The US Department of Health and Human Services: Its Importance in the Past and Present

We, as historians of medicine, express our support for the federal agencies and regulations that protect and promote human health. We know the long-term value of health-related federal agencies and share our perspectives below. We outline the importance of these institutions and the use of regulatory power for health and well-being. We highlight below three entities in the U.S. Department of Health and Human Services (HHS) that have authority over American health. We identify the potential damage to the health of Americans if their funding was curtailed or cut. We then describe how the regulations that these agencies administer protect the health of Americans in four specific areas: reproductive health, pasteurization, fluoridation, and vaccination.

1. The United States Food and Drug Administration (FDA) has been a widely trusted public health agency since the early twentieth century. Americans have benefited from the FDA’s regulatory authority that oversees the safety of 80 percent of food. It ensures that cosmetics do not harm their users; pharmaceuticals are both safe and effective; medical devices injure no one; and radiation-emitting devices are safe to use in homes and medical facilities. Without the legal structures that undergird its work—including the Food, Drug, and Cosmetic Act of 1938 and Kefauver-Harris Amendments of 1962—coupled with the everyday (and often unrecognized) work of its field force and regulators, the public’s health would be in danger.^[1] In fall 1937, for example, a mass-produced sulfa drug (elixir sulfanilamide), which was adulterated with a chemical present in antifreeze, killed over one hundred people, including 33 children. This specific tragedy helped secure the passage of the 1938 Act. The FDA also promotes preventative public health initiatives and regulates drug approval processes. In July 2023, for example, the FDA approved the Opill, the first over-the-counter contraceptive pill, to reduce unwanted pregnancies and the adverse health outcomes that often follow. All of these activities keep the public safe and encourage future innovations to keep medical products ever safer, more effective, and more affordable. Without the agency, or if the agency’s supervisory and regulatory roles are greatly decreased, the nation would see a return to an earlier time of limited control over dangerous substances and increased harm to citizens.
2. A second agency within HHS, the Centers for Medicare and Medicaid Services (CMS), funds essential health care services for approximately 40 percent of the US population through Medicare and Medicaid programs. These programs provide access to essential medical services, prescription drugs, preventive health services, mental health services, hospitals, community health centers, skilled nursing homes, and home health care. Since their establishment in 1965, these two programs have significantly expanded access to essential health care services. Medicare milestones include: eligibility for persons with disabilities and end-stage renal disease (1972), prescription drug benefits (2003), and coverage of preventive care services (2010). Medicaid milestones include: eligibility for elderly, blind, and disabled individuals (1972), access to mental health services (2015), and increased enrollment during the COVID-19 national emergency (2020). Many regulatory and legislative initiatives in the histories of these programs have affected program funding, provider payments, provider participation, eligibility requirements, enrollment, retention, coverage policies, service access, service delivery, payment models, incentives, utilization, and quality. Ongoing regulatory and legislative initiatives have significant impacts on public health by determining the number of program enrollees, access to health care providers, and use of essential health care services. To take one example, of the 1.2 million Americans in nursing homes in 2020, 60 percent had Medicaid coverage, and any reduction in funding would lower their quality of care.^[2] The critical role of the Medicare and Medicaid programs in protecting public health must be preserved.
3. The implementation of the Patient Protection and Affordable Care Act (ACA) in 2010 has led to historic reductions in the number of Americans who lack health insurance. About 20 million people have obtained coverage through the ACA’s marketplace plans and Medicaid expansions.^[3] The ACA has increased health insurance coverage for low-income people, people of color, and children. It has reduced the number of uninsured young adults by allowing dependents to stay on their parents’ health plans until age 26. The ACA also protects tens of millions of people in all types of health insurance plans. It prevents health insurers from excluding or charging higher premiums for people with preexisting health conditions; bans insurance discrimination on the basis of race, color, national origin, age, disability, sex, gender identity, sexual orientation, sex characteristics, and pregnancy-related conditions; ensures access for people with limited English proficiency; and requires coverage of a range of essential and preventive services, including contraception, maternity and newborn care, prescription drugs, vaccines, and cancer screenings.^[4] The ACA reduces medical bankruptcy and improves health. Weakening the ACA would endanger those most in need of its coverage and protections and would have a negative impact on the overall health and economic wellbeing of Americans and endanger those most in need of its coverage and protection.

Four of our specific areas of concern are:

1. Reproductive health includes the medical care, access to resources and information, and autonomy of all who can reproduce in the present or future. Several government agencies oversee the provisions of reproductive care. To take one example, Medicaid covers preventative services for low-income pregnant persons and others of reproductive age. Medicaid also paid for 41.3% of American childbirths in 2022 and covers postpartum care. Cuts to Medicaid funding would make reproductive healthcare cost-prohibitive for many lower-income families. To take another example, since the U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision in June 2022, there is no longer a federally protected right to an abortion, and many states have either banned the procedure outright or enacted strict barriers to it. Women with pregnancy complications and their fetuses have died as a result of state laws restricting abortion when a fetal heartbeat is present.^[5] Moreover, medical professionals trained to perform the procedures are leaving abortion-restricted states due to threats to their practices, and doctors specializing in obstetrics and gynecology are opting out of residences in those states, leaving pregnant persons with ever-fewer care options.^[6] Any additional bans or restrictions would result in further substandard reproductive health care, poorer maternal and infant health outcomes, and injuries and deaths of pregnant persons who cannot access abortions safely.
2. In the late nineteenth century, almost 13 percent of American infants died before age one, and more than half from diarrhea. Physicians blamed milk, and federal efforts to regulate the dairy industry became part of a critical effort from the 1880s onward to lower infant mortality. Eventual legislation included requirements to keep milk cold during shipping, to ship and sell milk in sealed bottles, and to pasteurize milk. As these laws took effect, the diarrheal death rate among infants due to spoiled and adulterated milk decreased to near zero by the 1920s, especially after the United States Public Health Service developed the “Standard Milk Ordinance” regulation and after municipalities mandated pasteurization. Pasteurization entails heating a liquid to a certain temperature for a specific amount of time, followed by rapid cooling, to destroy microbes. For decades, the dairy industry fought each piece of legislation, arguing that the additional cost to the industry of pasteurizing and bottling milk would put dairies out of business. What the American public learned instead was that regulating milk saves lives. “Raw milk” killed children in the nineteenth and early twentieth centuries, and pasteurization prevented, and continues to prevent, children’s deaths. To weaken milk regulations and to allow the sale of raw milk again would undermine food safety and adversely affect infants and children.^[7]
3. Fluoride has been added to water to prevent dental caries for both children and adults in the U.S. since 1945. Today, about 75% of American homes are connected to public water systems receiving fluoridated water, still leaving more than 72 million Americans without it. Community water fluoridation (CWF) is a nationwide effort that reflects the interface between science, policy, and practice and focuses on the water needs of all community and social groups without discrimination. It involves actions taken by local community councils, health and water boards, state legislatures, health departments, national regulatory and science agencies, independent science entities, and professional and nonprofit organizations. The U.S. Centers for Disease Control and Prevention (CDC) considers CWF—which covered the water supply of 290 million Americans in 2022—as one of the ten most important public health achievements of the 20^th century U.S.^[8] This measure has proved to be the most effective and practical tool for preventing tooth decay, reducing pain and infection, and lowering the need for costly treatment. Removing fluoride from water and reducing the CDC’s oversight would increase the cumulative effects of dental disease on community health with substantial economic, social and medical implications.^[9]
4. Vaccination is a vital public health tool that has reduced life-threatening infectious diseases such as measles, mumps, rubella, bacterial meningitis, pertussis, and hepatitis globally.^[10] Vaccination led to the complete eradication of smallpox (in 1980), two wild polio strains (in 2015 and 2019), and rinderpest (in 2011), an epizootic disease in herd animals.^[11] Since President Dwight D. Eisenhower signed the Polio Vaccine Assistance Act of 1955, the U.S. federal government has played a central role in the research, regulation, and distribution of vaccines in order to protect the American public’s health and wellbeing. Due to the development of a safe vaccine and widespread vaccination requirements, new polio cases in the U.S. dropped from 20,000 in 1952 to zero in 1979.^[12] Federal agencies in the present provide millions of dollars to fund life-saving vaccine research and production while regulating how vaccine research, production, and distribution occurs.^[13] Medicare and Medicaid cover vaccine costs for many of the U.S.’s most vulnerable individuals, notably children and the elderly.^[14] Through coordination among governmental agencies and programs, private and public manufacturers and distributors, and clinics, hospitals, and medical care providers, the government ensures that the vaccines Americans receive are safe and effective. This work safeguards the American public from the outbreak and reintroduction of dangerous epidemic diseases, creating a healthier society for all.

In summary, we affirm the historical and ongoing importance of these agencies, laws, and regulations. We oppose initiatives to dismantle, defund, or diminish federal institutions that protect and promote health and well-being.

Signed:

Emily Abel
Rima D. Apple
Charlotte G. Borst
Julie K. Brown
Kristin Brig-Ortiz
Simone Caron
Vicki Daniel
Donna Drucker
Lara Friedenfelds
Janet Golden
Janet Greenlees
Marta E. Hanson
Beatrix Hoffman
Alison Klairmont Lingo
Judith Leavitt
Minji Lee
Kimberly S. Lenahan
Lucille Lester
Lauren MacIvor Thompson
Barbra Mann Wall
Jimmy Wilkinson Meyer
Heather Munro Prescott
Erin L. Paterson
Katharine Park
Alicia Puglionesi
Karen Reeds
Susan M. Reverby
Londa Schiebinger
Melanie Steiner
Courtney Thompson

Lara Freidenfelds

Lara Freidenfelds is a historian of health, reproduction, and parenting in America. She is the author of The Myth of the Perfect Pregnancy: a History of Miscarriage in America and The Modern Period: Menstruation in Twentieth-Century America. Sign up for her newsletter and find links to her op-eds and blog essays at www.larafreidenfelds.com.

• Lara Freidenfelds

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Donna J. Drucker

Donna J. Drucker, MLS, PhD, is Assistant Director of the Office of Scholarship and Research Development at the Columbia University School of Nursing. Her books include Contraception: A Concise History (MIT Press, 2020) and Fertility Technology (MIT Press, 2023).

• Donna J. Drucker

  https://nursingclio.org/author/donna-j-drucker/

  The Misuse of History in The Business of Birth Control

Emily K. Abel

Emily K. Abel is professor emerita at the UCLA-Fielding School of Public Health. Her most recent book is Gluten Free for Life: Celiac Disease, Medical Recognition, and the Food Industry(New York University Press, 2024).

This author does not have any more posts.

Beatrix Hoffmann

Beatrix Hoffman is Board of Trustees Professor of History at Northern Illinois University. She is the author of The Wages of Sickness: The Politics of Health Insurance in Progressive America; Health Care for Some: Rights and Rationing in the United States since 1930; and a new book, Borders of Care: Immigrants, Migrants, and the Fight for Health Care in the United States.

This author does not have any more posts.

Kristin Brig-Ortiz

Kristin is a PhD candidate in the history of medicine at Johns Hopkins University. Her dissertation examines the intersection of water management and public health in nineteenth-century colonial South Africa, focusing on the ways port city administrators and residents collaborated and conflicted over how best to deal with their hydrological environments.

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  The Heifer and Its Lymph: The Animal Vaccine Establishment’s Register Book
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  “The Mommy Instinct” and Vaccinations