As the election season heats up, candidates at all levels, from every party, are proposing a vision for improving well-being in their communities and across the country. They often turn to quick fixes to address immediate needs. Though necessary, a heavy or exclusive focus on urgent services leads us to miss the opportunity to rethink systems that would produce enduring health and well-being that all Americans desperately need, particularly those who are struggling and suffering.
Fortunately, there is already a well-designed, whole-of-government effort to build resilience and equitably improve health and well-being. This is an initiative that has been advanced by administrations from both parties. I led the development of this effort while working for the U.S. Department of Health and Human Services from 2020 through Fall 2021.
The Federal Plan for Equitable Long-Term Recovery and Resilience, ELTRR, unveiled just over a year ago, stands in contrast to previous government plans to address health inequities thanks to collaboration among 45 historically siloed agencies at the federal level. The plan also supports communities to engage in self-driven discussions of needs and solutions, and it focuses on advancing the vital conditions for health and well-being we all need to thrive, like basic needs for health and safety, humane housing, a thriving natural world, meaningful work and wealth, and more.
The ELTRR specifies 78 well-organized recommendations for interagency action, detailing how different federal entities could connect through mutual interests and existing authorities. Most recommendations are tied to a specific vital condition, along with 10 that address cross-cutting infrastructure and governance.
Recently, ADM Rachel L. Levine, Assistant Secretary for Health at HHS, said of the plan, “We are now describing what it takes to build equity and transformational resilience into federal mindsets, federal skill sets, and federal work systems.”
Interagency collaboration
At a time when gridlock in government seems to dominate the headlines, this plan demonstrates that interagency collaboration at the highest levels of government is possible and that agency actors can devise tangible solutions to America’s most pressing problems.
The vital conditions have also gained real traction with many multi-sector coalitions, accountable communities of health, health systems, and national organizations as a viable path toward addressing health inequities and making meaningful progress on the social determinants of health. I hear from them often with questions about when the federal government is going to catch up with their needs and support the flow of federal resources to state and local entities as outlined in the ELTRR.
Last year, the first recommendation in a consensus study report from the National Academies Federal Policy to Advance Racial, Ethnic, and Tribal Health Equity called for “a senior leader within the Office of Management and Budget (OMB) [to] be appointed to serve as the co-chair of the Equitable Long-Term Recovery and Resilience Steering Committee.” Several other recommendations in the report align with and amplify the recommendations found within the ELTRR. There is continued consensus about the plan’s value, but steps to ensure successful implementation have fallen short.
The federal government must take the next step: formalize the work by creating the Executive Steering Committee and solicit an external Federal Advisory Committee so that the hard work of implementation can get underway with transparency and accountability, as intended.
There’s no time to waste. Recent reporting from the New York Times and the Washington Post leaves very little room for debate: America’s health care system is in need of a major intervention. America spends more and gets less out of its health care system than any other comparable nation. Despite efforts from civil society and government alike, trends are heading in the wrong direction on nearly every indicator.
Business-as-usual practices—and politics–are impediments to the kind of change we need. To ensure the ELTRR recommendations are put into practice, the federal government must organize an advisory group that will oversee the execution of the plan. The ELTRR isn’t just the right plan to meet the moment; it also has the added distinction of NOT calling for new funding initiatives or agency authorities. It is an elegant roadmap to make government work better for the people it most needs to serve. The time is now: leaders within government who are failing to adequately empower the interagency workgroup need to get out of the way and allow the value of this work to unfold.
True progress can be achieved only by transforming the systems that hold the country’s problems in place, as is the intention with the ELTRR plan. The very nature of transformation resists being boiled down to a sound bite in an election cycle. These reforms aren’t going to win debate points but will win progress on the things that matter to improve Americans’ lives.
Becky Payne is the President and CEO of The Rippel Foundation, which is committed to fostering equitable health and well-being. From 2002-2021 she served in a variety of leadership roles within the U.S. Centers for Disease Control and Prevention (CDC) and HHS, where she was responsible for designing and launching new, large-scale initiatives, including the ELTRR.
