BOX 1-2


  1. To meet twenty-first century challenges to America’s health, the secretary of HHS should clearly articulate and actively promote a vision for the nation’s health, ensure that the department’s mission supports that vision, and establish a small number of measurable goals focused on critical challenges.

    1. The secretary should lead a thorough and thoughtful process to identify and prioritize the nation’s key health challenges.

    2. The secretary should, in this process, consult widely with internal department leaders, others in the executive branch, Congress, governors and state-level officials, health care providers, scientific and professional organizations, and public interest and advocacy groups.

    3. The secretary should establish a vision, mission, and goals that respond to twenty-first century challenges, enable greater programmatic continuity over time, and that can be used to focus department staff and activities on leading priorities, strengthen the public health infrastructure, facilitate assessment of impact, and lead to corrective action.

    4. The secretary, working closely with the White House and Congress, should take a major role in promoting and achieving health reform nationwide.

  1. 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.

    1. The heads of all department units should ensure that their activities and operations are aligned with the department’s vision, mission, and goals and marshal their resources to achieve them.

    2. The secretary should reduce directly reporting senior-level officials to a manageable number. Although secretarial management styles differ, a rigorous decision-making process for both policy and operations must be established, along with accountability for results.

    3. The secretary should ensure a more prominent and powerful role for the surgeon general, who, in addition to leading the Commissioned Corps, should be a strong advocate for the health of the American people and work actively to educate Americans on important health issues. The secretary should work with the President and Congress to establish a process for identifying surgeon general candidates for Presidential appointment that gives high priority to qualifications and leadership, and Congress is strongly urged to consider a longer term for this office.

    4. The secretary should work with the President and Congress to establish a selection process for the department’s senior-level officials that protects the scientific and administrative integrity of major departmental units, promotes progress toward departmental goals, and is based primarily on the candidates’ qualifications and experience. Congress again is strongly urged to consider longer terms for some of these officials—especially the directors of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), and the commis

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