A bipartisan panel of health experts is calling Tuesday for an overhaul of America’s public health system that would greatly expand the role of the federal government, giving Washington the authority to set minimum health standards and coordinate a group of nearly 3,000 states, local and tribal. agencies.
The recommendations stem from what the panel, the Commonwealth Fund Commission on the National Public Health System, described as the inadequacies and inequities of the United States’ response to the coronavirus pandemic, which has killed more than a million Americans.
But in a report released Tuesday, the panel said it also wanted 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.
By recommending the creation of a “new national public health system,” the bipartisan panel, funded by the Commonwealth Fund, a nonprofit think tank focused on health care issues, is dipping its toe into contentious political waters.
While other countries have centralized public health authorities, public health in the United States is managed primarily at the state and local levels. The Centers for Disease Control and Prevention, the federal public health agency, does not have the authority to compel states to act — it cannot, for example, investigate outbreaks of infectious diseases in a particular state unless it has an invitation from officials state to do so.
State health agencies and the CDC have a long history of cooperation, but throughout the pandemic, elected state officials — especially those in red states — have been reluctant to relinquish 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 collection” as a reason why 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.
Dr. Julie L. Gerberding, a panel member who served as CDC director in President George W. Bush’s administration, said the pandemic “has taught us that we have to have a coordinated and integrated public health network that works – and the only way we can pull this together is by having a national approach.”
The panel’s report comes as Congress is considering legislation that takes a different approach to supporting the nation’s public health infrastructure. The Senate Health Committee has approved 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 the nation’s public health agencies.
The commission’s recommendations are more comprehensive. The panel, led by Dr. Margaret A. Hamburg, commissioner of the Food and Drug Administration under President Barack Obama, is calling for the creation of a new position — Under Secretary for Public Health — within the Department of Health and Human Services to oversee the nation’s 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 power to set minimum health standards for states.
“Our public health system is a federalist system with states and localities having considerable autonomy — and appropriately so, as they adapt to the needs of their states and communities,” said Dr. Hamburg in an interview. “However, the public health protection that individuals receive should not depend entirely on where you live. There has to be a core set of expectations.”