Response to: "Rescuing the NIH before it is too late".

We, the directors of the 27 NIH institutes and centers, wanted to respond to the points made by Andrew Marks in his recent editorial. While we appreciate that the scientific community has concerns, the current initiatives and directions of the NIH have been developed through planning processes that reflect openness and continued constituency input, all aimed at assessing scientific opportunities and addressing public health needs.

Paradigms and progress in building research capacity in international environmental health.

Populations in low- and middle-income nations bear significant risks for poor health due to air, land and water contamination; natural resource depletion; deterioration of ecosystems; contaminated food supplies and other conditions related to poverty, including poor housing, crowding and inadequate nutrition and health care. These risks, related to rapid industrialization, increasing urbanization, poor land use, natural changes in ecology and other conditions, will only increase in the coming decades if current trends persist. The implications on populations' health include increased spread or emergence of disease, particularly those that impact children disproportionately, and added stress on already overburdened or weakened health care systems. To address environmental health conditions in a relevant manner in resource-poor settings, the training of scientists and health professionals from these settings is key to setting priorities and identifying cost-effective interventions. Training of professionals in a range of environmental health disciplines is a prerequisite for the establishment of effective national and international policies. Working to strengthen local expertise and scientific capacity is one of the most effective and lasting ways to affect positive policy change in environmental health. This paper describes four paradigms that support research training and research programs to meet the increasing and changing needs in this field. Factors influencing the development of the programs and their evolution are discussed as well as trends for the future.