The Department must concern itself continually with the efficacy of systems that provide various types of health and/or human services to Americans. When these systems undergo changes that alter their effectiveness (either positively or negatively) in maintaining or improving the quality of life of their clients, the Department's progress toward its goals is similarly influenced.
Changes in the repertoire of health services over the long term are determined more than anything else by the interplay of scientific and technical advances on the one hand and demographic, economic, social, and environmental trends on the other. The rate at which new diagnostic capabilities, therapies, and interventions become assimilated into medicine generally determines the dimensions and pace of change with respect to what services are possible. But the likelihood that any given individual will be affected significantly by these developments is influenced heavily by the combination of his/her health status and personal financial circumstances as well as the national value system -- as manifest in the decisions of providers and policy-makers regarding which health services are available when, where, to whom, and under what circumstances.
In contrast, for welfare programs and other human services, changes in the national value system -- especially as distilled through the processes of representative government -- outweigh science and technology by a wide margin in determining the dimension and pace of policy change. Social-science research has contributed to the evolution primarily through analyzing shifts in cultural values as they occur and assessing their implications and thereby informing policy-makers about the effectiveness of different programs and policies in fulfilling national values.
The largest and most rapid changes in health/human services in recent years have involved the ways they are financed, organized, and made available. The course and consequences of these changes therefore warrant special attention by the Department for the foreseeable future. Further, that effort must embrace the multiple perspectives that arise from the different roles played by its agencies -- e.g., purchaser of health services, provider of supplemental income support and in-kind human services, monitor of the health status of the population, sponsor of myriad programs to improve the quality and/or accessibility of selected aspects of health/human services, and sponsor of basic and targeted research to expand the knowledge base within the pertinent medical, behavioral, and social sciences.
The well-being of vulnerable populations commands high priority from all these perspectives. The Department traditionally has been attentive to the needs of those who, for various reasons, do not have access to an adequate array of health and human services -- e.g., disadvantaged children; disadvantaged pregnant women; the frail elderly; Native Americans; racial and ethnic minorities; individuals with chronic, severe physical or mental disabilities; substance abusers; the unemployed; the uninsured; the homeless; migrant workers; and immigrants. As health-/human-services systems evolve, these populations almost invariably are among the first to experience adverse consequences and among the last to receive benefits. Continued emphasis on vulnerable populations therefore seems imperative as the Department seeks to monitor and assess not only the transformations in health/human services already underway but also the potentially more significant changes that are yet to come.
The remainder of this section discusses transformations involving health services and human services, respectively, and then addresses related issues involving data resources. The Appendices summarize an impressive array of ongoing and planned activities by DHHS agencies. Appendix 1 presents the summaries thematically; Appendix 2 presents them by agency/office.