We all need to be worried about the attack on national health policies and programs

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The Department of Health and Human Services (HHS) has undergone immense transition as of late, including a new health secretary and the resignation of the Centers for Disease Control and Prevention director. However, other major health-care policy initiatives that affect all federal health agendas have been slipping under the radar since this fall.

Every four years, the Department of Health and Human Services (HHS) releases a new strategic plan, proposing updated goals and performance measures for public health, research, and health services.

{mosads}It has an oversight of 10 major departments including the Centers for Disease Control and Prevention, the National Institutes of Health, and the Centers for Medicare and Medicaid Services. The strategic plan tradition establishes all health-related priorities at both the federal and state level with measurable goals and specific outcomes that guide program funding.


In late September 2017, the Trump administration proposed its HHS strategic plan. The proposed plan contains numerous worrisome items that reflect a shift in HHS priorities and could potentially violate the rights and access to care of the American people:

Specific vulnerable populations and their health disparities are not discussed

In the last Strategic plan for 2014-2018, communities that suffer from persistent health disparities were specified, including racial and ethnic minorities, people with disabilities, refugees, LGBTQ individuals, people with limited English proficiency and people with limited health literacy skills.

These vulnerable groups were not mentioned in the proposed Ppan for 2018-2022, threatening progress on these critical problems as well as the continuation of successful programming and resources. To give one example of stark health disparities that exists in the United States: black women are 3 to4 times more likely to die from pregnancy complications than white women regardless of income status.

Few data-driven goals and outcomes that are measurable, which endangers accountability.

Past strategic plans have included benchmarks to measure progress, such as increasing a percentage of adults who are screened for depression, or decreasing the total morphine milligram equivalents dispensed.

Instead, the proposed plan lacks measurable performance goals and uses “strategies” with vague terms, such as “promote,” “engage with,” or “encourage.”

It is federal law that the plan establishes performance goals in an “objective, quantifiable, and measurable form” and must “provide a description of how the performance goals are to be achieved including…clearly defined milestones.” Without this, government accountability and program funding are threatened.

The proposed plan elevates religious and personal beliefs instead of evidence-based care

The proposed plan specified that the DHHS serves “Americans at every stage of life, beginning at conception” and the “ultimate goal is to improve healthcare outcomes for all people, including the unborn, across healthcare settings.”

This language reflects only one particular religious belief. This new definition of life could impact access to contraceptive and abortion services, resulting in poorer maternal health and birth outcomes. Patients deserve unbiased health-care services so that they can choose health-care services that are consistent with their individual morality and circumstances.

Thousands of comments from all health-care disciplines, including nursing, psychology, social work, and medicine criticized the removal of essential goals included in previous strategic plans, especially the potential barriers to services for underserved populations.

The American Academy of Nursing noted the need for “initiatives to address the health needs of all underserved populations” and the American Medical Association (AMA) opposed “any modifications to the [gender identify] rule that would jeopardize the health and wellbeing of vulnerable populations.”

A co-signed letter from seven influential health organizations, including the American Heart Association and March of Dimes, encouraged the HHS to promote “increased access to adequate and affordable healthcare.”

Despite these protests made by prominent organizations, the proposed plan and the covert withholding of oppositional comments did not make headline periodical or television news, though was covered by some sources like Bustle and Politico.

As a nurse researcher in a college of nursing, my colleagues (along with family and friends) were shocked and relatively unaware of the significant changes in the proposed HHS plan.

This lack of knowledge can have dire consequences. If health-care professionals are not aware of such significant changes to the federal health-care agenda, we run the risk of watching access and services slip away from our patients that need it the most.

Why weren’t all health-care providers and the public talking about this potential violation of health-care rights? One possibility is that there was too much noise in the media. The endless stream of catastrophes, including natural disasters, shootings, racism, sexism, has pushed other important issues to the back burner.

Another issue may be too little communication and advertisement from key professional and health-care organizations. As a Jonas Policy Fellow for the American Academy of Nursing, my mentors and colleagues circulated the call for comments regarding the proposed plan. More organizations of all sizes need similar rapid response communication systems, and must rely on social media to spread news quickly.

This is a call to action for health-care professionals to become acutely aware of the changing health-care goals and policies that affect our profession and patients.

We must passionately advocate for the health of our patients, just as we would in the clinic, but this time on social media and in professional organizations. We must be keepers of public health and protect the rights of vulnerable populations.

Shannon Halloway is a postdoctoral research fellow at Rush University College of Nursing, Jonas Policy Scholar, and a Public Voices Fellow. Diana Taylor is professor emerita at the School of Nursing of University of California San Francisco and chair of the Women’s Health Expert Panel of the American Academy of Nursing.


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