Defra's budget for day-to-day spending is to be cut by 15% over the next four years. This will be difficult to achieve since total budget reductions of about a quarter during the last Parliament have already identified easily achievable savings and removed the more obvious inefficiencies across the Defra family. Defra is one of the smaller government departments, with Exchequer funding of just over £2 billion, but it performs vital functions. We endorse the Defra Secretary of State's vision for a world-class food and farming sector, a robust rural economy and an enhanced natural environment. Managing environmental and rural economy issues together can help deliver that vision but this, together with meeting the challenges of protecting the UK from natural hazards, requires adequate resources. Protecting the nation against, for example, flood and animal or plant diseases carries multi-million pound costs; the costs to the economy, society and the environment of not doing so may, however, be even greater. The challenges facing Defra are first whether the reduced budget available to it is sufficient for its task, and second how to make the correct policy choices so as to allocate smaller funds effectively.

1. Introduction and methods of work.-- 2. Alcohol: equity and social determinants.-- 3. Cardiovascular disease: equity and social determinants.-- 4. Health and nutrition of children: equity and social determinants.-- 5. Diabetes: equity and social determinants.-- 6. Food safety: equity and social determinants.-- 7. Mental disorders: equity and social determinants.-- 8. Neglected tropical diseases: equity and social determinants.-- 9. Oral health: equity and social determinants.-- 10. Unintended pregnancy and pregnancy outcome: equity and social determinants.-- 11. Tobacco use: equity and social determinants.-- 12. Tuberculosis: the role of risk factors and social determinants.-- 13. Violence and unintentional injury: equity and social determinants.-- 14. Synergy for equity.

Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

Climate change is causing unprecedented damage to our ecosystem. Increasing temperatures, ocean warming and acidification, severe droughts, wildfires, altered precipitation patterns, melting glaciers, rising sea levels and amplification of extreme weather events have direct implications for our food systems. While the impacts of such environmental factors on food security are well known, the effects on food safety receive less attention. The purpose of Climate change: Unpacking the burden on food safety is to identify and attempt to quantify some current and anticipated food safety issues that are associated with climate change. The food safety hazards considered in the publication are foodborne pathogens and parasites, harmful algal blooms, pesticides, mycotoxins and heavy metals with emphasis on methylmercury. There is also, a dedicated section on the benefits of forward-looking approaches such as horizon scanning and foresight, which will not only aid in anticipating future challenges in a shifting global food safety landscape, but also help build resilient food systems that can be continually updated as more knowledge is assimilated. By building a more widespread and better understanding of the consequences climate change has on food safety, it is hoped that this document will aid in fostering stronger international cooperation in making our food safer by reducing the global burden of these concerns.

In 1900, for every 1,000 babies born in the United States, 100 would die before their first birthday, often due to infectious diseases. Today, vaccines exist for many viral and bacterial diseases. The National Childhood Vaccine Injury Act, passed in 1986, was intended to bolster vaccine research and development through the federal coordination of vaccine initiatives and to provide relief to vaccine manufacturers facing financial burdens. The legislation also intended to address concerns about the safety of vaccines by instituting a compensation program, setting up a passive surveillance system for vaccine adverse events, and by providing information to consumers. A key component of the legislation required the U.S. Department of Health and Human Services to collaborate with the Institute of Medicine to assess concerns about the safety of vaccines and potential adverse events, especially in children. Adverse Effects of Vaccines reviews the epidemiological, clinical, and biological evidence regarding adverse health events associated with specific vaccines covered by the National Vaccine Injury Compensation Program (VICP), including the varicella zoster vaccine, influenza vaccines, the hepatitis B vaccine, and the human papillomavirus vaccine, among others. For each possible adverse event, the report reviews peer-reviewed primary studies, summarizes their findings, and evaluates the epidemiological, clinical, and biological evidence. It finds that while no vaccine is 100 percent safe, very few adverse events are shown to be caused by vaccines. In addition, the evidence shows that vaccines do not cause several conditions. For example, the MMR vaccine is not associated with autism or childhood diabetes. Also, the DTaP vaccine is not associated with diabetes and the influenza vaccine given as a shot does not exacerbate asthma. Adverse Effects of Vaccines will be of special interest to the National Vaccine Program Office, the VICP, the Centers for Disease Control and Prevention, vaccine safety researchers and manufacturers, parents, caregivers, and health professionals in the private and public sectors.