HHS Global Health Strategy 2012

The Department of Health and Human Services (HHS) published its “Global Health Strategy” (GHS).  Although the chief mission of HHS is to enhance the health and well being of all Americans, HHS noted the importance of cooperating with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world.   

Whether implementing life-saving vaccination programs or building public health infrastructure where none exists, HHS has consistently offered its unmatched expertise and resources for the betterment of Americans and people around the world.  But some of the most critical global health issues can only be tackled in concert with other entities, whether in our own country, like the State Department or the U.S. Agency for International Development, or with partnerships with the international community through the World Health Organization, Ministries of Health, and non-government organizations around the world.  Only through these multiple and collaborative efforts will we truly make a mark by improving global health. 

It is with these thoughts in mind that HHS Secretary Kathleen Sebelius called for the creation of the Department’s first Global Health Strategy.  The GHS will guide HHS’ actions as the agency asserts its important role in the global health environment.  The strategy reflects the best advice from the Department’s leading experts – from the Food and Drug Administration (FDA) scientists stationed in China who monitor global food trade, to the National Institutes of Health (NIH) laboratory researchers in Mexico who strengthen HHS preparedness for the many diseases that threaten to cross borders. 

The strategy reflects the importance of global public health in realizing not only America’s own diplomatic and security goals, but also the goals of other nations. The GHS articulates the strategies that will guide these global efforts to prevent disease, disability and death, promote health and well-being, advance knowledge and innovation, and strengthen partnerships and systems to improve responsiveness to myriad health challenges at home and abroad.  The strategic approach to global health requires: 

• Implementation and evaluation of research, policies, programs, and practices that improve health, health services, and health equity;
• Emphasis on transnational health issues, determinants and solutions; and
• Promotion of interdisciplinary collaboration within and beyond the health sciences 

Goals of GHS 

The Global Health Strategy identifies three goals that contribute to achieving HHS’s global health vision of a healthier, safer world: 

1. To protect and promote the health and well-being of Americans through global health action;
2. To provide leadership and technical expertise in science, policy, programs, and practice to improve global health; and
3. To work in concert with interagency partners to advance U.S. interests in international diplomacy, development, and security through global health action. 

Supporting these goals are ten critical objectives that focus on strategic priorities that benefit the American people as well as populations across the globe: 

1. Enhance global surveillance to detect, control and prevent diseases and health concerns;
2. Prevent infectious diseases and other health threats from crossing borders;
3. Prepare for and respond to international outbreaks and public health emergencies;
4. Increase the safety and integrity of global manufacturing and supply chains for medical products, food and feed;
5. Strengthen and implement international science-based international health and safety standards;
6. Catalyze biomedical and public health research and innovation for new interventions that improve health and well-being;
7. Identify and exchange best practices to improve health strategies and health systems;
8. Address the changing global patterns of death, illness and disability;
9. Support the President’s Global Health Initiative to achieve major improvements in health outcomes for women, children and families; and

10.  Advance health diplomacy through scientific and technical expertise. 

The Principles underlying the Global Health Strategy are:

• Using evidence-based knowledge to inform decisions
• Leveraging strengths through partnership and coordination
• Responding to local needs
• Building local capacities
• Ensuring a lasting, measurable impact
• Emphasizing prevention
• Improving the equity of health 

Legal Framework  

HHS is directed by Congress and entrusted by the American people to protect their health and well-being. HHS’s global authorities reside in three major areas: U.S. Code, appropriations law, and International Health Regulations. Within the U.S. code, several titles authorize global action on health issues: Title 6—Domestic Security, related to the control of communicable diseases; Title 21—Food and Drugs, relating to foods, human and veterinary drugs, biologics, and medical devices; Title 22—Foreign Relations and Intercourse, covering research and training, as well as HIV/AIDS, tuberculosis, and malaria; and Title 42—The Public Health and Welfare, which includes the codification and roles of the Public Health Service (PHS) and covers research, capacity building, and activities related to influenza, border health, outbreak and emergency response, infectious diseases, public health, and immunization programs.

HHS’s global authorities are also embedded in appropriations law, such as establishment of the Global Disease Detection program through the 2004 Consolidated Appropriations Bill, and funding for pandemic influenza preparedness and surveillance activities under the 2006 Defense Appropriations Act. Finally, the United States is bound by the International Health Regulations (IHR), a treaty binding on all the Member States of the World Health Organization (WHO), focused on prevention of, and response to, acute public health risks with the potential to cross borders and threaten people worldwide. 

To accomplish their mission, HHS acts both domestically and internationally. Most of the 11 HHS agencies and 18 staff offices engage in global health activities, particularly the Centers for Disease Control and Prevention (CDC), FDA, the Health Resources and Services Administration (HRSA), and NIH. HHS has over 300 officials stationed in more than 75 foreign countries – including a significant number working within foreign ministries of health and multilateral organizations – where we have seen growing demand for HHS scientific, technical, and regulatory expertise in policy, programs and practice. 

Given current resources and our core mandate, it is not possible to meet every demand, but through the GHS, HHS will leverage our assets to maximize global impact.  HHS will do this by setting priorities for international engagements, improving collaboration and coordination among HHS agencies and offices, strengthening relationships with USG, multilateral, and other partners at headquarters and in the field, and supporting the global exchange of best practices and lessons learned. 

In addition, HHS has included, for the first time, a global health topic area within Healthy People 2020 – the Nation’s public health goals and objectives for the next decade. While we believe the USG and HHS play a strong leadership role in the global health arena, it is nonetheless important to recognize that our own programs and policies can learn and benefit from the successes of other countries and partners as well. 

Specific GHS Objectives 

Objective 1: Enhance Global Health Surveillance.  To achieve this objective, HHS will Strengthen global surveillance to detect, track, identify, control and prevent diseases and address health concerns that may directly or indirectly have an impact on the U.S. population. Key priorities:  

• Support countries and multilateral organizations to strengthen surveillance systems, addressing current gaps (e.g., integrating surveillance for human and animal diseases, and communicable and non-communicable diseases) and ensuring interoperability of systems, both within and across countries
• Assist with improving workforce and laboratory capacity to support diagnosis for disease surveillance
• Provide leadership and technical expertise, often embedded within Ministries of Health, to ensure surveillance efforts are timely, evidence-based, data-driven, internationally shared and actionable to inform public health policies and decision-making
• Develop and evaluate innovative surveillance, information management, and communication strategies 

Objective 2: Prevent Infectious Diseases and Other Health Threats.  To achieve this goal, HHS will work with global partners to enhance health security and prevent the introduction, transmission and spread of infectious diseases and other health threats within and across borders. Key Priorities:  

• Support the development of sustainable capacities among partner governments and international agencies for addressing both public health emergencies and day-to-day public health needs, consistent with the International Health Regulations (2005)
• Facilitate development, use, and evaluation of vaccines and other prevention strategies such as vector control and safe water, focusing on achieving global disease reduction goals
• Support database and information technology infrastructure with global access and common portals for monitoring purposes, including measures for early warning systems and monitoring holdings of dangerous pathogens
• Ensure effective risk and crisis communication by coordinating with global partners to disseminate public information and emergency notification, especially to at-risk populations and stakeholders 

Objective 3: Prepare for and Respond to Public Health Emergencies.  To meet this objective, HHS will  mobilize and support an immediate health-sector response to international outbreaks and public health emergencies. Key Priorities:  

• Support the development of sustainable response capacities and coordination mechanisms for addressing public health emergencies consistent with the International Health Regulations(2005)
• Provide technical expertise and share mechanisms for investigating disease outbreaks and identifying their cause
• Collaborate with international partners to develop best practices and standard indicators and guidelines for responding to natural and man-made disasters, including a focus on improved coordination and response practices
• Develop policy frameworks, agreements and operational plans to facilitate HHS decision-making in response to both single and multiple international requests for emergency assistance, including for the deployment of medical countermeasures and HHS personnel 

Objective 4: Increase the Safety and Integrity of Global Manufacturing and Supply Chains.  HHS will meet this objective by  enhancing regulatory systems and global manufacturing and supply chains to ensure the safety of medical products, food, and feed that enter into the United States.Key Priorities: 

• Identify key risks in the global manufacturing and supply chain and implement strategies to mitigate them in cooperation with other governments and international agencies
• Strengthen strategic regulatory partnerships to promote a safer, higher quality global supply of medical products, food and feed 

Objective 5: Strengthen International Standards through Multilateral Engagement.  HHS will provide leadership to establish, strengthen and implement science-based international health and safety standards and support multilateral efforts to improve global health policies, programs, and practice. Key Priorities:

• Ensure an appropriate leadership role for the U.S. in the development of science-based norms and standards, particularly within the World Health Organization and other multilateral bodies addressing health issues
• Strengthen existing multilateral relationships and develop new strategic alliances to maximize the achievement of our global health goals and objectives 

Objective 6: Catalyze Health Research Globally.  HHS will catalyze biomedical and public health research and innovation globally to promote the discovery, development, delivery and evaluation of new interventions that improve health and well-being across national borders. Key Priorities:  

• Address research priorities that are linked to scientific opportunity, public health needs, and the evolving burden of disease
• Support the rapid translation of research results into new or improved preventive, diagnostic, and treatment products and processes, and incorporation into health policies and practice, in diverse global settings, including resource-poor environments
• Encourage research that identifies causative pathways of the spread of infectious disease and other health threats 

Objective 7: Identify and Exchange Best Practices to Strengthen Health Systems.  HHS will increase the exchange of best practices to improve health strategies, with a focus on comprehensive strengthening of health systems. The six critical building blocks of a health system are health services, the health workforce, health information systems, medical products and technologies, health financing, and leadership and governance. Key Priorities:  

• Support collaborative health system strengthening activities, including workforce development, that are both consistent with country priorities and have the greatest potential public health impact
• Promote the global exchange of best practices and lessons learned to ensure that evidence supports decisions and program implementation
• Address the underproduction and retention of health professionals in developing countries 

Objective 8: Address the Changing Global Patterns of Death, Illness and Disability.  HHS will encourage global action to address the major current and emerging contributors to global death, illness and disability. Key Priorities:  

• Promote the development, implementation, evaluation and dissemination of cost-effective prevention, policies, strategies and interventions for NCDs
• Promote the integration of effective public health policies and trade policies
• Strengthen health system capacities to address multiple NCDs by fostering evidence-based interdisciplinary practice and promoting integrated community approaches that include other sectors 

Objective 9: Support the Global Health Initiative (GHI). HHS will support the GHI to achieve major improvements in health outcomes through strengthened health systems, with emphasis on women, children and families, as confirmation of the US commitment to the health-related Millennium Development Goals. Key Priorities:  

• Contribute to the achievement of GHI goals and principles in the areas of HIV, malaria, TB, neglected tropical disease, maternal and child health, nutrition, safe water, sanitation, and hygiene, and focusing on women-centered programming, country ownership, integration and coordination, and health system strengthening
• Support the integration of public health services for prevention and control of key diseases such as HIV/AIDS and vaccine-preventable diseases with other priority health interventions in health facilities and other settings, as appropriate. 

Objective 10: Advance Health Diplomacy. Within the broader context of U.S. foreign policy, HHS will engage on health issues with diplomatic partners, whether individual countries or international organizations and strengthen peer-to-peer technical, public health, and scientific relationships. Key Priorities:  

• Assign health attachés to selected U.S. embassies for international cooperation, ensuring that political, security, development and health objectives are maximized
• Establish a Global Health Career Track within HHS to formalize career opportunities and training for people working in the global health arena, including in overseas assignments
• Partner with the Department of State to bolster knowledge about global health among the diplomatic corps
• Strengthen diplomatic knowledge, negotiation skills and understanding of development principles for HHS field staff and technical health experts