The Funding Mismatch

Fragmented Funding Across Federal Agencies

Given the taxing effects of pollutants on human health, research on the mechanisms of action across public scientific agencies is greatly undervalued. Based on our assessment of FY2022–2025 grant data, less than 1% of NIH funding ($1.0B of $167.5B) studies how chemical pollutants cause disease. This field rarely aims to identify molecular targets or develop interventions. At NSF, environmental health research represents less than 1% of funding ($0.15B of $18.8B), focused on basic science without translational application. EPA dedicates roughly 8% ($8.1B) to health research (e.g., epidemiology, toxicology, and exposure assessment), however this purely serves regulatory purposes: determining safe exposure thresholds, not discovering druggable targets or protective interventions. The vast majority of EPA funding ($42B) goes to monitoring and remediation. No agency funds research with the sole purpose of bridging environmental exposures to actionable molecular targets. Epidemiologists identify associations; toxicologists characterize hazards; but no one systematically asks which biological pathways are disrupted and how to protect against them.

The Current State

With rising rates of many chronic conditions, the projected societal and economic burden of disease in the United States is expected to exceed $6 trillion annually by 2030, driven by healthcare expenditures, lost productivity, and disability.¹ Currently, the U.S. healthcare system is oriented around reactively responding to downstream disease states. Yet proactively curbing upstream drivers of disease remains an underexplored solution space. Detecting and intervening prior to full-blown symptoms requires a greater understanding of the underlying factors that contribute to chronic conditions.

While inheritable factors contribute to disease susceptibility, environmental exposures account for a substantial share of risk for many of today's most prevalent conditions. In the United States alone, air pollution is associated with an estimated 100,000–200,000 premature deaths annually, with fine particulate matter (PM_2.5) linked to cardiovascular disease, diabetes, neurodegenerative disease, and multiple cancers.^2,3 Lead exposure contributes to tens of thousands of excess cardiovascular deaths each year in U.S. adults, even at blood lead levels previously considered safe.⁴ Endocrine-disrupting chemicals are estimated to impose approximately $340 billion annually in U.S. healthcare expenditures and lost productivity, driven largely by neurodevelopmental impairment, metabolic disease, and reproductive disorders.⁵ Organophosphate pesticides alone are estimated to cost the United States roughly $44 billion per year in lost lifetime earnings due to exposure-associated neurodevelopmental impairment in children.⁶ This figure does not include additional healthcare and productivity costs associated with pesticide-linked malignancies, neurodegenerative disease, or acute poisoning, suggesting that the total pesticide-attributable burden is substantially higher.

Despite the scale of these estimates, research dollars remain overwhelmingly concentrated on treating late-stage disease. As evidence, we analyzed over 12,000 grants in eight disease categories from fiscal year 2024 to assess how few National Institutes of Health (NIH) dollars are dedicated to studying environmental contributors relative to molecular mechanisms and clinical research (see NIH Methods). Only $12.5M of $253M in NIH grants tagged for Parkinson's disease were dedicated to environmental exposures, despite twin studies suggesting that only 30–40% of Parkinson's disease risk is explained by genetic factors, with the remainder attributable to non-genetic influences.⁷ Similarly, of the $492M in NIH funding designated to lung cancer research, only $8M supports research on non-smoking chemical exposures, even though non-smoking lung cancer accounts for approximately 10–20% of diagnoses in the United States.⁸ These examples reflect a structural blind spot: NIH invests billions in treating disease and comparatively little in deterring chronic conditions upstream, missing opportunities for cost savings and long-term national resilience.

Crises and Politics Shape NIH Priorities, Leaving Environmental Health Behind

There has been a longstanding funding gap impeding progress at the intersection of biotechnology and environmental toxicants. Examining pollutants as chemical agents of disease has historically fallen outside the purview of major U.S. research agencies, creating a Bermuda triangle-like void. The Environmental Protection Agency (EPA) has focused on defining toxicity thresholds to inform regulation. The National Science Foundation (NSF) has emphasized fundamental discovery, often decoupled from translational or population-level disease prevention.

And while EPA and NSF budgets have remained relatively flat over the past half-century (inflation-adjusted), NIH funding has grown substantially (Figure 2).⁹ However, much of this growth has been directed toward downstream therapeutics research aligned with commercialization pathways. As the world's largest public funder of health research, NIH priorities exert outsized influence: every $1 of NIH funding generates approximately $8 in subsequent private-sector R&D investment within a decade.¹⁰

Tracing trends in federal appropriations for the NIH budget over the past 50 years reveals how urgency shapes federal research priorities. The National Heart, Lung, and Blood Institute (NHLBI) expanded in the 1970s in response to cardiovascular diseases being labeled as the nation's leading causes of death.¹¹ Also in the 1970s, National Cancer Institute (NCI) funding surged after the National Cancer Act launched the "War on Cancer," and was reinforced through a bipartisan push to double the NIH budget in the late 1990s and early 2000s.¹² The AIDS epidemic fueled funding to the National Institute of Allergy and Infectious Diseases (NIAID) in the 1990s, followed by the largest single funding increase (57%) in the history of any institute after September 11, 2001 to bolster defense against chemical, biological, radiological, or nuclear (CBRN) threats.¹³ More recently, the National Institute on Aging (NIA) gained traction after the National Alzheimer's Project Act passed in 2011 and subsequent lifting of federal spending caps in 2016.¹⁴ This time coincided with great promise that genomic approaches would unlock many new therapeutics, which largely failed to materialize and underscores the risk of overreliance on single-technology solutions for complex multi-factorial diseases.

Overall, NIH funding patterns reflect public pressure, shifts in disease burden, and national health security priorities, which is highly relevant to the Four Rotations premise described herein.

The NIEHS Moment of Urgency Is Well Overdue

Unlike several disease-focused institutes, the National Institute of Environmental Health Sciences (NIEHS) has not experienced a comparable funding surge over the past five decades. Pollution and chemical exposures have not been consistently prioritized as central drivers of U.S. morbidity and mortality. This persists despite substantial evidence linking pesticides, endocrine disruptors, PFAS, and heavy metals to cardiovascular, metabolic, reproductive, and neurodegenerative disease.^5,15

The dominant "single exposure–single effect" paradigm inherited from occupational toxicology presents a conceptual barrier to integration into translational pipelines. Real-world exposures are cumulative, involve mixtures, occur at lower concentrations, and often act during sensitive developmental windows, producing nonlinear biological responses over long latency periods.¹⁶ Even among NIH grants studying chemical exposures, only about 12% support true longitudinal cohort studies tracking health outcomes over time—and these are often supplemental analyses on existing cohorts rather than studies designed specifically to characterize exposure-disease relationships.

NIEHS is uniquely positioned to lead a methodological shift toward mechanistic characterization of cumulative environmental exposures. Integration of exposure-driven molecular insights across NIH institutes would enable identification of actionable targets aligned with biotech discovery pipelines.

According to the NIH Research, Condition, and Disease Categories (RCDC) dashboard, substantial public investment already exists in domains aligned with this strategy (Figure 3), including clinical research (~$19B), biotechnology/bioengineering (>$15B combined), and prevention (~$12B).¹⁷ Embedding exposure science within these translational umbrellas would recalibrate biomedical research toward upstream risk mitigation.

The Opportunity: Biotech Meets Environmental Health

Infrastructure exists—it just needs to be connected

Federal agencies have begun laying groundwork for a biotechnology-enabled environmental health paradigm. The EPA's ToxCast and Tox21 programs apply high-throughput in vitro assays and computational toxicology to evaluate thousands of chemicals and identify biologically relevant pathway perturbations.^18,19 NIH's Network for Exposomics in the United States (NEXUS), led by NIEHS, supports coordination and methodological development to integrate cumulative environmental exposures with multi-omics and health data across the lifespan.²⁰ NSF supports foundational research in biosensors, environmental monitoring technologies, and advanced analytics essential for exposure quantification.²¹

Collectively, these initiatives demonstrate that the technological infrastructure exists to integrate exposure-driven biology into mainstream biomedical research. Aligning exposure-related molecular insights with biotech discovery pipelines could expand the universe of druggable targets and enable proactive interventions against chronic disease onset.

The potential economic implications are substantial. Even modest reductions in environmentally mediated chronic disease risk could translate into billions in annual healthcare savings and meaningful gains in workforce productivity. The Impact Model included in this application illustrates the potential scale of this opportunity: by addressing the pollution-attributable fraction of common diseases, we can project the healthcare costs avoided, the investment required, and the number of people who could benefit from curative or preventive interventions. Environmental health initiatives riding alongside the epicenter of U.S. biotech and clinical research could develop new addressable molecular targets to build resilience against cellular harm—transforming environmental health from a regulatory concern into a therapeutic frontier.