Federal, state, and local government agencies have differing roles with regard to public health emergency preparedness and response. In addition, the President’s proposal transfers control over many of the programs that provide preparedness and response support for the state and local governments to a new Department of Homeland Security. Transfer of Certain Public Health Programs Has Potential to Improve Coordination

The transfer of federal assets and resources in the President’s proposed legislation has the potential to improve coordination of public health preparedness and response activities at the federal, state, and local levels. In addition, we have discussed the need for an institutionalized responsibility for homeland security in federal statute. New Department’s Control of Essential Public Health Capacities Raises Concern

The President’s proposal to shift the responsibility for all programs assisting state and local agencies in public health emergency preparedness and response from HHS to the new department raises concern because of the dual-purpose nature of these activities. Therefore, we are concerned about the transfer of control over the programs, including priority setting, that the proposal would give to the new department. We recognize the need for coordination of these activities with other homeland security functions, but the President’s proposal is not clear on how the public health and homeland security objectives would be balanced. The current proposal does not clearly provide a structure that ensures that the goals of both homeland security and public health will be met. In addition to coordination, we believe the role of the new department should include forging collaborative relationships with programs at all levels of government and developing a strategic plan for research and development. The transfer of the HHS medical response programs has the potential to reduce overlap among programs and facilitate response in times of disaster. Related GAO Products

	Homeland Security

Homeland Security: Title III of the Homeland Security Act of 2002. Homeland Security: Responsibility and Accountability for Achieving National Goals. National Preparedness: Integration of Federal, State, Local, and Private Sector Efforts Is Critical to an Effective National Strategy for Homeland Security. Combating Terrorism: Intergovernmental Cooperation in the Development of a National Strategy to Enhance State and Local Preparedness. Determining Performance and Accountability Challenges and High Risks.
What GAO Found

Federal, state, and local governments share responsibility for terrorist attacks. However, local government, including police and fire departments, emergency medical personnel, and public health agencies, is typically the first responder to an incident. The federal government historically has provided leadership, training, and funding assistance. In the aftermath of September 11, for instance, one-quarter of the $40 billion Emergency Response Fund was earmarked for homeland security, including enhancing state and local government preparedness. Because the national security threat is diffuse and the challenge is highly intergovernmental, national policymakers must formulate strategies with a firm understanding of the interests, capacity, and challenges facing those governments. The development of a national strategy will improve national preparedness and enhance partnerships between federal, state, and local governments. The creation of the Office of Homeland Security is an important and potentially significant first step. The Office of Homeland Security's strategic plan should (1) define and clarify the appropriate roles and responsibilities of federal, state, and local entities; (2) establish goals and performance measures to guide the nation's preparedness efforts; and (3) carefully choose the most appropriate tools of government to implement the national strategy and achieve national goals. The President's proposed Homeland Security Act of 2002 would bring many federal agencies with homeland security responsibilities--including public health preparedness and response--into one department to mobilize and focus assets and resources at all levels of government. GAO believes that the proposed reorganization has the potential to repair fragmentation in the coordination of public health preparedness and response programs at the federal, state, and local levels. The proposal would institutionalize the responsibility for homeland security in federal statute. In addition to improving overall coordination, the transfer of programs from multiple agencies to the new department could reduce overlap among programs and facilitate response in times of disaster. There are concerns about the proposed transfer of control of public health assistance programs that have both public health and homeland security functions from Health and Human Services to the new department. Transferring control of these programs, including priority setting, to the new department has the potential to disrupt some programs that are critical to basic public health responsibilities. GAO does not believe that the President's proposal is sufficiently clear on how both the homeland security and public health objectives would be accomplished.