divisions, without positions such as undersecretaries or assistant secretaries with line authority.

  • The department’s data and information systems inadequately support decision making and program assessment.

  • Responsibility for key issues is fragmented across agencies, making it difficult to leverage resources for maximum impact; for example, obesity—now generally considered one of the nation’s foremost health issues—is addressed by programs in nearly every health and human services agency.

  • The once-powerful position of assistant secretary for health (ASH) no longer has authority over the department’s major public health agencies and, consequently, has little capacity to generate or inspire change in the public health sector. Instead, the ASH oversees 16 offices, many focused on socially sensitive areas—such as biomedical ethics, reproductive health, HIV/AIDS policy, and minority and women’s health (HHS, 2008a).

  • The department has made insufficient progress toward achieving the nation’s current health goals—for example, of the Healthy People 2010 objectives set a decade ago, only one-third have seen progress (HHS Office of Disease Prevention and Health Promotion, 2005).

  • The HHS workforce needs major strengthening.

Each such internal issue should be evaluated to determine whether the secretary has authority to remedy it or whether the involvement of Congress is required.


The process of establishing vision, mission, and goals relates to the seven elements of organizational success noted in Chapter 1—most notably, strategy, systems, and shared vision (Bradach, 1996). All three of these expressions of purpose are essential for the effective functioning of any organization.

This report does not recommend what the department’s vision for the nation, its own mission, or its goals should be. Instead, the committee firmly believes that these choices belong to the President and the secretary, that they must be articulated clearly and forcefully and promulgated

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