Related Recommendation

  1. 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.


Continuity, competence, and scientific integrity will be enhanced to the extent that heads of HHS’s science agencies—primarily NIH, CDC, FDA, and AHRQ—are appointed without regard to politics and may remain in their positions for fixed terms that may straddle presidential transitions. Given the importance of these positions to protecting the public’s health, they should be filled quickly after vacancies occur. Indeed, any new secretary’s team should be put in place without undue delays.

When the White House and the secretary select top departmental officials—and when Congress considers their confirmation—they should not impose an ideological test, but should look for leadership and management qualifications, as well as scientific or technical expertise. The latter is of particular importance because the secretary’s primary skills are likely to be focused on management and leadership. These departmental officials must be able to

  • assess competing scientific opinions and recognize when the science remains inconclusive,

  • balance scientific interests and uncertainty with the practicalities of resource limitations,

  • authoritatively fend off doctrinaire demands while respecting diverse human values, and

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