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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 U.S. public health system, which would significantly increase the role of the federal government, and give Washington the power to set minimum health standards and create a patchwork of nearly 3,000 state, local and tribal agencies.

The recommendations stem from what the panel, the Commonwealth Fund Commission on a National Public Health System, described as the shortcomings and inequalities 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 failure of national health agencies to protect Americans from other health risks, including drug overdoses, diabetes and maternal deaths.

By recommending the creation of a new “national public health system,” the bipartisan panel funded by the Commonwealth Fund, a nonprofit research group focusing on health issues, is dipping its toe in 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 levels. The Centers for Disease Control and Prevention, the federal public health agency, has no power to compel states to act — for example, it cannot investigate outbreaks of communicable disease in a particular state unless invited to do so by state officials. So.

State health agencies and the CDC have a long history of working together, but during 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, for example, vaccination data with the federal government, a number of states were hesitant.

In its report, the panel cited “archaic approaches to data collection” as one reason why so many Americans have died. It called on Congress to empower the Department of Health and Human Services to set and enforce data collection standards.

dr. Julie L. Gerberding, a member of the panel who served as CDC director in President George W. Bush’s administration, said the pandemic has “taught us that we need to have a coordinated, integrated public health network that works — and that we can only bring them together through a national approach.”

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

The committee’s recommendations are more far-reaching. The panel, led by Dr. Margaret A. Hamburg, the Food and Drug Administration Commissioner under President Barack Obama, calls for the creation of a new position – Under Secretary for Public Health – within the Department of 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 system is a federalist system with states and places that have considerable autonomy — and rightly so, as they adapt to the needs of their states and communities,” said Dr. Hamburg in an interview. “However, the public health protections that individuals receive should not depend entirely on where you live. There has to be a core of expectations.”

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