In 2002, "President Bush signed into law the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, which, among other things, eliminated the need to convene an advisory committee to amend the list of diseases" listed as quarantineable (Misrahi, Foster, Shaw, & Cetron 2004).
This law became significant during the SARS scare. Before 2002 "the list of federal quarantinable diseases in the United States had not been revised since 1983. It included cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, and viral hemorrhagic fevers such as Marburg, Ebola, and Congo-Crimean" fevers (Misrahi, Foster, Shaw, & Cetron 2004). The CDC was able to quickly ad SARS to the list. In the past, the CDC "generally deferred to state and local health authorities...to restrict the movement of persons within their boundaries" with such diseases (Misrahi, Foster, Shaw, & Cetron 2004). Its greater legislative ability to move quickly in classifying the illness as requiring extraordinary measures to quarantine individuals or exclude them from entry into the country was cited as a reason SARS did not reach the proportions it did in the Far East. Additionally, a comment that a "lesson learned from the outbreak is that federal, state, and local officials will have to work closely in coordinating quarantine actions at all levels of government" with HHS departments might behoove the HHS to heed in other areas of its operation such as the FDA's issuance of dietary guidelines (Misrahi, Foster, Shaw, & Cetron 2004).
A further agency under the control of the HHS is the Agency for Toxic Substances and Disease Registry. This Agency works with states and other federal agencies, to prevent exposure to hazardous substances from waste sites, often in conjunction with the U.S. Environmental Protection Agency. Yet again, the extent to which human health is affected by substances produced by powerful corporations and the burning of fossil fuels and global warming may embroil aspects of HHS's auspices in controversy, especially when it is in conjunction with other agencies (Definition of HHS, 2008, Medicine Net)..
Another part of the HHS that has been the subject of recent debate is that of the Health Resources and Services Administration -- HRSA helps provide health resources for medically underserved populations (additionally the Indian Health Service provides a similar array of social services and cares to individuals in need of Native American ancestry). Issues pertaining to sexuality are often affected in this aspect of the HHS's work. For example, quite recently the Bush Administration issued a statement that expanded the ability of health care workers, hospitals, and health insurance companies to refuse to provide health services for "sincere religious belief or moral convictions" (DeNoon 2008). HHS issued the press statement which defended the new policy covering an estimated 571,947 health provision entities including doctors' offices, pharmacies, hospitals, insurers, medical and nursing schools, diagnostic labs, nursing homes, and state governments agencies that provide health care.
The Bush Administration, an admitted foe of abortion, was viewed by many women's groups as using the policy to limit the reproductive right of choice. Even the American Medical Association decried the new Bush law noting that it: "expands the range of health care institutions and individuals who may refuse to provide services, and broadens the scope... beyond the actual provision of health care services to information and counseling about health services as well as referrals" (DeNoon 2008). The American Medical Association AMA was also worried that the new protections were so broad in terms of who was defined as a health care provider that receptionists could refuse to schedule patients for medically necessary services, and people who "clean or maintain equipment or rooms" could interrupt patient care if they claimed the treatment went against their conscience (DeNoon 2008). To repeal the rule, the incoming Obama administration could act on its own, or Congress could take the initiative pass a law repealing the rule. Regardless, this is an illustration of how the policy of the HHS is affected, some would say, tainted with politics. The FDA in the past was subject to similar political criticism from anti-abortion advocates when it approved Plan B, an emergency contraceptive method known as the 'morning after pill' opposed by anti-abortion activists who disliked the fact it would prevent a fertilized embryo from anchoring in a mother's womb (Johnson 2006).
Thus health advice is never politically or socially 'neutral' when disseminated through the law or a government agency like HHS. Take even the seemingly noncontroversial subject of breast-feeding babies. In 2004, HHS was pressured to end its advertising campaign warning that not breastfeeding could hurt a newborn's health. "It featured striking photos of insulin syringes and asthma inhalers topped with rubber nipples," implying that not breast-feeding is linked to babies that are more likely to develop obesity and Type II Diabetes as well as asthma later in life (Kaufman & Lee, 2008, p.1). "Plans to run these blunt ads infuriated the politically powerful infant formula industry, which hired a former chairman of the Republican National Committee and a former top regulatory official to lobby the Health and Human Services Department. Not long afterward, department political appointees toned down the campaign" (Kaufman & Lee, 2008, p.1). The formula industry's influence to change the advertisement's content eventually subjected HHS to scrutiny by Congress, which felt that the "administration repeatedly allowed political considerations to interfere with his efforts to promote public health" (Kaufman & Lee, 2008, p.1). The "campaign HHS used did not simply drop the disputed statistics in the draft ads. The initial idea was to startle women with images starkly warning that babies could become ill. Instead, the final ads cited how breast-feeding benefits babies -- an approach that the ad company hired by HHS had advised would be ineffective. The department also pulled back on several related promotional efforts" (Kaufman & Lee, 2008, p.1).
But HHS has been subjected to criticism by advocates of mothers as well as the formula industry regarding its advocacy of breast-feeding. For example, breast-feeding advocates lobbied an end to hospitals giving free formula to new mothers upon leaving the hospital, fearing that mothers might be more apt try the formula during a "rough patch" if the baby was not feeding properly or the mother found breastfeeding painful. They feared the practice of giving formula confused mothers (Samuels 2006). HHS agreed and said that "hospital distribution of formula could unduly influence a mothers' decision to breastfeed for as long as possible" and urged hospitals to cease the practice (Samuels 2006). However, many women, particularly poor women may have difficulty producing enough milk to nourish their children or may need to go back to work quickly for economic reasons and cannot breast-feed. Pressuring hospitals to discourage women who intend to use formula to seek appropriate advice in how much to give or what kind to select may be more harmful in the long run, even if breast-feeding is 'best' for women capable of doing so.
A public health conundrum at the heart of HHS policy also relates to the question of legal and illegal drug abuse. Is drug abuse an illness or a crime? While certain aspects of the government view drug abuse solely as a crime, within HHS there is a department known as the Substance Abuse and Mental Health Services Administration (SAMHSA) that works to improve the quality and availability of substance abuse prevention, addiction treatment, and mental health services (Definition of HHS, 2008, Medicine Net).
Finally, under the reach of the HHS is the Agency for Health Care Policy and Research. "AHCPR supports cost-cutting research on health care systems, health care quality and cost issues, and effectiveness of medical treatments" (Definition of HHS, 2008, Medicine Net). Again, political allegations regarding the pressure of outside interest, specifically insurance companies, have tainted the reputation of this agency. "The U.S. government and private insurers are becoming more resistant to paying for "never events" -- avoidable accidents, errors, and conditions, including health care-associated infections" such as those caused by improper hand-washing (Mika, 2008, p. 2495). "The Government Accountability Office (GAO) released a report critical of the leadership of the Department of Health and Human Services (HHS) in its efforts to reduce the number of health care-associated infections. Both actions came while private insurers were announcing lists of never events for which they will not reimburse hospitals" (Mika, 2008, p. 2495). Refusing to reimburse hospitals for such expenses can have serious public health consequences, as the number of strains of antibiotic-resistant bacteria is on the rise, particularly in hospitals, as are populations such as the elderly which are at greater risk because of their compromised immune systems.
To envision a future for the HHS that is untainted by politics is unrealistic, given that it is lead by a presidential appointment, and…