[dropcap]P[/dropcap]eople living in rural communities have unique health and health care challenges.  They are more likely to have limited access to affordable and quality care, they experience health inequities and high rates of chronic disease, and are confronted with the lack of mental health services and shortages of health care providers. The fact that 19 percent of the U.S. population lives in rural areas and face these obstacles more often than those in urban areas reinforces the need for more research and innovation to improve health outcomes in these communities.

Biomedical research is a field of science that examines diseases and looks for ways to prevent and treat them. It can provide important information about disease trends and risk factors, develop treatments or interventions, and examine health care costs and use.

Generally, funds for medical research come from governmental or public sources. The National Institutes of Health (NIH) is the largest public funder of biomedical research in the world, investing more than $32 billion a year to enhance life and reduce illness and disability. NIH-funded research has led to breakthroughs and new treatments that help people live longer, healthier lives and build the research foundation that drives discovery.

Stability of research dollars is dependent on the economy. Over the past decade, U.S. biological and medical research has fallen off due to budget cuts, sequestration, and inflationary losses. The National Institutes of Health (NIH) experienced a loss of 22 percent of its capacity to fund research from 2003 to 2015. This reduction in funding capacity has resulted in fewer grants which leads in turn to fewer new discoveries and, ultimately, in talented researchers leaving the field.

Medical research dollars are also subject to political maneuverings. It was recently disclosed that funding designated for rural health programs, medical research and other priorities were shifted to cover expenses that resulted from President Trump’s zero-tolerance illegal immigration policy. According to Politico, at least $40 million in HHS funds have been spent on care, housing and reunification efforts for families separated at the border.

President Trump’s budget proposals for 2017 and 2018 both included further cuts to NIH funding, but these suggested cuts have been largely ignored by Congress. The NIH budget grew by roughly $2 billion in 2018 and is poised for another increase in 2019. Although efforts of US science agencies including the NIH have been historically supported by lawmakers, scientist shouldn’t become complacent. It is only a matter of time before those funding reductions become reality, leaving researchers in a lurch.

One might say that private sources of funding for research is an option, but the generosity of private philanthropists such as Bill Gates and Mark Zuckerberg account for only a small percentage of the funding needed for cutting edge research endeavors. Private investment is another source of revenue, of course, but many private investors are looking for a short term return on their investments, an approach which is not always conducive to scientific discovery.

Inequity in the distribution of government funding is a fact of life, but there are countless initiatives important for the health of rural Americans that will suffer if there isn’t enough money to go around.