2.8: 2025 Reorganization of HHS
- Page ID
- 118479
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)The reorganization of the Department of Health and Human Services (HHS) is underway as this book is being written.
Among the changes being implemented:
- Staffing of HHS being reduced from 82,000 to 62,000
- 28 Divisions reduced to 15, with some functions being eliminated and others combined
- Regional offices reduced from 10 to 5
- Creation of a new division called Make America Healthy Again, or AHA, for projects selected directly by Secretary Robert F. Kennedy Jr.
- New focus on "ending America’s epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the elimination of environmental toxins" (HHS press release, April 3, 2025).
It is too soon to assess the full impact of this reorganization. Even on the HHS website, as of writing this page, the Organizational Chart remains as it was in 2024, suggesting that some of the proposed changes may not yet be finalized. Several lawsuits underway question the executive branch (Presidential) power to eliminate or reorganize institutions that were established by Congress, the legislative branch -- although a decision from the Supreme Court in July 2025 allowed the Trump Administration to go ahead with layoffs and program eliminations. At this moment, it seems likely that HHS will be fundamentally reconfigured, its mission changed or realigned, and its personnel and funding drastically reduced.
How might we assess the impact of such changes? Let's consider some criteria by which that impact might be evaluated:
- There are the criteria put forth by Secretary of HHS Robert F. Kennedy, Jr. himself:
- Greater transparency in government agencies and improved public trust
- Improved health and wellbeing of the population, achieved at reduced cost to the taxpayer, especially regarding chronic disease and exposure to environmental toxins
- We could also assess the changes in light of the mission of the organizations that are being changed, for example, the mission of the CDC:
- Preparedness to respond to health threats of all types
- Impacts on health security
- Ability to conduct health research
- Ability to inform the public
- Other criteria might be related to data collection and data quality. Questions to inform those criteria might include:
- With substantial cutbacks in the public health infrastructure, what types of data continue to be collected and what types are discontinued?
- How is the integrity of the data maintained or improved?
- How easily are data accessed by researchers and clinicians?
- What types of research are continued or discontinued?
- Health outcomes are where the rubber hits the road -- how do these changes affect morbidity and mortality?
- Life expectancy overall and for sub-populations
- Rates of disease, overall and for sub-populations
- Access to healthcare for screening and treatment
- Quality of life as measured by DALYs or another indicator
The articles and websites below provide public health perspectives on these changes. The majority of them are highly critical of these changes -- as the majority of mainstream public health organizations and scholars see the 2025 reorganization of HHS as a deep blow to the public's health.
In an April 2 letter from the Advisory Committee to the Director of the CDC (authorized by Congress) to the HHS Secretary and the Acting CDC Director, many different programs that have been affected by the layoffs and funding cuts were highlighted: HIV prevention, occupational health and safety, investigation of cancer clusters, asthma, violence prevention, tobacco use, lead poisoning, global health threats, and more. "In aggregate, the breadth of these reductions is staggering and compromise many of our Nation's best efforts to attack the leading causes of preventable death and illness affecting families and communities across our country" (Rubin, 2025, pp. 1760-1761).
References:
Fact sheet: HHS’ transformation to make america healthy again. HHS.gov. (2025a, April 3). https://www.hhs.gov/press-room/hhs-r...act-sheet.html
Gliad, S., & Frank, R. G. (2025, April 22). Trump administration’s HHS cuts: Creating waste and inefficiency, not eliminating them | health affairs forefront. Health Affairs. https://www.healthaffairs.org/conten...iminating-them
Public health under threat. American Public Health Association. (n.d.). https://www.apha.org/topics-and-issu...h-under-threat
Demirjian , K., & Mandavilli, A. (2025, April 17). Trump administration proposes sharp budget cuts for H.H.S. - The New York Times. New York Times. https://www.nytimes.com/2025/04/17/u...ment-cuts.html
Rubin R. Experts Say Abrupt and “Staggering” CDC Cuts Will Cost Lives. JAMA. 2025;333(20):1760–1762. doi:10.1001/jama.2025.6592
Altman, D. (2025, April 4). Decoding the HHS reorganization. KFF. https://www.kff.org/from-drew-altman...eorganization/