Brief # 91

Health and Gender Policy

The Public Health System in the US: Does it Work?

By Justin Lee

January 19,2021



Newly inaugurated President Biden nominated Xavier Becerra to lead and be the next Secretary of the US Department of Health and Human Services (HHS). The HHS is comprised of various public health and human services agencies and offices that provide guidance, oversee and regulate operations, and establish laws and regulations. Agencies like the Centers of Disease Control and Prevention (CDC), Food and Drug Administration (FDA), National Institutes of Health (NIH), and the US Public Health Service Commissioned Corps (lead by the Surgeon General) all branch within the HHS.

As the HHS presides as the federal entity in setting public health policies and guidance, the responsibility of protecting the public health of Americans primarily lies within  state and local governments. State health agencies collect and analyze health data and are responsible for implementing national and state mandates. The states also have the power to set certain policies and standards of their own. Local health departments are more the “front line” agencies, responsible for health education, screening, immunizations, disease control and health/mental/ambulatory services within its jurisdiction.

This system of distributing public health responsibility and power between federal, state, and local levels provides a level of autonomy and governance to the state and local health agencies. But does this system work? Like China, should the federal government dictate public health and decrease the power of state and local agencies to ensure federal orders are carried out nationwide?



It is clear that China, and many east Asian countries, have handled the COVID-19 pandemic more efficiently than the US and Europe. Some of the east Asian countries had existing agencies and organizations already established to track and implement measures in an infectious disease outbreak, such as Japan. Many of the same countries also have previous experience with large scale coronavirus outbreaks, such as SARS and MERS. For many of these governments in regards to social distancing, wearing facial coverings, and contact tracing, the question was not if these measures should be implemented but rather how quick can these measures be implemented.

So given the failure of the US to establish any real nationwide contract tracing measures, and the inconsistent messaging from federal, state, and local agencies in regards to social distancing, facial coverings, and other protective measures for protecting Americans, should the US reconsider how we structure our public health system? The answer is no. The American public health system is designed to protect the public health system of all Americans, from those living in urban Los Angeles to those living in the Kentucky countryside. The state and local health agencies should have the direct power and authority to regulate and implement measures needed for the benefit of their citizens. Federal lockdown measures will affect urban Americans differently than Americans living the countryside. State and local governments should know and be able to take federal guidance and implement specific measures to their jurisdiction.

That being said, the federal government and HHS plays a critical role in American public health by setting the tone and guidance for state and local governments. The failure of the US in controlling the spread of COVID-19 and distributing approved vaccines lies from the failure of the Trump administration to provide effective leadership and guidance. Inconsistent messaging and directives regarding the importance of facial coverings, social distancing, and contact tracing in combination of delayed decisions critical in controlling the spread of the pandemic has lead to the worst health crisis in American history. Despite many east Asian countries having had a pandemic blueprint that America could have built their own response from quickly, the federal government failed to provide the consistent messaging and guidance needed to exemplify its role in protecting public health for Americans.

President Biden comes into power at a critical time where COVID-19 continues to surge in urban cities across the US, but also has the means to finally take control of the pandemic through the distribution of treatment and vaccines. President Biden and his new administration has made it clear that the pandemic is a priority in his first 100 days in office; a hopeful sign for state and local health agencies that the federal leadership and guidance that was missing could finally arrive to help.

Learn More

Helpful links

NCBI: Summary of Public Health

HHS: Family of Agencies

Reuters: Biden Pick for HHS Secretary

MarketWatch: Asia Response to COVID

Engagement Resources

The American Red Cross heavily relies on volunteers to assist during a health crisis; including the COVID-19 pandemic. Volunteers play active roles in clinical and non-clinical settings. The American Red Cross also operates one of the largest blood donation networks in the US. To volunteer in a clinical setting and/or to give blood, use the links below:

ARC: Become a Volunteer

ARC: Give Blood

Trust for America’s Health is a public health policy and research organization that advocates for a nation that values the health and well-being of Americans. Their organization has valuable information regarding health policies and issues on a federal and state level, and also actively publishes reports regarding public health on their website. To find more information or to get involved, use the link below:

TFAH Website

The American Public Health Association is an organization aimed to Improve the health of the public and achieve equity in health status. As the main publishers for the American Journal of Public Health and The Nation’s Health newspapers, APHA educates the public on public health, policy statements, and advocacy for public health. To volunteer or become a member, use the link below:

APHA Website

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