Homeland Security: New Department Could Improve Coordination but May Complicate Public Health Priority Setting

Since the terrorist attacks of September 2001, and the subsequent anthrax incidents, there has been concern about the ability of the federal government to prepare for and coordinate an effective public health response to such events. More than 20 federal departments and agencies carry some responsibility for bioterrorism preparedness and response. Emergency response is further complicated by the need to coordinate actions with agencies at the state and local level, where much of the response activity would occur. The President's proposed Homeland Security Act of 2002 would bring many of the federal entities with public health preparedness and response responsibilities into one department to mobilize and focus assets and resources at all levels of government. The proposed reorganization has the potential to repair the fragmentation in the coordination of public health preparedness and response at the federal, state, and local levels. In addition to improving overall coordination, the transfer of programs from multiple agencies to the new department could reduce overlap among programs and facilitate response in times of disaster. However, there are concerns about the proposed transfer of control from the Department of Health and Human Services to the new department for public health assistance programs that have both basic public health and homeland security functions. Transferring control over these programs, including priority setting, to the new department has the potential to disrupt some programs that are critical to basic public health responsibilities. The President's proposal is not clear on how both the homeland security and the public health objectives would be accomplished.