The American Public Health Association's Position on the Proposed Department of Homeland Security

6/27/2002

From: Kelly O'Brien of the APHA, 202-777-2510

WASHINGTON, June 27 -- The American Public Health Association (APHA) is concerned that key components of the Administration's proposed legislation to create a new Department of Homeland Security may undermine efforts to strengthen the nation's public health system. While coordination and communication among health entities, law enforcement and the intelligence community are essential, the integrity of the public health system and the science upon which it is based must be preserved.

Under the Administration's proposal, many of the federal public health functions would be transferred to the new Homeland Security Department; other responsibilities would be shared between the new Department and their current home at the Department of Health and Human Services (HHS). This bifurcation threatens to weaken efforts to achieve an effective, responsive broad-based public health system that is prepared for all emergencies, whether naturally occurring outbreaks or intentional acts of terrorism.

In either a naturally occurring outbreak or an intentional act of terrorism, the public health response is initially the same because the cause of the outbreak is often not known. It is critical that the resources, capacity and training that is so urgently needed to bolster the core public health capacity at all levels and for all types of outbreaks is not neglected and that scientific integrity is maintained.

The Department of Homeland Security proposal does not adequately delineate the public health roles and responsibilities of the new department and HHS. Further, the proposal separates the priority setting and the funding streams for public health programs from the operations and implementation of such activities. The result is a lack of accountability for public health objectives and the potential for disruption of public health assistance programs that have basic public health responsibilities as well as homeland security functions.

Furthermore, the capability to respond to outbreaks and develop countermeasures is based on sound science. Biomedical and applied research conducted at the Department of Health and Human Services is part of a research continuum aimed at developing the nation's defenses against and responses to biological threats. HHS is best qualified to determine research priorities and conduct such research. The proposed restructuring of authorities in the Administration's bill creates instability for research programs and may divert funding away from the current integrated research effort.

APHA supports the Public Health and Security and Bioterrorism Act of 2002 that the President recently signed into law. This law recognizes the need to improve the basic public health system infrastructure and increase the ability to identify, respond to, and prevent problems of public health importance generally, including the health aspects of a terrorist attack. The cornerstone of this legislation is a grant program to state and local entities administered by HHS. Shifting the management of these efficient, accountable programs from the public health experts at the Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) to a new department focused solely on security issues raises concerns that public health priorities and outcomes will no longer be guided by the expertise of public health professionals. It also detracts attention away from the need to improve core capacity and may, in fact, result in improving bioterrorism preparedness while weakening the overall public health infrastructure that has already been historically neglected.

While opposing the transfer of public health authorities and scientific research, APHA supports the coordination role of the proposed new department and believes it may in fact reduce the current fragmentation that exists. APHA has long advocated for improved relationships, communication and coordination among public health entities, law enforcement and the intelligence community. A new Department of Homeland Security or other mechanisms that would coordinate the cumbersome federal health preparedness and response efforts and streamline the planning process between the various funders, such as the Federal Emergency Management Agency and the Department of Justice is needed. APHA welcomes the leadership that a coordinated effort at the Department of Homeland Security would provide.

However, APHA recommends that to both achieve coordination and maintain current public health authorities the Secretary of HHS or his designee be represented as part of a planning and coordination team assembled by the Department of Homeland Security or other coordination entity rather than transferring his authority to a new department as outlined in the Administration's proposal.

APHA opposes transferring public health priority setting, funding, research and program management to a new department. APHA urges Congress and the Administration to preserve the integrity of the current public health system and leave public health preparedness with those individuals and agencies with the expertise and credibility to get the job done. The primary responsibility for public health funding, priority setting research and program management should remain within the Department of Health and Human Services.

APHA is the oldest and largest organization of public health professionals and represents more than 50,000 members from over 50 public health occupations. Based on the values of health, equity, diversity, empowerment, integrity, dignity and knowledge for individuals and communities, APHA is the leading professional association that promotes and protects the health of the people.