Not only does the US lack a Cabinet secretary of health to assure highest level attention to the promotion of health and prevention of disease, this is one of the few countries that lacks a comprehensive policy on access to health services and the financing of personal care services, putting even more of a burden on the prevention and health promotion system.

Given our federal system and hesitancy to support “big government”, it is not surprising that health functions are spread across many agencies.

This high-level diffusion of responsibility may also be due to the fact that we as a nation are in conflict over whether health is truly a community concern, or whether health-related products and services are appropriately left to the marketplace along with all other consumer goods.