Florida's $3.6 billion budget deficit for next year has the Legislature searching for ways to reduce government expenditures. • On the table for consideration is a recommendation by Gov. Rick Scott's transition team to create a super agency by combining the Department of Health, the Agency for Health Care Administration, mental health programs in the Department of Children and Families, the Department of Elder Affairs and the Agency for Persons with Disabilities.
A variation of this proposal has been offered by Rep. Janet Adkins, R-Fernandina Beach, in HB 115, and by Sen. Steve Oelrich, R-Gainesville, in SB 528, that would create a department of health and human services.
A large superagency would likely meet the same fate as the Florida Department of Health and Rehabilitative Services that operated between 1969 and 1996. The Health Department, the Agency for Health Care Administration, the DCF, the Department of Elder Affairs and other agencies were components of this department.
Why was it broken up into smaller, mission-focused agencies? To improve program effectiveness. Agencies would have a single mission, management would be focused, smaller bureaucracies would solve problems quicker and better. Agencies would be able to work more closely with their advocates and constituent groups.
What has gone wrong? Florida's explosive population growth and a "limited government political philosophy" have weakened these mission-focused agencies. Agency funding has not kept pace with their needs.
Recreating a super agency will not improve program efficiency. A handful of management positions could be deleted. But there would be no appreciable savings unless programs were also eliminated or reduced.
The Health Department needs capable and experienced public health leadership and the support of the administration and Legislature to promote the "10 essential public health services" that are recommended by the Centers for Disease Control and Prevention and the American Public Health Association. The 10 essential services serve as national standards across the country. The first three focus on improving the health of the population. They are:
• Monitor health status to identify and solve community health problems.
• Diagnose and investigate health problems and health hazards in the community.
• Inform, educate and empower people about health issues.
One of the most important functions of the Health Department is to improve the health of Floridians. Unfortunately, almost no funding is available to target childhood obesity or to educate the public about the importance of good nutrition and physical exercise, which is crucial to reducing the prevalence of diabetes, heart disease, stroke and other chronic health conditions.
A focus on the national standards that guide public health programs would yield a healthier population less in need of medical services, which is the most effective strategy to control health care costs to business, government and individuals. Our health care costs on a per capita basis are 40 percent higher than in Canada and about twice those in industrialized European countries. Our high health care costs make our products less competitive in the international economy and reduce resources for education, our infrastructure and for public safety and for other important needs.
The Department of Health was singled out by Rick Scott's transition team as in need of significant reform because the "department's culture was suffering from a lack of incentive, leadership, and vision." It was certainly important for the transition team to examine the mission of public health, but this should lead to ensuring that the department has the resources and infrastructure to effectively address the 10 essential services. Putting it in a mega agency won't accomplish this.
The Department of Health needs to be energized and led by public health experts. It needs to remain an independent mission-focused agency. The governor's management team and legislative leadership need to take a closer look at public health needs and the role the department can play in reducing health care costs before they act.
Ed Feaver and Bob Williams are former secretaries of the Florida Department of Health and Rehabilitative Services and Dr. E. Charlton Prather served twice as the state health officer, Florida's chief public health official. All are members of the Health Care Advisory Council of the Florida Public Interest Research Group.