EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE
OF CHILD HEALTH AND HUMAN DEVELOPMENT (NICHD)
THE NEXT DECADE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
A MESSAGE FROM THE DIRECTOR
The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), part of
the National Institutes of Health (NIH), completed its scientific Visioning process as the Institute approached
its 50th anniversary. Beyond celebrating the past, this anniversary inspired the NICHD to set compelling
research directions for the future.
This was no easy task. Established in 1962, the NICHD has a broad mission that challenges us to ensure
that every person is born healthy and wanted, that women suffer no harmful effects from reproductive
processes, and that all children have the chance to achieve their full potential for healthy and productive
lives, free from disease or disability, and to ensure the health, productivity, independence, and well-being of
all people through optimal rehabilitation.
NICHD science spans the understanding of the basic mechanisms that transform cells into healthy and
effectively functioning individuals, to clinical studies that can improve the lifelong health and well-being of
women, children, and those with disabilities. With a focus on strengthening the stewardship of the research
enterprise and the 50th anniversary approaching, the time was right for the NICHD to explore, with its
community of stakeholders, what we might achieve together within the next decade.
The NICHD scientific Visioning process began with Institute staff and the National Advisory Child Health and
Human Development Council identifying a set of broad themes to focus our science and discussions. These
discussions were held in nine different workshops followed by a consensus-building meeting. In the process,
the Institute convened more than 700 multidisciplinary experts, the vast majority from outside the NIH, to
create this Vision and establish shared views of where and how to direct future research.
The resulting Vision statement includes key concepts derived from the workshops and the white papers they
produced. The concepts are aggregated into seven distinct scientific areas, ranging from developmental
biology to population dynamics. Each area encompasses both broad scientific goals and more specific
research initiatives. These range from efforts involving the frontiers of molecular biology to investigations
that can yield novel, evidence-based, public health interventions that can be adopted nationally and
globally. In all cases, the concepts suggest future scientific directions, not just for NICHD, but for all of our
research collaborators.
In the end, each of the workshops highlighted a similar theme—that the values and policies of the research
enterprise must forge a positive future for the next generation of scientists and for society. This is addressed
in the final section of this document, Conduct of Science.
Beyond creating a statement itself, the scientific Visioning process was designed to bring together diverse
voices that could assemble and generate new perspectives for existing research problems and assist in
identifying new opportunities. The Visioning process and the statement that follows acknowledge that we are
entering a new and promising era in biomedical research. In the next decade, we must be ambitious and choose
research questions not because they are the easiest to answer, but because they are the most important.
Alan E. Guttmacher, M.D.
NICHD Director
1
CONTENTS

Developmental Biology ................................................................................................... 2
Developmental Origins of Health and Disease ................................................................ 4
Pregnancy and Pregnancy Outcomes .............................................................................. 6
Reproduction .................................................................................................................. 8
Behavior and Cognition ................................................................................................. 10
Plasticity and Rehabilitation .......................................................................................... 14
Population Dynamics ..................................................................................................... 18
Conduct of Science ....................................................................................................... 22
2

DEVELOPMENTAL
BIOLOGY
Research in developmental biology expands our
understanding of the earliest origins of many
diseases and conditions. Starting at the molecular
and cellular levels, this research provides the basis for
understanding such key processes as embryogenesis,
morphogenesis, organogenesis, and tissue growth and
differentiation. Future developmental biology research
should give scientists the knowledge and tools they
need to predict and identify the pathways that allow
them to prevent—or ameliorate the impact of—an
array of human structural and functional variations.
Animal Cells in Culture
3
DEVELOPMENTAL BIOLOGY
Years of work in developmental biology now
provide unique opportunities to benefit human
health by offering new ways to apply genetic
research and by supporting emerging fields such
as regenerative medicine. Now it is essential to
study cellular reprogramming as well as in vitro
and in vivo approaches to organ development and
cellular growth in three dimensions and over time.
Advancing knowledge in genomic regulation and
the integrative biology of development will allow
researchers to understand various phenotypes in
model organisms and in humans. These organisms
could extend from prokaryotes to yeast, from
sea urchins to zebrafish to mice, because no
single animal model fully recapitulates the
effects of a gene or a pathway on developmental
processes. Researchers must also have open
access to systematic cataloging of phenotypes
in these organisms, made freely and widely
available in databases that are expertly filled and
continuously updated.
Basic research should include single-cell and
single-molecule imaging and the development of
bioinformatic tools to advance our understanding
of systems biology. We must also seek to
understand the effects—and the mechanisms of
those effects—of the environment on early cellular
developmental processes. Such information will
be critical to guiding future research and health
care, as regenerative and genomic (“personalized”
or “individualized”) medicine transforms the way
scientists and clinicians investigate and apply new
knowledge to address many developmental and
other conditions.
Serotonin Receptor Activity in Mus Musculus
Courtesy Margaret I. Davis
Mus Musculus Embryo, Day 11
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1. Begin to develop a comprehensive guide to
developmental defects. This would include
data from multiple organisms and descriptions
of the molecular pathway(s) and the genomic
and epigenetic regulation involved across
developmental stages.
2. Construct a library of pluripotent cells
that give rise to organs and/or tissues with
potential clinical applications; eventually, for
each pluripotent cell line, researchers should
demonstrate organ and/or tissue development,
with in vitro and in vivo testing in model
organisms and, possibly, in humans.
4

DEVELOPMENTAL
ORIGINS OF HEALTH
AND DISEASE
We now know that the complex interactions between
many different biological and external factors, starting
before conception, can influence development across
the life course and across generations. Unraveling
this complex interplay demands a new level of
interdisciplinary understanding and sophisticated
delineation of systemic pathways. Key to this is
understanding how specific genetic, biological,
environmental, behavioral, and social factors interact
over time to influence health and disease. This is
particularly important to understand across a broad
range of environmental exposures and interactions.
Increasing our understanding of the developmental
origins of health and disease promises a future in
which clinicians can use novel methods to predict���
and act to prevent, treat, or even reverse—many
conditions or disabilities.
Human-Induced Pluripotent Stem Cells
5
DEVELOPMENTAL ORIGINS OF HEALTH AND DISEASE
Science, medicine, and society now face a wide range
of chronic diseases as their next great challenge,
having made substantial progress in the 20th century
tackling the most common causes of early morbidity
and mortality. Much of this success was related to
tremendous improvements in such areas as prenatal
and perinatal care, labor and delivery, vaccination,
antibiotics, and surgical treatment of congenital and
other defects. Partly due to these past advances,
an increasing number of individuals—even those
with chromosomal, single gene, or developmental
disorders that were previously lethal early in life—
now live long enough to develop chronic illness that
may affect their well-being over many decades. This,
and the delayed expression of heretofore unidentified
individual genetic variants, has led to a population of
patients with previously unseen issues that must be
managed in later life.
In addition, environmental factors that are rapidly
changing—due to technological advances and
changes in the physical and built environment, human
behavior, and societal and family patterns—increase
the need to understand how disease, across the life
course, has origins early in life. Fortunately, this need
arises as new tools—such as the human genome map,
increasingly more efficient means of genome analysis,
and other “-omic” approaches—become more useful
and easily accessible for biomedical research and
wide-ranging health applications.
Understanding the developmental origins of health
and disease will benefit from interdisciplinary and
global studies, and from prioritizing research on
today’s most common chronic conditions and
diseases, such as obesity, diabetes, heart disease,
stroke, cognitive deterioration, and cancer. In
addition, researchers must study specific at-risk
cohorts and groups of unusually healthy subjects.
This will help scientists identify genes, environments,
molecular interactions, and epigenetic states that
affect early or situational morbidity or extreme
healthy longevity.
Some of the earliest origins of health and disease
start during preconception, conception, pregnancy,
labor, or delivery. These unique life stages warrant
careful study for their individual and combined
contributions to both risks and protections in later
life. Researchers must also understand the effects
of the environment on the maternal and paternal
germlines, identify the early development of the
zygote and cell lineages in vitro versus in vivo, and
systematically investigate health outcomes of children
born through assisted reproduction technologies. It
is also essential for scientists to explore fully the role
of the placenta, cataloging the effects of maternal
and fetal exposures and understanding how different
pathways, at various points of gestational age, may
affect later health outcomes.
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1. Make substantial progress on systematic tissue
banking of placentas, which should be linked
to genetic and epigenetic data, periodic and
standardized phenotyping of the offspring,
and the development of updated molecular
tools to support sophisticated analyses of gene
expression and genetic pathways.
2. Begin to develop an online, multi-institutional,
and continuously updated study of
multigenerational effects on health, growth,
and development. This research would include
data on individual genotypes with genomic
structure and individual gene sequences;
parenting, lifestyle, residence, and other
environmental factors; phenotypes (e.g.,
cardiovascular fitness, bone health, measures
of insulin resistance); and epigenetic changes in
peripheral DNA and any diseased tissues.
6

PREGNANCY
AND PREGNANCY
OUTCOMES
Millions of mothers and infants in the United States
and throughout the world are at increased risk for
poor pregnancy outcomes. Understanding pregnancy
processes and fetal development can pave the
way for predicting and preventing these lifelong
consequences. Basic research in this area starts
by vastly expanding our current understanding of
normative pregnancy mechanisms, beginning at the
molecular and cellular levels. Scientists must fully
understand implantation, placentation, and the full
interplay of forces involved in two entities—living
one within the other—that shape fetal development,
birth outcomes, and the future health of the mother.
Researchers would apply this knowledge to reduce
the lifelong impact of pregnancy on women, improve
the prospects of a healthy pregnancy for women with
disabilities, and reduce disparities in outcomes for
both mother and child.
Ultrasound of Human Pregnancy
7
PREGNANCY AND PREGNANCY OUTCOMES
The last century brought unequivocal advances
in both the understanding and management of
pregnancy. However, new technologies and the
revolution in molecular tools are rapidly expanding
opportunities to explain the basic processes
underlying the physiology and pathophysiology of
pregnancy, maternal-fetal interactions, and various
pregnancy outcomes.
Better pregnancy outcomes will result from
understanding the basic biology of pregnancy as an
intricate process—one that modifies both maternal
and fetal immunity and hormonal environments
while interacting through the placenta and allowing
the mother and fetus to react as both one and
two units. Targets for new research should include
delineating the gestome (the molecular network that
harmonizes maternal-placental-fetal functions) and
the exposome (the effect of the environment on the
developing fetus).
Fetal development and placental function, and their
response to outside challenges (e.g., toxins, drugs,
infections) are prime areas for clinical studies in
pregnancy research. Identifying the multisystemic
factors contributing to stillbirth and prematurity,
including how genetic variation and the microbiome
influence placental function and fetal development,
would be an important achievement. It is also
necessary to determine the full range of effects
of timing and mode of delivery. New frontiers lie
in improving hemodynamic measurement and
imaging techniques for diagnosing placental disease,
and in identifying the critical hormonal and other
biomarkers of fetal maldevelopment, microbiomic
effects, placental dysfunction, and prematurity.
Biomarkers are also needed to enhance early
recognition of fetal brain and other defects.
In their efforts to study and identify the complex
causes of stillbirth and prematurity, researchers
must develop and test evidence-based measures
documenting prevention efficacy. Researchers
must also work on improving neonatal care and
outcomes for preterm infants. This will require
conducting multi-institutional studies, understanding
early environmental effects on infant development
with linkage to pregnancy data, and applying
individualized medicine and genetic/genomic data to
maternal and newborn care.
To advance the health of women, researchers must
study pregnancy as both a biomarker and as a
cause of later disease in the mother. This involves
examining events such as preeclampsia as a
potential indicator of later stroke, or examining such
conditions as metabolic syndrome of pregnancy as
an indicator of later cardiovascular risk. Likewise,
researchers should examine how pregnancy
itself can contribute to later disease and develop
interventions to lessen these effects. For the
increasing number of pregnant women with chronic
medical conditions or disabilities, researchers must
delineate the effects of pregnancy on their infants’
birth outcomes as well as on the mother’s health
during and after pregnancy.
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1. Delineate the grid of the complex causes of
stillbirth and prematurity and outline evidence-
based measures (derived from a variety of
sources, including multi-institutional studies)
for their prevention.
2. Create a comprehensive four-dimensional
atlas of in utero development. This would
include data at the gene–cellular level,
which delineate the effects of specific gene
expression and epigenetic changes due to the
physical environment and other influences (e.g.,
social environment, toxins, drugs), linked to
information about resulting phenotypes.
8

REPRODUCTION
Reproductive health is an essential element of well-
being and of our ability to ensure the health of
successive generations. In the future, expanding our
understanding of reproductive biology and behaviors,
starting at the molecular level, and increasing our
knowledge in clinical and behavioral applications
will allow researchers to better define the etiology
and pathophysiology of gynecologic disorders, help
individuals control or improve fertility, and manage
the critical transitions that mark reproductive health
across the lifespan.
Testes T.S. Tissue
9
REPRODUCTION
The ability for individuals to control their own fertility
through a range of effective male and female
contraception options and through improved
assisted reproduction techniques is essential to
health and well-being. Successful reproduction
depends on the anatomy and function of both
the female and male reproductive tracts and
includes menstrual and hormonal function, gamete
formation and development, fertilization, embryo
development, implantation, placentation, and fetal
development. Scientists must further research on all
of these aspects of reproduction, while expanding
our knowledge about reproductive behaviors and
the economic, behavioral, and social factors in, and
the effects of, family planning.
Today, researchers can take advantage of advanced
technologies, bioinformatics, systems biology,
and chemical genomics and related tools to
develop biomarkers. These, in turn, can provide
the foundation for identifying novel diagnostic and
therapeutic targets for conditions affecting fertility
and fecundity in males and females. It is also critical
for additional studies to focus on stem cells, cellular
differentiation, organogenesis, and tissue repair to
strengthen the link between regenerative medicine
and reproduction research.
To reduce the incidence of adult-onset male and
female reproductive disorders, scientists must
better understand a variety of developmental
processes. This begins with creating a full
understanding of both normative and etiological
mechanisms, starting with early developmental
processes in utero and continuing throughout
infancy, childhood, puberty, and other reproductive
transition stages. Researchers must gain a better
understanding of the molecular physiology of
puberty, the menstrual cycle in adolescents,
and the impact of early environment and altered
nutrition/disease on how reproductive functions
develop or evolve over time. This research includes
understanding the biology, special vulnerabilities,
and life implications of reproductive transitions
(e.g., puberty, andropause, menopause). These life
phases must be destigmatized and their physiology
well documented through normative anatomical,
hormonal, and biochemical data.
Gynecologic disorders, including endometriosis,
pelvic floor disorders, and fibroids, affect quality
of life on multiple dimensions, especially when
accompanied by comorbid conditions such as
infertility, obesity, metabolic dysfunction, chronic
pain, or mood disorders. Developing novel
approaches to prevent, diagnose, and manage these
often interrelated conditions, premised on a detailed
understanding of normative and pathological
mechanisms, could greatly improve quality of
life for women across the lifespan. Because both
reproductive health and sexual health significantly
influence quality of life, any clinical study assessing
overall quality of life should include these factors.
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1. Develop means to characterize both female
and male single germline cells at specific stages
of development.
2. Develop novel male and nonhormonal
contraceptive agents.
3. Understand how microbial flora change during
periods of reproductive transition and the
health effects of these changes.
4. Delineate the genetic, epigenetic, and
environmental interactions underlying the etiology
of at least three major gynecological disorders.
Human Endometrium
10

BEHAVIOR
AND COGNITION
Behavioral factors can significantly promote positive
health outcomes or increase the risk of adverse ones.
Similarly, cognition—with its key relationships to
neurodevelopment and learning—is part of a lifelong
process that underlies overall human functioning.
Basic and translational research that combines
neuropsychological, behavioral, and social science
perspectives, as well as new tools, will advance our
understanding of the mechanisms underlying typical
and atypical behavior and cognition. In the future, this
enhanced understanding of behavior and cognition
can ameliorate an array of developmental conditions
or help individuals interact with the world in ways that
can sustain or improve their health and well-being.
Positron Emission Tomography/
Computed Tomography Scan of Human Brain
11
BEHAVIOR AND COGNITION
Many research disciplines will need to work
together to characterize the full range of typical
and atypical behavioral and cognitive trajectories
across the lifespan. First steps will involve
identifying the mechanisms underlying behavioral
and cognitive development at the molecular,
cellular, and brain system levels; detailing how
these mechanisms interact with complex
environmental factors; and pinpointing sensitive
periods for perception, learning, memory,
language, reasoning, and executive function.
This will require researchers to use emerging
technologies to characterize how the epigenome
and gene expression not only influence, but also
are influenced by, the interaction between
behavior and the environment over time. It will
also require researchers to exploit new
technologies that allow them to visualize and
identify the complex pathways through which
targeted behavioral and pharmacologic
interventions affect brain structure and function.
Together, this knowledge can help identify
which periods during neurobiological and
behavioral transitions are most susceptible to
specific types of change or interventions. To
hasten such advances, researchers must also
develop innovative animal models of human
behavior and robust behavioral markers or
biomarkers of specific behaviors. These can
also be used to predict or benchmark a wide
spectrum of behaviors.
Identifying specific genetic variants that influence
the development of behaviors or cognitive traits
will also be important to unraveling the origins
and mechanisms underlying normative behavioral
and cognitive development. When combined with
a better understanding of other individual,
familial, and community-based factors, this critical
genetic information will provide the foundation
for developing more personalized interventions to
improve health outcomes.
12
BEHAVIOR AND COGNITION
Similarly, understanding the neurobiological bases,
developing the full developmental spectrum and
trajectories, identifying key biologic markers for
behavioral or cognitive disorders, and characterizing
endophenotypes for specific disorders should allow
researchers to identify the most promising
therapeutic targets. This knowledge will also allow
researchers and clinicians to determine the most
sensitive time periods and the most effective
behavioral interventions to prevent these disorders,
ameliorate their symptoms, and maximize function.
For specific conditions such as autism spectrum
disorders, Down syndrome, and Fragile X syndrome,
for which a stream of multidisciplinary advances is
emerging, researchers should be able to identify the
key mechanisms and primary causal factors leading to
these conditions. This, in turn, should provide the
cornerstone for developing a broad range of more
timely and effective interventions.
Of growing interest are the effects that emerging
technologies and media have on cognitive trajectories
through their influence on the developing central
nervous system, learning, problem solving, social
interaction, and communication. It is important to
understand how new technologies affect cognition,
particularly during sensitive developmental periods,
in different populations and settings. It is also
important to identify how these technologies can be
used to prevent, remediate, or treat a range of
learning and developmental conditions.
Another research frontier lies in fully uncovering and
understanding how specific physical (whether natural
or engineered) and social environmental exposures
Human Neuron
13
BEHAVIOR AND COGNITION
shape behaviors or alter developmental trajectories
and influence health outcomes. These exposures may
be as direct as the use of neonatal incubators or as
complex as growing up in poverty, surviving early
traumatic events or injuries, being exposed to
violence, or coping with incarceration as a youth.
Projecting the impact of these exposures and
identifying which individual, family, or community
factors are most likely to promote positive outcomes,
such as resiliency, are essential for developing
protective interventions.
Researchers must take an interdisciplinary approach
to identify how differing cognitive abilities and
behaviors influence individual, family, and community
health and well-being. Intervention research and
studies to optimize the lives of individuals with a
range of typical and atypical cognitive abilities and
behaviors must also assess the costs and benefits to
family members and society. Incorporating these
perspectives can significantly alter how scientists
interpret and implement cognitive and behavioral
research advances.
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1.
Identify 5,000 genetic variants that influence
specific behaviors or cognitive traits.
2. Fully understand the neurobiological
bases, delineate the full developmental
spectrum and trajectories, and identify
the key biologic markers for five
behavioral or cognitive disorders.
3.
Identify the causes of autism spectrum disorder,
and begin to employ that knowledge to
develop effective and targeted interventions.
14

PLASTICITY AND
REHABILITATION
Understanding plasticity—the mechanisms underlying
adaptive or maladaptive change at the cellular, tissue,
organ, or system level—in its broadest sense is core
to understanding both human development and
rehabilitation. Given emerging scientific insights,
researchers have left behind the era when plasticity
was thought to exist only early in life and now have
substantial evidence about how it occurs across the
human lifespan. Our current challenge is to build upon
these insights and learn how to harness plasticity more
effectively to improve functioning across organ systems
and to remodel, maintain, or enhance functioning in
response to a range of biological challenges such as
injury, other forms of trauma, and disease.
Human Spinal Cord Neurosphere
Courtesy Micheal Weible, Department of Anatomy and
Histology, University of Sydney Sydney, Australia
15
PLASTICITY AND REHABILITATION
Plasticity is often viewed in terms of neural
plasticity, as it affects physical, behavioral, and
cognitive functioning; however, changes to other
organ systems can also influence the ability
to develop, maintain, or regain function or to
heal. The challenge for scientists is to generate
fundamental knowledge about plasticity,
understand how it responds to both endogenous
and exogenous factors, and translate this
knowledge into interventions that can maximize
developmental and rehabilitative outcomes.
As a first step, researchers must develop novel
model organisms. These must be capable of
acting in a variety of environmental situations
and represent a spectrum of plastic behaviors
influenced by a broad range of perturbations.
Such models can rapidly advance the scientific
understanding of plasticity at the cellular and
molecular levels. In addition, researchers must
contrast normative plasticity in developing systems
to plasticity in more mature systems that may have
suffered injury, developmental maladaptation,
or disease. This will help researchers understand
whether and how the ability to habilitate under
specific developmental conditions relates to
expected variations in, or abnormal regulation of,
normative plastic forces. Researchers must also
understand tissue- and organ-specific regenerative,
repair, adaptive, and restorative processes across
the lifespan, starting in the neonatal period, if not
during pregnancy. The ultimate goal is to identify
the normative and optimal range of plasticity for
different populations.
Additional studies must unravel the influence of
various factors, such as those associated with
gender and the tropic function of hormones,
and how genetic or epigenetic mechanisms
influence plasticity. In doing so, it is important
to distinguish harmful changes from those that
maintain homeostasis. Together, such studies
will provide the basis for identifying and defining
the most sensitive periods—and the most
appropriate mechanisms and strategies—for
modulating plasticity. To translate this advanced
understanding of mechanisms underlying plasticity
into interventions that induce repair or enhance
rehabilitation, researchers must also identify the
primary environmental or extrinsic factors that
influence plasticity and their substrates.
Such extrinsic factors can range from diet
and exercise to stress, family, and other social
influences. Knowledge of such factors will provide
additional targets for developing new cellular and
molecular (e.g., stem cell and gene therapies),
pharmacologic, and clinical (e.g., electrical
stimulation or therapeutic exercise) interventions.
Such foundational knowledge is also important for
creating new generations of assistive devices.
16
PLASTICITY AND REHABILITATION
Creating new, or enhancing existing, interventions
or therapies will not be enough. To optimize
the impact, researchers must bring together
sophisticated combinations of biomarkers and
technology to predict which interventions or
therapies, and combinations thereof, are most
likely to succeed. In addition to being clinically
and functionally significant, surrogate measures
must be able to track intervention success, discern
responders from nonresponders, and indicate the
ability of different groups of patients to sustain
progress under a variety of circumstances.
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1.
Identify distinct biological mechanisms that
translate explicit factors in the exposome to
specific neuroplastic responses, and identify
novel markers of these processes.
2. Develop a range of robotics that will enable
individuals with developmental or acquired
disabilities to obtain or maximize daily function
in their home settings.
17
3. Develop practical, effective, and inexpensive
rehabilitative interventions, such as upper
and lower extremity prostheses, that can be
developed as prototypes and manufactured,
maintained, and used in a variety of global and
resource-poor settings.
4. Determine the magnitude of risk and long-term
impact of concussive injuries to understand how
the brain responds to a range of such injuries.
This would include targeting injuries that may not
be easily discernable and are most common for
a range of developmental stages, from infancy
through adulthood. This work would also include
designing developmentally appropriate and
effective measures for prevention, protection,
and treatment.
5. Understand and begin to compare, at the
genetic and epigenetic levels, the key factors
controlling the plasticity of neonates, infants,
children, and adolescents to those controlling
plasticity of adults.
PLASTICITY AND REHABILITATION
18

POPULATION
DYNAMICS
Some of the fundamentals of population dynamics rest
on the understanding that individuals, families, and
communities are critical units through which population-
level factors interact with genetic and other biological
and environmental variables. These interactions, in
turn, can influence, if not determine, individual health
across the lifespan. Understanding how the forces
that shape populations can influence health, together
with understanding why some populations with similar
genetic endowments and environmental exposures
experience diverse health outcomes, can inform the
development of effective population- and community-
based interventions and can help identify factors that
can eliminate health disparities.
Social Interaction Data
19
POPULATION DYNAMICS
A key challenge in population dynamics starts
with understanding the rapid and profound
changes shaping families in the United States and
around the world. This includes understanding
how biological, social, and other environmental
factors, in concert with population dynamics,
influence the health and well-being of mothers,
fathers, children, families, communities, and
societies. Such research would include identifying
how extremes in maternal and paternal age
and their impacts on fecundity, pregnancy
outcomes, gender roles, and family formation
affect the modern family. Researchers must
also examine how family structures and the
intergenerational transmission of such factors
as knowledge and economic security affect
child health and developmental outcomes.
Innovative, multidisciplinary approaches are
needed to unravel how complex patterns of
migration and urbanization influence health
over generations by altering social, economic,
and educational dynamics, including the ethnic
and cultural characteristics of neighborhoods,
communities and societies. Other vital
research area will involve characterizing how
technology is altering social interactions and
access to information, thereby influencing
family choices, behaviors, and well-being.
To understand how population dynamics and
other factors interact to transform health,
scientists must create and employ a new
20
POPULATION DYNAMICS

l
generation of cutting-edge data collection
approaches, sophisticated analytic methods,
and novel, rigorous statistical measures. These
strategies must be able to assess biological,
physical, and social processes in a range of
diverse families, communities, and populations.
To identify the most salient biological and socia
factors and processes amenable to intervention
at the individual, family, and community levels,
scientists can study distinct populations with
shared genetic characteristics, environmental
exposures, or social experiences, using new
approaches based on observational research,
naturally occurring experiments, and clinical
trials. Other ambitious methods include
mapping the exposome and conducting
exposome-wide association studies (EWAS)
of susceptible populations over time.
An important population dynamic is emerging
as individuals with intellectual, developmental,
and physical differences are now living longer,
with varying degrees of health and functioning,
due to medical and other advances. To
maximize the quality of life and productivity
for these populations, researchers must better
document the scope, range, and impact of
these trends and better understand how they
influence the health and well-being of families,
neighborhoods, and communities. Based on this
understanding, researchers must also conduct
an array of multidisciplinary studies to inform
policies, design programs, and enable leaders
to implement activities that meet basic needs
(e.g., housing, learning, employment, other
social opportunities). This research must provide
the comprehensive evidence for what works
and how to scale programs at the population
level, accounting for unique biomedical factors,
individual behaviors and needs, family and
community characteristics, and social forces.
This might include conducting EWAS for these
distinct groups of individuals, and identifying
the key points and types of interventions most
likely to maximize health and quality of life.
21
POPULATION DYNAMICS
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1. Catalog and identify interrelated environmental
and genetic factors that are key to mediating
the health of individuals, families, and
communities, focusing particularly on
populations with distinct genetic characteristics
or environmental exposures.
2. Understand the changing population
dynamics associated with increasing the
health and longevity of persons with
a range of physical, intellectual, and
developmental disabilities and, based on
this knowledge, develop better community-
and population-based health care and living
options for individuals with intellectual,
developmental, and physical differences.
22

CONDUCT
OF SCIENCE
The NICHD’s scientific Visioning process identified not
only many promising opportunities across the scope of
our mission, but also more universal ideas about how
we must conduct science to enhance future progress
in virtually all areas of biomedical research. Although
many of these issues are not unique to the Institute’s
mission, many are particularly pronounced and critical to
achieving our future goals. One avenue to success will
involve finding multiple ways to advance transdisciplinary
science. Another will involve creating novel approaches
to address the vast amount of scientific information to
be accumulated from complex longitudinal studies and
repositories housing lifetimes of biological specimens.
And yet another path will be to continue to develop
and sustain a diverse cadre of scientists and biomedical
researchers. Ultimately, however, our future success will
be measured not by research investments or publications
alone, but by our ability to translate and implement our
scientific advances into actions that improve the health
of all women, children, persons with disabilities, and
communities around the world.
23
CONDUCT OF SCIENCE
Transdisciplinary science needs to become
more common. This requires both novel ways
to remove current systemic structural obstacles
to such research and enhanced rewards for
its pursuit. Our commitment must go beyond
promoting traditional collaborations to changing
and enhancing the way in which multiple
disciplines interact. This may include the
support of multidisciplinary group sabbaticals,
“transdisciplinary incubators,” and other
innovative programs that set aside dedicated time
and space for scientists from different disciplines
to learn from each other and to frame and solve
problems jointly.
Opportunities must increase for researchers
from different disciplines and institutions to
obtain joint funding and publish together.
Criteria for academic advancement must
take into account and actively promote the
involvement of researchers in transdisciplinary
and team research. The scientific community
needs to acknowledge that today’s researcher
can contribute significantly by being a “middle
author” of a 20-author publication. Increasingly,
academia will need to award credit for grants with
co- or even multiple-principal investigators who
are often not in the same department, or school,
or even institution.
Training the biomedical researchers of the
future requires awareness that, although
solitary scientists and single discipline groups
will continue to make important contributions,
transdisciplinary research is a growing part
of science that requires a different skill set,
experiential background, and way of working.
Even though it may be neither efficient nor
effective to train large numbers of researchers
with deep expertise in more than one discipline,
such scientists clearly will have important roles
to play. Perhaps more common will be scientists
with deep expertise in a single discipline,
but whose training has equipped them with
“fluency��� in others. The ability to read and
analyze publications in other disciplines, to
understand and utilize the tools and approaches
of other disciplines, and to communicate
effectively with those in other fields will be
major assets. Teaching such abilities usually will
require a transdisciplinary approach, including
training experiences and mentorship in multiple
disciplinary frameworks.
DNA Sequence Results
Sustaining transdisciplinary research will profit
from novel ways to work with private industry and
nonprofit organizations, new media tools, and
expanded efforts to facilitate communication and
public outreach. Hosting registries and blogs,
developing interactive curricula, supporting
programs that match young researchers to
multiple mentors, and creating incentives to
attract and retain researchers from different
disciplines all along their career trajectories will
further transdisciplinary research.
A transdisciplinary view must be applied to how we
study, frame, and measure health outcomes. New
perspectives are particularly needed for assessing
quality of life for women, infants, children, families,
and individuals with disabilities. Data collected
through longitudinal studies of healthy and at-risk
cohorts will help researchers better understand
correlations among specific exposures and
individuals’ health, across the lifespan and across
generations. Scientists must create novel ways
to acquire these data, exploiting technologies
created in other fields (e.g., geographic
information systems) and developing toolkits and
multidisciplinary rapid-response teams that allow
for the collection of exposure and outcome data in
the event of “natural experiments.”
24
CONDUCT OF SCIENCE
Biorepositories with diverse sample types
will also be invaluable for future research.
These should be linked to a wide variety of
environmental exposures and multidimensional
phenotypes, starting before pregnancy and
including the perinatal period and healthy
individuals. Gathering these data will require
researchers to develop a new generation of tools
in molecular imaging, microscopy, biosensors,
biomanipulators, and the expansion of “-omic”
and other libraries that go across the lifespan.
Future, rapid, and transdisciplinary research
advances will depend on our ability to harness
bioinformatics and the resulting data that come
from computational biology. The challenge will
be finding creative and more efficient ways to
analyze, store, disseminate, and share data—
both new and from older studies—widely and
effectively. This will require transdisciplinary
and other researchers to create standardized
ontologies and nomenclatures, harmonize data
systems, and increase access to shared databases
that also provide innovative analytic tools. To
support these efforts, the scientific establishment
will need to find appropriate ways to recognize
and reward the intellectual contributions of those
who gather the data and create the tools.
Finally, expanded and more widely linked and
accessible data will demand finding new ways to
protect the confidentiality and privacy of research
participants. This must be a shared responsibility,
as researchers move to a default ethos in which
data, especially those derived with government
funding, belongs not to the principal investigator,
25
CONDUCT OF SCIENCE
but to society. Enhancing confidentiality and
privacy must also be done in a way that maximizes
the efficiency and effectiveness of research, with
any redesign of appropriate rules or regulations
completed in a way that protects participants
while furthering science.
Clinical research is essential for translating
basic scientific advances into improved health
outcomes. To maximize what can be learned
from often labor-intensive and costly clinical
trials and to help ensure participant safety,
researchers can fully analyze existing clinical
and preclinical research before embarking on
such trials. Creating centralized, accessible, and
intuitively organized electronic warehouses of
clinical research would help immensely. Clinical
researchers must also identify the most effective
clinical research strategies for diverse contexts,
including low-resource settings. As this is done,
it is critical to integrate economic impact analysis
of interventions into the full array of clinical
research. Together, these actions will help all
fields identify why some interventions fail to
produce expected results, and develop the best
strategies to translate advances into evidence-
based health care practice.
Public involvement will remain essential to
ensuring that research is implemented in ways
that sustain progress and improve health.
All who support biomedical research must
disseminate information to scientists, health
care practitioners, and the public in ways that
improve transparency, create new insights, and
inform practice. All involved in the support and
conduct of research must also build strong ties
with communities, continuously engaging their
members so that they can actively participate
in framing the research that is most likely to
identify the factors that influence their health.
This engagement will enable scientists to
respond immediately to emerging situations
and enhance the possibility of developing more
timely and effective interventions. All fields must
take advantage of new ways to communicate
advances, ensuring that their scientific meaning
and health implications are transmitted clearly to
a wide array of audiences.
None of the changes in the ways that we conduct
science will be possible without continuously
renewing and re-energizing our scientific
workforce. We must capture the attention of
students much earlier in the learning pipeline
and expose them to, and excite them with, the
full range of science inherent in the NICHD
mission. This means enhancing interest in
everything ranging from basic physiology and
pathophysiology to the behavioral sciences. It
also requires developing new ways to enhance
interdisciplinary fluency and equip students with
the biocomputational skills they need to analyze
and interpret the surge of linked, longitudinal,
and complex research information.
Given the globalization of research and the health
problems that the NICHD seeks to address,
tomorrow’s scientists must overcome a wide
array of complex challenges inherent in working
in international environments and addressing
the health problems of diverse populations.
This will be difficult to achieve without a more
diverse body of scientists. We need to create
more effective ways of attracting and retaining
researchers from underrepresented population
groups, such as viewing young research
participants as a pool of diverse individuals from
which to recruit future scientists.
WITHIN THE NEXT 10 YEARS,
SCIENTISTS SHOULD BE ABLE TO:
1. Develop biorepositories that capture the diversity
of the U.S. population.
2.
Involve the public in better reporting,
identification, and definition of normal
life processes, including pregnancy, child
development, and adolescence.
3. Change the predominant model for data use to
one of open access.
IN APPRECIATION
The NICHD’s scientific Vision process and resulting
statement would not have been possible without the
dedicated efforts of more than 700 multidisciplinary
experts and numerous Institute and other staff.
We thank you all for your invaluable contributions.















N AT O N A L I N S T T U E S O F H E A LT H
Research for a L fet me
YEARS
Pub No. 13-7940
http://www.nichd.nih.gov/vision