• The public health infrastructure is weak and, in many locales, hard-pressed to meet current demands, much less those of the future.

  • The United States trails many other countries in achieving desired health outcomes and longevity, despite having the world’s highest level of per capita health care spending.

Unfortunately, HHS is not a high-performance organization, oriented to change and steady improvement. Over the years, change at HHS has been driven by the piecemeal accretion of programs legislatively mandated by various congressional committees, frequently without commensurate resources or regard for the department’s capacity to manage them. One result is a department that is not optimally designed to meet the nation’s current and future health challenges.


The department’s current structure, operations, and culture must be viewed against the backdrop of today’s environment and the needs of the future. It is in this context that Representatives Henry A. Waxman and Tom Davis, the chair and ranking minority member, respectively, of the U.S. House of Representatives Committee on Oversight and Government Reform in the 110th Congress, asked the Institute of Medicine (IOM) to assess whether HHS is “ideally organized” to meet the enduring and emerging health challenges facing our nation. Box S-1 describes the statement of task with which the committee was charged.


Statement of Task

To respond to Representatives Waxman’s and Davis’s request for a study of the organizational challenges facing HHS and a set of recommendations to address them, the IOM framed the following statement of task for the Committee on Improving the Organization of the U.S. Department of Health and Human Services (HHS) to Advance the Health of Our Population:

  • What are the unifying elements of the mission of the department? What are the missions of its constituent agencies, and how do their activities relate to the public health, health care quality, and health care cost challenges facing the United States?

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