• global threats to health (including pandemics, emerging infections, bioterrorism, natural disasters, and climate change);

  • workforce shortages;

  • the crumbling public health infrastructure;

  • social, environmental, and behavioral factors affecting health; and

  • health disparities and the needs of vulnerable populations.

The review of the nation’s top health challenges cannot begin with a blank slate; it must take into account HHS’s ongoing responsibilities and legislated commitments and should incorporate contributions from many quarters. It should include the White House and Congress, state government, the private sector, and a small number of individuals with unique perspectives, such as the head of the World Health Organization, or leading scientists and innovators.

Within the administration, the process of identifying the nation’s top health challenges needs to be a team effort involving the White House and leaders of other cabinet-level departments (Warshaw, 1996). Many federal departments have major health programs (see Box 2-1), and some health challenges—such as improving the response to national emergencies—cross traditional department jurisdictions. Much is to be gained by closer collaboration between HHS and other departments—such as Homeland Security—and agencies, such as the Social Security Administration or Environmental Protection Agency—whose actions greatly affect the health of the public.

The opinions of leaders of the congressional committees with oversight or appropriations responsibility for HHS must be solicited. This would include members of the 12 Senate and House committees and 6 subcommittees that currently oversee the department or its component agencies (see Box 2-2). Participation in the priority-setting process might improve the department’s responsiveness to public concerns while also helping members of Congress take into account the enormous number of challenges the department faces, stem the number of legislatively mandated programs layered on the department, and persuade members to allow the department more flexibility in program implementation (see Chapter 6).



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