HHS in the 21st Century Charting a New Course for a Healthier America (2009) / Chapter Skim
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3 Foster Adaptability and Alignment
3 Foster Adaptability and Alignment
Pages 55-86
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From page 55... ...
RECOMMENDATION 2 Foster Adaptability and Alignment To improve the public's health and achieve the department's goals, the secretary should align and focus the department on performance and encourage creative use of scientifically based approaches to meet new and enduring challenges.
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From page 56... ...
f. The secretary should ensure that all department health programs, including the reimbursement programs, reinforce public health priorities and strategies in order to provide a consistent frame work for protecting the public from health risks, promoting health, preventing disease and disabil ity, and providing health services for vulnerable populations in the most efficient, cost-effective ways.
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From page 57... ...
SCOPE OF THE CHALLENGES As the organization charged with primary responsibility for ensuring the health and well-being of Americans, HHS must keep pace with rapid advances in many fields -- biomedical sciences, health care technologies, the organization of health care, information technologies, health and social services research, and quality improvement. It also must keep abreast of emerging global threats to health, rising consumer expectations, and pressure for cost control and greater efficiency.
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From page 58... ...
Second, globalization -- the growing interdependence among enterprises, economies, and governments -- complicates any effort to improve or protect health, placing many risk factors beyond the department's control. For example, the globalization of the food supply has the potential to introduce a wide range of contaminants.
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From page 59... ...
• Through its research agenda, HHS supports the nation's bio medical and health research community, health insurers, and health plans. • Finally, through its funding for health professions training, HHS interacts with the medical schools and other health professions educational programs that represent the future health care work force.
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From page 60... ...
While the secretary needs a good rapport with the President, in addition to strong leadership and management skills, the committee places equal importance on the need for these skills among agency heads, who also must possess strong scientific and technical expertise and be able to work as a team led and coordinated, through some internal arrangement, by the secretary's office. Currently, 30 official positions report directly to the secretary (HHS, 2008)
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From page 61... ...
The secretary's role should be to concentrate on major emerging problems, or controversies, and on a handful of major initiatives, such as health reform, on the department's budget and key appointments, and to serve as "ambassador" for the department to other cabinet agencies, Congress, and the private health sector. To create a new level of senior officials -- including perhaps an undersecretary, powerful assistant secretaries, or some other configuration -- might require congressional approval, but would follow the norm of other cabinet-level departments.
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From page 62... ...
While day-to-day operations could be managed by a new senior official (or officials) , agency heads should, of course, always have direct access to the secretary for major policy decisions, budget planning, and in times of crisis.
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From page 63... ...
Everett Koop, living up to his iconic status as a "straight talker," demanded greater attention to HIV/AIDS. • In the 1990s Surgeon General David Satcher advocated action to provide mental health parity, reduce health disparities, and end discrimination based on sexual orientation, and reinvigorated the campaign to control tobacco.
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From page 64... ...
. After Surgeon General Richard Carmona left office, he accused the administration of silencing him on embryonic stem cell research, abstinence-only sex education, contraception, climate change, prison health, and mental health, and discouraging him from supporting the Special Olympics (Harris, 2007)
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From page 65... ...
• Secure bipartisanship support prior to an appointment, for exam ple, by consultation with the chair and ranking member of the Senate Committee on Health, Education, Labor, and Pensions. These types of processes would respond to most of the reforms recommended by a recent National Academies committee as ways to ensure the best science and technology appointments for government by addressing the need to attract the best leadership; make appointments speedily; provide continuity; improve the process by which candidates are nominated, cleared, and confirmed; and broaden the pool of potential candidates (NRC, 2008)
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From page 66... ...
The secre tary should work with the President and Con gress to establish a process for identifying surgeon general candidates for Presidential appointment that gives high priority to qualifications and lead ership, and Congress is strongly urged to consider a longer term for this office. A PROTECTED CORPS OF SCIENTIFIC LEADERS Continuity, competence, and scientific integrity will be enhanced to the extent that heads of HHS's science agencies -- primarily NIH, CDC, FDA, and AHRQ -- are appointed without regard to politics and may remain in their positions for fixed terms that may straddle presidential transitions.
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From page 67... ...
However, if agency head appointments are, as recommended, based on leadership, management skills, and scientific expertise, with minimal political considerations, then incumbents to these positions may well survive a change in administration. The committee recommends that multiyear, fixed terms be considered, 3 because it would support greater management and intellectual continuity -- especially for research projects with long trajectories -- avoid at least some turnover that may be unnecessary, decrease the amount of time that top leadership 3 Note that the director of the National Science Foundation and the commissioner of the Social Security Administration currently have six-year terms; that commissioners of the Federal Communications Commission have five-year terms; and that past IOM committees likewise recommended a six-year term for the NIH Director and FDA Commissioner.
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From page 68... ...
Related Recommendations d. The secretary should work with the President and Congress to establish a selection process for the department's senior-level officials that pro tects the scientific and administrative integrity of major departmental units, promotes progress to ward departmental goals, and is based primarily on the candidates' qualifications and experience.
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From page 69... ...
Exercising so little direct influence, HHS must be focused in its health promotion efforts and evolve with changing circumstances, and it must be the leading advocate within the federal government, and with the American people, for achieving population health. The federal government provides financial support for the nation's health in a variety of ways, which include providing direct payment for about a quarter of the nation's health care services (mostly through Medicare and Medicaid)
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From page 70... ...
. In 2002, the Institute of Medicine recommended adoption of "a population health approach that considers the multiple determinants of health." That committee also recommended strengthening the governmental public health infrastructure (both federal and state)
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From page 71... ...
Attributes of an integrated public health agenda, in addition to helping create an aligned and coherent mission, as discussed above and in Chapter 2, would include the following: • Insistence that public health interventions, as well as medical services, create value -- they should produce improvements or benefits for the greatest number of individuals, to the most vul nerable populations, to the greatest degree possible, and at the lowest cost. • Calculation of the full value of public health services -- value should not be determined by just measuring the costs and bene fits to the health sector, but should also include estimates of so cietal costs and benefits.
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From page 72... ...
Related Recommendation f. The secretary should ensure that all department health programs, including the reimbursement programs, reinforce public health priorities and strategies in order to provide a consistent frame work for protecting the public from health risks, promoting health, preventing disease and disabil ity, and providing health services for vulnerable populations in the most efficient, cost-effective ways.
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From page 73... ...
In HHS, the kinds of scientific expertise needed are broad: they include biomedical scientists doing laboratory and clinical research, behavioral scientists, statisticians and epidemiologists, health services researchers, policy analysts, economists, and others applying their skills to solving problems that range from the size of a molecule to the size of the health care system. Although much of this report dwells on the applied sciences, especially health services research and systems analysis, the committee recognizes that basic biomedical research is essential to achieving continued medical progress.
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From page 74... ...
These include decisions relating to fundamental HHS responsibilities: • Biomedical research funding has been affected, such as the elimination of federal funding for embryonic stem cell research on cell lines established after 2001, despite the potential value of such research (IOM, 2005)
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From page 75... ...
In the regulatory sphere, for example, the link between valid, reliable information and policies must be strong enough to meet legal challenges, as well as critiques by members of Congress, the news media, organizations representing various HHS constituencies, and the public. In short, decision makers must have access to scientific findings, transparent methods of reviewing them, free of influence by the regulated industries, and plausible ways to resolve questions when scientific findings conflict or are inconclusive (Wagner and Steinzor, 2006)
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From page 76... ...
STABILIZED RESEARCH FUNDING Scientific research projects typically extend well beyond a single fiscal year. Predictability in funding is important, and delays in budget approvals can be especially injurious to the large, multiyear, multiinstitutional, multidisciplinary projects that now distinguish scientific inquiry (IOM, 2003)
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From page 77... ...
This has left the agency's budget an order-of-magnitude smaller than every other major PHS agency except FDA, whose budget is still five times that of AHRQ. 6 AHRQ's mission is to support, conduct, and disseminate research that improves access to care and the outcomes, quality, cost, and utilization of health care services -- in other words, to increase the value of the health care services Americans receive.
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From page 78... ...
: The nation's food supply is at risk. Crisis management in FDA's two food safety centers, Center for Food Safety and Applied Nutrition and Center for Veterinary Medi 7 Food safety issues have garnered a great deal of attention in Congress.
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From page 79... ...
Moreover, monitoring any food-related outbreaks that occur -- the 8 The Subcommittee on Science and Technology concluded that "science at the FDA is in a precarious position: the Agency suffers from serious scientific deficiencies and is not positioned to meet current or emerging regulatory responsibilities." The report indicates that the science base of the entire agency is lacking, not just in the area of food safety, and is in need of reinforcement (FDA Subcommittee on Science and Technology, 2007)
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From page 80... ...
. Food regulation is diffused across at least 12 agencies, including FDA, USDA's FSIS, the National Marine Fisheries Service of the Commerce Department, the Environmental Protection Agency (regulating pesticides)
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From page 81... ...
Congress should assess the large collection of food safety laws regulating various commodities to determine whether they should be updated and coordinated, in light of an evolving industry, improved science for detecting hazards, trends in contamination, and globalization of food products and ingredients. The goal should be to mount a public healthoriented regulatory program that not only would prevent food-borne illnesses, but also would make rational use of federal food safety resources.
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From page 82... ...
5. Recognizing the need to strengthen its food safety regulatory op erations, FDA recently developed a Food Protection Plan, an in tegrated strategy to protect the food supply through prevention, intervention, and response (FDA, 2007b)
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From page 83... ...
Finally, because drug regulation so dominates the current FDA, 10 the committee was not persuaded that the unified food safety function should be lodged automatically within that agency. Creation of a new, focused food safety entity might be preferable.
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From page 84... ...
2007b. Food protection plan: An integrated strategy for protecting the nation's food supply.
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From page 85... ...
2005. Guidelines for human embryonic stem cell research.
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From page 86... ...
2008. Fixing food safety: Protecting Amer ica's food supply from farm to fork.
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