Weighing in on ARPA-H: Taking an Integrative Approach

Earlier this year, U.S. President Biden requested $6.5 billion to create a new Advanced Research Projects Agency for Health (ARPA-H) that would accelerate biomedical innovation and adoption of technologies and approaches to revolutionize healthcare and medicine. ARPA-H would be housed within the National Institutes of Health (NIH) and is inspired by the Defense Advanced Research Projects Agency (DARPA) program that has “driven breakthrough advances for the Department of Defense for more than 60 years.” 

This is an incredible opportunity to transform health in the United States. But to be successful, and to address health equity, we believe ARPA-H must take an integrative approach that looks at the total lived experience and upstream drivers of health — and should not just focus on disease. We’ve been making our voice, as well as our support for ARPA-H, heard.    

In August, Nova Institute President and Founder Brian Berman was selected to be one of a few stakeholders to present during NIH’s ARPA-H listening sessions — view the video here (Professor Berman’s remarks begin around the 42 minute mark). 

We also responded to an opinion piece about ARPA-H published in Science magazine with our own letter, also published online (authored by Professor Berman as well as Nova Institute Scholars Susan Prescott and Steve Woolf):

SEP. 7, 2021

ARPA-H: biomedical solutions to the health crisis require an integrated exposome approach

Bold new approaches are urgently needed to overcome the mounting health crisis (1). The proposed Advanced Research Projects Agency for Health (ARPA-H) within the National Institutes of Health provides a promising opportunity to achieve this, through a vision that considers entire ecosystems and all populations, with vulnerable groups in mind (2). 

While new technologies for earlier detection and more effective treatment are critical, we urge equal attention to the wider (physical, emotional, social, political, and economic) environmental ecosystems driving the noncommunicable disease (NCD) crisis in the first place. No matter how innovative, a “downstream” targeted focus on disease will ultimately fail if not considered in tandem with the “upstream” total lived experience (the exposome), which determines vulnerabilities of individuals and communities over time (3, 4).

The “omics” revolution offers new opportunities for truly personalized approaches that consider not only optimal pharmacological interventions but also measures of personal ecology (3, 5) and strategies to buffer adversity and promote flourishing (6).

This means considering environmental factors (positive and negative) that influence individual ecology, including microbiomes (5, 7) to differentially determine disease risk and treatment response. It should address racial and socio-economic health inequities, reflected in unequal access to healthy food, safe green spaces, clean air and water, employment, and financial security—highlighted by the COVID-19 pandemic (8). Critically, as life expectancy (and NCD risk) are strongly determined by early life environments, ARPA-H should invest in early interventions as a matter of effectiveness and social justice.

Critically, this calls for an integrated, cross-sectoral vision that spans the interwoven connections affecting health across the scales of people, places, and planet. Initiatives like ARPA-H are uniquely placed to build this broader exposome perspective, which will not only enhance the quest for health equity through personalized, precision medicine but encourage cross-sectoral partnerships—as human health ultimately depends on addressing our social and environmental challenges (4).

We agree wholeheartedly with common themes echoed throughout the ARPA-H listening sessions, such as the need for better, more integrated data, the imperative to reduce or eliminate health inequities, and the potential for novel advances catalyzed by collaboration across scientific disciplines. 

Stay tuned for more updates about what could be a gamechanger for the American approach to health and equity.