Former agency heads, policy experts say US needs a more centralized approach to public health

A panel of former federal health leaders and other public health experts is advising policymakers to revamp the nation’s public health system in favor of a more centralized approach with greater authority across the country’s thousands of health departments.

The group called for Congress to establish a new position—potentially an “under secretary for public health” within the Department of Health and Human Services (HHS)—that could serve as a single federal focal point for the country’s public health efforts.

Additionally, it said Congress should provide more stable support for public health agencies at the state, local, tribe and territory levels. The funds would come with an understanding that these agencies meet “basic standards for delivering … core capabilities” as assessed through an accreditation process established by the strengthened federal public health authority.

This new structure, paired with other recommendations surrounding a modernized public health IT system, executive branch buy-in and tighter connections with local-level agencies, will be necessary to develop a “national public health system” better equipped for disease outbreaks and noncommunicable health threats alike, the experts said.

“The United States lacks a national public health system capable of protecting and improving health, advancing health equity every day, and responding effectively to emergencies,” the Commonwealth Fund Commission on a National Public Health System wrote in a report released Tuesday.

“While the public health systems of other nations led coordinated responses [to COVID-19] with strong data systems, networks of advanced laboratories, effective communications and teams of outreach workers, the U.S. response splintered, leading to widely disparate outcomes across the country. The consequences of these deficiencies reach far beyond the current pandemic and undermine the nation’s ability to respond to ongoing and pressing health challenges,” they wrote.

Convened by the Commonwealth Fund, the commission includes a slew of experts from academia and both sides of the political aisle—Obama-era Food and Drug Administration (FDA) Commissioner Margaret Hamburg, M.D., George W. Bush’s Centers for Disease Control and Prevention (CDC) director Julie Gerberding, M.D., and Johns Hopkins Bloomberg School of Public Health Dean Ellen MacKenzie, Ph.D., to name a few.

The group recommended their structural recommendations be accompanied by roughly $8 billion in new investments toward improved IT and other public health infrastructure—“an amount that pales in comparison to the trillions of dollars lost as a result of the inadequate public health response to the pandemic,” they wrote.

Congress has already signaled its intent to overhaul the nation’s public health system. Earlier this year, the Senate Health, Education, Labor and Pensions Committee previewed and then advanced bipartisan legislation that would place greater scrutiny on FDA and CDC leadership and strategy. The PREVENT Pandemics Act also seeks to bolster the public health workforce, clamp down on misinformation and improve surveillance monitoring, among other efforts.