4.2: U.S. Public Health Agencies

4.2 U.S. Public Health Agencies

The U.S. Department of Health and Human Services (HHS) is a federal executive department responsible for promoting and protecting the health and well-being of all Americans. Its primary mission is to enhance the health and human services available to the U.S. population, ensure the safety of food and drugs, advance medical research, and administer various social welfare and healthcare programs. HHS plays a crucial role in shaping and implementing policies related to healthcare, public health, and human services in the United States. The president of the United States appoints secretaries to their cabinet to lead HHS and its agencies. Therefore, the leadership and focus of each of these agencies can change with each new federal administration. 

Agencies that HHS oversees include these listed below. We’ll go over a few of them in more detail later on in this chapter. 

• The Food and Drug Administration (FDA): This agency is responsible for regulating and ensuring the safety of food, drugs, medical devices, vaccines, cosmetics, supplements, and tobacco products. Prescription drugs, medical devices, and biologics (like vaccines) have to go through rigorous testing to get approval by the FDA. If people are getting sick from a particular food or infant formula, or if the food company did not correctly label the food for potential allergens, it is part of the FDA’s role to investigate where the contaminated food is coming from and issue recalls. It is important to note that nutritional supplements and herbs are regulated by the FDA but not in the same way as drugs (Office of the Commissioner, 2023).    

• The Centers for Medicare and Medicaid Services (CMS): CMS administers the nation's major public healthcare programs: Medicare and Medicaid. Medicare is primarily for people over 65 years of age, and Medicaid is designed to provide healthcare for people in poverty and those with disabilities. Sometimes seniors who are also living in poverty are supported by both systems. The Children’s Health Insurance Program (CHIP) is also a part of Medicaid - both of which are funded by both the federal government and state governments. CHIP supports healthcare for children whose parents may make too much money to qualify for Medicaid, but not enough to afford private health insurance (Centers for Medicare and Medicaid Services, n.d.). Medicare and Medicaid are the largest payers of healthcare in the US. For example, over 40% of all births are paid for by Medicaid (Valenzuela & Osterman J.K., 2023).

• The National Institutes of Health (NIH): This is the primary agency for conducting and supporting medical research, including funding research into diseases, public health, and medical innovation. The sprawling NIH campus located in Bethesda, Maryland, includes a clinical research hospital and laboratories focused on specific areas of cutting edge health research - called “intramural research”. But the NIH is also responsible for funding “extramural research” through grants . These grants fund research in health and science at universities, medical centers, laboratories and other institutions, both in the U.S. and abroad (NIH, 2025). 

• The Centers for Disease Control and Prevention (CDC): The CDC is probably the most familiar public health agency to Americans. This is because it is the primary national public health agency which focuses on disease prevention, emergency preparedness, and the tracking of public health data. The CDC is also the nation’s primary epidemiological center, and conducts surveillance of current health issues affecting Americans. Headquarters of the CDC are located in Atlanta, GA. 

• The Administration for Children and Families (ACF): This agency administers various programs and services aimed at promoting the economic and social well-being of children, families, and communities. These programs include financial assistance like the Temporary Assistance for Needy Families (TANF), support for children with disabilities through the Head Start program, support for foster kids, or help paying for childcare or utilities (ACF, 2024). 

• The Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA works to improve mental health and reduce the impact of substance abuse and addiction. This agency has 9 regional offices around the U.S., and collaborates with regional and local agencies to support initiatives tackling substance abuse, suicide prevention, and other behavioral health issues (SAMHSA, 2024). 

• The Agency for Healthcare Research and Quality (AHRQ): Established in the 1990s after several reports found that medical errors contributed to a large number of deaths, this agency conducts research to improve the quality, accessibility, and affordability of healthcare services in the U.S. The agency’s focus is on patient safety and preventing medical mistakes, as well as reducing healthcare costs and improving efficiency (AHRQ, 2025). 

• The Indian Health Service (IHS): Established in the 1950s, this agency provides healthcare services to more than 2 million American Indian and Alaska Native populations. The IHS comprises not only hospitals and clinics in rural and urban tribal areas, but also tackles the complex public health needs of tribes including water fluoridation, pandemic response, and diabetes management (Kruse et al., 2022).  

HHS as it exists today was established in 1979. However, its origins can be traced back to the early 20th century when the federal government started to take an active interest in public health and welfare issues. The predecessor agencies and departments that eventually merged to form HHS include the United States Public Health Service, the Social Security Administration, and various other federal agencies responsible for health and welfare programs. Over the years, HHS has played a pivotal role in shaping healthcare policy, conducting research, and administering various programs to improve public health and human services across the United States. It has been instrumental in the implementation of significant healthcare reforms, including the Affordable Care Act (aka “Obamacare”). 

Update 

In 2025, the second Trump administration took drastic steps to cut federally funded programs, including reducing employees by 20,000 (through firings and early retirement), closing 5/10 regional offices around the country, and collapsing several agencies into one titled the “Administration for a Health America” (AHA). This new agency will contain these former agencies: Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute for Occupational Safety and Health (NIOSH), with the promise of creating a more efficient use of taxpayer dollars (HHS Press Office, 2025). Some programs have been eliminated entirely or their funding moved to the new AHA agency, including those that focus on chronic disease prevention, global health, HIV prevention and research, birth defects, developmental disabilities, injury prevention, and occupational safety and health (Gold & Ingram, 2025). The NIH is slated to lose around 43% of their budget that funds cutting edge biomedical research, threatening the discovery and development of new treatments and drugs, which will eventually translate into shorter lifespans and a significant economic impact (Cutler & Glaeser, 2025). Other cuts under this administration threaten the Environmental Protection Agency which is losing both funding and staff, including the majority of their scientific staff - including biologists and toxicologists (Daly, 2025). The small Agency for Healthcare Research and Quality (AHRQ) is likely to also be eliminated (Allen, 2025). Public health experts warn that these cuts to funding will have immediate, profound, and likely deadly effects. Food safety, children’s health, senior programs, emergency preparedness, drug treatment, and cutting edge research will all suffer, leading to a rise in preventable disease and death (For Our Health, 2025).

Without a good understanding of what each of these agencies do, it may be difficult to anticipate the impact that these cuts and firings will have on the future of public health in America. In the next few pages, we’ll focus specifically on a few agencies and what they do to protect our population’s health.