Howard K Koh, MD, MPH
Assistant Secretary for Health, US Department of Health and Human Services

At the Office of the Assistant Secretary for Health (OASH) for the US Department of Health and Human Services (HHS), we uphold mobilizing leadership in science and prevention as a cornerstone of our mission.

To do so, we engage many public partners as well as those in the private sector. Through these collaborations, we can build stronger systems of prevention and care for the country and help people reach their highest attainable standard of health. Our efforts involve 14 core OASH public health offices—including the Office of the Surgeon General and the US Public Health Service Commissioned Corps—as well as 10 regional health offices across the nation and 10 presidential and secretarial advisory committees. Specific programs and projects address issues of disease prevention, health promotion, vaccine supply and safety, HIV and chronic infectious diseases, blood supply, bioethics, physical fitness, sports and nutrition, population affairs, research integrity, human research protections, women’s health, adolescent health, minority health, health disparities, and more.

Some recent examples of our mission in action include:

• prevention through the Affordable Care Act,
• national disease prevention and health promotion through the “Healthy People 2020” Initiative,
• HHS strategic action plan for tobacco control,
• national HIV/AIDS strategy, and
• national coordination of seasonal flu vaccination.

Too many people do not reach their full potential for health because of preventable conditions. With the recent passage of the new Affordable Care Act, the country faces a transformative opportunity to build true systems of prevention and eliminate health disparities. In addition to emphasizing coverage, quality, and affordability, the law encourages a new era for health and well-being by:

• providing improved access for many clinical preventive services (such as screening tests and vaccinations) without cost-sharing for those covered in new plans,
• providing new wellness benefits through Medicare,
• promoting workplace wellness programs,
• strengthening the role of communities in promoting prevention, and
• elevating prevention through the establishment of the new National Prevention, Health Promotion and Public Health Council (involving more than a dozen federal agencies), a National Prevention and Promotion Strategy, and a new Prevention and Public Health Fund .

OASH promotes these historic prevention opportunities through many of our core offices, in collaboration with partners throughout HHS and the broader national community.

National Disease Prevention and Health Promotion through the “Healthy People 2020 Initiative”

OASH, through its Office of Health Promotion and Disease Prevention, has just helped HHS unveil “Healthy People 2020,” a set of national health promotion and disease prevention goals for next decade. The new plan, the result of input from thousands of groups and individuals across the country, serves as a public health roadmap and compass for the nation.

Healthy People 2020 sets forth the following overarching goals for all Americans:

• to attain high quality and longer lives free of preventable disease, disability, injury, and premature death,
• to achieve health equity, eliminate disparities, and improve health for all groups,
• to create social and physical environments that promote good health for all, and
• to promote quality of life, healthy development, and healthy behaviors across all life stages.

Originally launched in 1979, Healthy People now offers an updated 20/20 vision for setting and monitoring national health objectives, encouraging new non-traditional collaborations across sectors, guiding individuals and communities to make informed health decisions, and serving as inspiration and aspiration for those who strive to make our country healthier.

HHS Strategic Action Plan for Tobacco Control

Tobacco use remains the leading cause of preventable death in the US, responsible for more than a thousand deaths a day. While our country has steadily reduced tobacco use over the past five decades, we have recently experienced a stall in declining consumption: 20.6% of adults and 19.5% of high school students still smoke cigarettes.

In response, OASH mobilized HHS leadership to generate the recent release of the first ever HHS comprehensive strategic action plan for tobacco control entitled, “Ending the Tobacco Epidemic: A Tobacco Control Strategic Action Plan.” The goal is to help the country to reach the “Healthy People” objective of a 12% adult smoking rate by 2020.

Four pillars serve as the foundation for the strategic action plan:

• engaging the public,
• improving public health by supporting evidence-based state and local tobacco control efforts,
• leading by example through maximum leverage of HHS assets, and
• accelerating research.

The strategic action plan capitalizes on recent historic prevention opportunities. The 2009 Family Smoking Prevention and Tobacco Control Act grants the FDA new authority to regulate the manufacture, marketing, and distribution of tobacco products. Included in the act is the new authority to place a series of graphic warning labels on 50% of the front and back of all cigarette packs sold in the US starting in 2012. In addition, the Centers for Medicare and Medicaid Services (CMS) have recently expanded Medicare coverage of smoking cessation services to beneficiaries who are smokers, not just those diagnosed with smoking-related disease. Related CMS coverage announcements, encompassing a number of tobacco-related provisions in the Affordable Care Act, are forthcoming.

Importantly, the strategic action plan supports evidence-based efforts of states and communities to advance cessation services, promote smoke-free public places, and move toward a society free from tobacco-related suffering and illness.

National HIV/AIDS Strategy

In July 2010, the president and the White House released the National HIV/AIDS Strategy (NHAS)—a comprehensive plan to address this epidemic. The NHAS vision calls for the US to “become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity, or socio-economic circumstance will have unfettered access to high-quality, life-extending care, free from stigma and discrimination.”

The NHAS proposes four major goals:

• to reduce the number of people who become infected with HIV,
• to increase access to care and optimize health outcomes for people living with HIV,
• to reduce HIV-related health disparities, and
• to achieve a more coordinated national response to the HIV epidemic.

OASH, through its Office of HIV/AIDS and Infectious Diseases, has led the HHS coordination of an implementation strategy for the NHAS by focusing efforts to align resources in major areas across the country where the disease has hit the hardest. Full mobilization of HHS resources will unify efforts on prevention, testing, linkage to care, and treatment. The strategy also provides timelines to measure progress toward those goals, gives clear responsibilities to federal HIV/AIDS programs, and sets expectations for accountability.

National Coordination of Seasonal Flu Vaccination

The 2009 global experience with H1N1 reinforced the message that the flu remains a serious and unpredictable disease. For the 2010-2011 season, OASH, through its National Vaccine Program Office, has helped to disseminate new national recommendations for influenza vaccination for everyone over six months of age. More than 160 million doses of vaccine have already been distributed throughout the country. In addition, special efforts are focused on reaching key populations, such as healthcare workers, minority populations, and pregnant women.

Summary

For the public health challenges reviewed here, and for many more, the issues play out in the public eye, impact the entire nation, and require solutions that lie well beyond the control of any single authority. We are committed to strengthening and broadening our partnerships to meet these leadership challenges. Together, our country can strengthen a broader “health in all policies approach” that will help each American move closer to achieving his or her highest standard of health.

As has been noted in Healthy People, the health of the individual is inseparable from the health of the larger community — and the health of each community drives the health of the entire country. The partnerships mobilized through OASH can make individuals, communities and the entire nation, healthier. We look forward to working with more colleagues across the country to achieve this goal.

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