provide a safety net of services for the poor and special populations; and they work to make the entire health care system better for everyone.

In addition to its health activities described below, HHS is responsible for two significant human services programs—the Administration on Aging and the Administration for Children and Families. These programs support a variety of services including community-based programs for older persons, Temporary Assistance for Needy Families, Head Start, adoption and foster care services, and prevention of family violence. As is discussed in Chapter 3, an individual’s health is determined by a variety of complex factors, including socioeconomic status, and the Administration on Aging and the Administration for Children and Families play an important role in assuring not only the financial well-being of their constituents, but also their health.

The sweep of the department and its many activities today is broad, though its beginnings were modest. For more than 200 years, the addition of new programs and agencies has created a patchwork of programs that is now the responsibility of HHS. Many units that began small are now large, complex enterprises in their own right. Carrying out these diverse roles involves agencies and people who represent multiple disciplines and organizational cultures. Biomedical researchers, regulators, service providers, payers, analysts, health education specialists—all have different priorities and ways of looking at the world and its problems. This makes it difficult to achieve organizational alignment—that is, to ensure that every agency, unit, and person in the organization is working toward a consistent set of goals.

If the department leadership had to deal only with achieving internal harmony, that in and of itself would be a significant challenge. However, it also must respond to the needs and desires of many other powerful players. The White House has health care priorities; so does Congress; and so do other departments, most notably, the Department of Homeland Security. HHS must consider the priorities and needs of the state and local health officials who implement its programs in communities; of advocacy groups that want attention to their issues; and of the health professions, provider groups, and institutions concerned about regulation and funding, as well as of a public that expects high-quality, affordable health care.

In today’s globally connected world, the department’s role and responsibilities do not end at the U.S. borders. People, knowledge, information, and goods travel across geographic boundaries more rapidly than ever. These transfers sometimes pose a risk to Americans: travelers may

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