY - BOOK AU - Institute of Medicine TI - America's Vital Interest in Global Health: Protecting Our People, Enhancing Our Economy, and Advancing Our International Interests SN - DO - 10.17226/5717 PY - 1997 UR - https://nap.nationalacademies.org/catalog/5717/americas-vital-interest-in-global-health-protecting-our-people-enhancing PB - The National Academies Press CY - Washington, DC LA - English KW - Health and Medicine AB - As populations throughout the world live longer, there is an increasing trend toward global commonality of health concerns. This trend mirrors a growing demand for health and access to new interventions to prevent, diagnose, and treat disease. The knowledge base required to meet these needs is not only of a technical kind, deriving from experiments of researchers, but must also draw from the experiences of governments in allocating resources effectively and efficiently to improve human health. This report from the Board on International Health of the Institute of Medicine focuses on the interest of the United States in these global health transitions. The report argues that America has a vital and direct stake in the health of people around the globe, and that this interest derives from both America's long and enduring tradition of humanitarian concern and compelling reasons of enlightened self-interest. ER -