The Department of Health and Human Services (DHHS) has a broad mandate to advance the health and welfare of Americans (see box), and has a significant role to play in addressing the asthma epidemic. DHHS' areas of responsibility for asthma include research, public health, and health services delivery.
In Fiscal Year 1999, the Department of Health and Human Services (DHHS) invest ed $ 145 million in research on asthma. DHHS is uniquely positioned to enhance the scientific knowledge required to prevent the onset of asthma and to improve the quality of life for millions of asthma patients and their families. DHHS-supported grantees have been responsible for many of the scientific breakthroughs that helped shape the Guidelines.
Relatively few DHHS dollars - under $10 million - were spent on public health practice for asthma. Public health practice activities are those that facilitate the work of the medical community and others to prevent disease, reduce the severity of symptoms and improve the quality of medical care. The role of government in public health includes: 1) the systematic collection and analysis of health information; 2) the development of goals and priorities based on scientific knowledge and measures to achieve them; 3) taking action through public education, advocacy, negotiation, and mobilization of resources; and 4) evaluation to determine whether policy goals are achieved (3).
The Department has supported -- and could substantially expand -- partnerships and model programs that are discovering new ways to increase dissemination and use of information about how to manage asthma to communities, health care providers, patients and their families. It continues to evaluate methods that are most effective in translating important research findings into clinical practice to improve the quality of care. DHHS could expand its evaluation of asthma care, as well as its efforts to track the disease, to more fully ensure that appropriate and timely interventions are routinely provided, particularly to those in greatest need. Several DHHS agencies have undertaken activities in this area, while others have the capacity for public health practice activities on asthma but have not yet made substantial investments. Expanded collaboration at the local level will facilitate progress in eliminating asthma-related disparities. (Appendix E describes in detail the asthma-related activities of DHHS agencies.)
Mission of the Department of Health and Human Services
The mission of DHHS is to enhance the health and well-being of Americans by providing for effective health and human services and by fostering strong, sustained advances in the sciences underlying medicine, public health, and social services. DHHS' six strategic goals are:
- Reduce the major threats to the health and productivity of all Americans.
- Improve the economic and social well-being of individuals, families, and communities in the United States.
- Improve access to health services and ensure the integrity of the nation's health entitlement and safety net programs.
- Improve the quality of health care and human services.
- Improve the nation's public health systems.
- Strengthen the nation's health sciences research enterprise and enhance its productivity.
The great majority of DHHS expenditures for asthma are for direct delivery of health services. Estimates of Medicaid and Medicare expenditures for treatment of asthma exceed one billion dollars per year (65). Thousands of people receive care for their asthma at DHHS-funded health centers and hospitals, but estimates of expenditures on asthma alone are impossible because costs are covered by large block grants that support comprehensive primary care, not disease-specific programs .
For two decades, the U.S. Public Health Service has used Healthy People reports to set specific national objectives for health, to organize concerted action among the public health and private sectors to meet them, and to provide indicators for monitoring progress (22). National goals for improving asthma health outcomes have been established as part of the Healthy People initiative. In the first report, Healthy People 2000 had three objectives specifically relevant to asthma: reduce hospitalizations, reduce activity restriction, and increase the proportion of people with asthma who receive formal patient education. Results of a mid-course evaluation of progress toward Healthy People 2000 goals for asthma were disappointing . For example, by 1996, there was no progress toward eliminating disparities in hospitalization rates for African-Americans and other non-whites compared to whites (66). New goals for asthma for 2010 -- with a special focus on eliminating disparities -- include numerical targets for reducing hospitalizations, reducing emergency room visits, and reducing the proportion of people with asthma who experience activity limitations (see Table 1 and Appendix G). The challenge of accelerating progress and achieving the goals set for 2010 is substantial, but the foundation for doing so is well established.