2022: the national institute of health and responding to new forms of childhood adversity

Child health care researchers and practitioners have a responsibility to ensure the health of the pediatric population. An important new question is whether recent changes in the burden of childhood disease and disability are reflected in the National Institute of Health (NIH) allocation process. Existing and new childhood adversities pose deleterious consequences on health and well-being. Take the leading cause of death among children. In 2020, firearm injuries became the leading cause of death among children and adolescents, exceeding those caused by motor vehicle crashes. From 2019 to 2020, the relative increase in the rate of firearm deaths of all types (suicide, homicide, unintentional, and undetermined) among children and adolescents was 29.5% – more than twice as high as the relative increase in the general population (Goldstick, Cunningham, & Carter, 2022). Understanding emerging child health challenges which pose the greatest threat to health and wellbeing can help NIH leaders decide how to use limited resources for maximum benefit. We offer an update on the NIH child health research portfolio and conclude that we might realign priorities to address new forms of childhood adversity. Despite an overall increase in NIH child research funding, scholars have noted that funding across diseases and conditions is uneven and insufficiently responsive to the changing burden of disease (Rees, Monuteaux, Herdell, Fleegler, & Bourgeois, 2021; Gordon & Corwin, 2022; Goldstick et al., 2022; Grummitt et al., 2021; Rockey & Wolinetz, 2015). The NIH reports that it recognizes the importance of the responsiveness of funding to the burden of disease as one of many considerations for setting research funding priorities. The NIH does not attempt to apply a one-size-fits-all approach to the burden of disease in funding decisions. It considers multiple data sources and examines each disease category on a case-by-case basis when determining the best strategy for the allocation of funds. However, research funding for existing and new child health challenges has been variable and insufficient. As a result, the NIH child health research priorities should be evaluated at regular intervals to meet changing individual and population health challenges. The NIH child health research portfolio is defined as the total funds obligated to conduct or support pediatric research. To improve consistency