Expert Panel to Call for Overhaul of U.S. Public Health System

A bipartisan panel of health experts will call on Tuesday for an overhaul of the US public health system that would dramatically expand the role of the federal government, giving Washington the power to set minimum health standards and coordinate a patchwork of nearly 3,000 state, local and tribal agencies.

The recommendations stem from what the panel, the Commonwealth Fund’s Commission on a National Public Health System, described as the inadequacies and inequities in the United States’ response to the coronavirus pandemic, which has killed more than one million Americans.

But in a report to be released Tuesday, the panel said it also wants to address the failures of the nation’s public health agencies to protect Americans from other health risks, including drug overdoses, diabetes and maternal mortality.

In recommending the creation of a new “national public health system”, the bipartisan panel, funded by the Commonwealth Fund, a non-profit research group focused on health issues, is dipping its toe into controversial political waters. .

While other countries have centralized public health authorities, public health in the United States is largely managed at the state and local level. The Centers for Disease Control and Prevention, the federal public health agency, does not have the power to compel states to act – they cannot, for example, investigate infectious disease outbreaks in a particular state unless that they are not invited by representatives of the State to do so. then.

State health agencies and the CDC have a long history of working together, but throughout the pandemic, state officials — especially those in red states — have been reluctant to cede control. When the CDC asked states to sign agreements to share vaccination data with the federal government, for example, a number of states balked.

In its report, the panel cited “archaic approaches to data aggregation” as one of the reasons so many Americans have died. He called on Congress to give the Department of Health and Human Services the authority to set and enforce data collection standards.

Panel member Dr. Julie L. Gerberding, who served as CDC director in the administration of President George W. Bush, said the pandemic “taught us that we need to have a coordinated and integrated public health network that works – and the only way to bring it all together is to have a national approach.

The panel’s report comes as Congress considers legislation that takes a different approach to strengthening the nation’s public health infrastructure. The Senate Health Committee passed a bipartisan measure that would require the CDC director to be confirmed by the Senate, and that calls for additional steps to improve coordination among public health agencies nationwide.

The commission’s recommendations are more radical. The panel, led by Dr. Margaret A. Hamburg, the commissioner of the Food and Drug Administration under President Barack Obama, calls for the creation of a new position – undersecretary of public health – within the Department of Health. Health and Human Services, to oversee the national public health system.

The undersecretary would coordinate the work of more than a dozen federal agencies that play a role in public health and would have the authority to set minimum health standards for states.

“Our public health care system is a federalist system with states and localities enjoying considerable autonomy — and appropriately, as they adapt to the needs of their states and communities,” Dr. Hamburg said in an interview. . “However, the public health protections that individuals enjoy should not depend entirely on where you live. There should be a basic set of expectations.

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