health infrastructure, facilitate assessment of impact, and lead to corrective action.

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

To provide greater value to the American people for its $700 billion in annual health expenditures, the Department of Health and Human Services (HHS) requires clear direction. The first step is to identify and prioritize key health challenges, which would then be used to guide the development of a compelling, well-articulated vision for the nation’s health, to ensure that the department’s mission statement adequately describes its role in achieving the vision, and to identify a relatively small number of explicit, measurable goals that are geared to meeting the nation’s greatest health challenges.

The secretary should launch a formal process for establishing these guidelines for action, building on, as appropriate, the department’s current mission and commitments, as well as its long history of ensuring health and human services, and special attention should be paid to the needs of vulnerable populations served by the department. The process not only should involve the many important constituencies whose advice is essential to moving forward but also should be one that can be completed in a timely way.

The uppermost challenge facing the nation at present is the fundamentally flawed health care system and the need for health reform. Additional challenges include

• the rising prevalence of costly chronic diseases;

• developing prevention and treatment methods for diseases that currently lack them;

• persistent poverty (affecting more than 37 million Americans in 2007) (U.S. Census Bureau, 2008);