Global Health within a Domestic Agency

In 2011 the U.S. Department of Health and Human Services introduced a Global Health Strategy, the first of its kind for what has traditionally been seen as an agency with primarily domestic responsibilities. The strategy outlines several objectives for the department’s international engagement and paints a picture of a close relationship between international and domestic health conditions. In her introduction to the strategy Secretary Kathleen Sebelius explains that “Although the chief mission of the U.S. Department of Health and Human Services is to enhance the health and well being of all Americans, it is critically important that we cooperate with other nations and international organizations to reduce the risks of disease, disability, and premature death throughout the world.

The HHS Global Health Strategy, with its emphasis on disease surveillance, food and drug safety, basic research, and health diplomacy, is noteworthy for its success in shining light on the important linkages between global and domestic health challenges. However, its development should be seen less as a stand-alone event and more as critical step within an ongoing process that has made global health a key element of the department’s work and made the department a critical player in the overall development and execution of U.S. global health policy and programs. The elevation of the position of the agency’s director of global affairs to that of assistant secretary at the end of 2012 is perhaps the most recent manifestation of the importance of global health to HHS’s mandate. How this came about is both a straightforward reflection of the increasing centrality of global health policy to U.S. international relations and a more complex story about interagency politics, negotiations, and collaboration.