health principles across its programs, including the major financing and research programs.

HHS policies and health and human services programs should incorporate current scientific knowledge and evidence-based practices. To accomplish this, the department needs to strengthen the science base of its programs and policy decisions. Political considerations cannot be allowed to override scientific evidence in the department’s decision making. Further, research funding needs to be stabilized and become more predictable. The Agency for Healthcare Research and Quality (AHRQ) is a primary example of an agency in need of stable, predictable funding. It has not had its own budget allocation since 2002, despite its mission to support, conduct, and disseminate research that improves access to care and the outcomes, quality, cost, and utilization of health care services—in other words, to gain the types of information needed to create value in the U.S. health system.

Nowhere is the weakness of HHS’s science base more apparent or potentially harmful to the public’s health than in the area of food safety. Authority for food safety is diffused across several federal agencies, with FDA and the Food Safety and Inspection Service of the U.S. Department of Agriculture (USDA) both playing lead roles. Currently, U.S. food safety agencies are ill-equipped and understaffed and cannot keep pace with the globalization of the food supply or advances in food science and technology.

Recommendation 2

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



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