Robert Cook-Deegan and Michael McGeary
The Jewel in the Federal Crown?
History, Politics, and the
National Institutes of Health
The National Institutes of Health (NIH), the United States' (and the world's) largest single funder of biomedical research, have grown enormously since World War II. Over this period, health research grew faster than other kinds of research, and the growth was greater in the United States than in other countries, in both absolute and relative terms. What are the reasons for this exceptional—and consistent—growth over six decades?
The policy story is one of bipartisan support for the National Institutes of Health through many election cycles, persisting through changes of Republican and Democratic control of Congress and the presidency. We believe this story is best understood through complementary approaches: history, political analysis, and identification of national values embraced by both major political parties. Citizen advocates emerged as credible champions for health research and academic health centers became a potent constituency. NIH stepped forward to support research during a five-year period when general support for a National Research Foundation was debated, and by the time the National Science Foundation took shape in 1950, NIH was already becoming the mainstay for health research. Other mission agencies likewise embraced basic as well as applied research. As a consequence, the United States never formed a central research ministry. The strong separation of legislative and executive branches of the U.S. government made Congress a target for healthresearch constituencies. All these factors converged to produce consistent, dramatic growth in health research over five decades.