United States Public Health Service

United States Public Health Service
Logo of the United States
Public Health Service

Flag of the U.S. Public Health Service
Agency overview
Formed1798 (1798)
(reorganized/renamed: 1871/1902/1912)
JurisdictionFederal government of the United States
HeadquartersHubert H. Humphrey Building
Washington, D.C.
Agency executive
Parent agencyDepartment of Health and Human Services
Websitehttps://www.hhs.gov/ash
"Public Health Service March"[1]

The United States Public Health Service (USPHS or PHS) is a collection of agencies of the Department of Health and Human Services concerned with public health, containing eight out of the department's eleven operating divisions. The Assistant Secretary for Health oversees the PHS. The Public Health Service Commissioned Corps (PHSCC) is the federal uniformed service of the PHS, and is one of the eight uniformed services of the United States.

PHS had its origins in the system of marine hospitals that originated in 1798. In 1871 these were consolidated into the Marine Hospital Service, and shortly afterwards the position of Surgeon General and the PHSCC were established. As the system's scope grew to include quarantine authority and research, it was renamed the Public Health Service in 1912. A series of reorganizations in 1966–1973 began a shift where PHS' divisions were promoted into departmental operating agencies, with PHS itself becoming a thin layer of hierarchy above them rather than an operating agency in its own right. In 1995, PHS agencies were shifted to report directly to the Secretary of Health and Human Services rather the Assistant Secretary for Health, eliminating PHS as an administrative level in the organizational hierarchy.

Organization

Eight of the eleven operating agencies, and three staff offices, are designated as part of the Public Health Service within the Department of Health and Human Services (HHS):[2][3]

The three other operating agencies of HHS are designated human services agencies and are not part of the Public Health Service. These are the Centers for Medicare and Medicaid Services, Administration for Children and Families, and Administration for Community Living.[2][3]

United States Public Health Service Commissioned Corps

The United States Public Health Service Commissioned Corps (PHSCC) employs more than 6,000 uniformed public health professionals for the purpose of delivering public health promotion and disease prevention programs and advancing public health science. Members of the Commissioned Corps often serve on the frontlines in the fight against disease and poor health conditions.

The mission of the U.S. Public Health Service Commissioned Corps is to protect, promote, and advance the health and safety of the people of the United States. According to the PHSCC, this mission is achieved through rapid and effective response to public health needs, leadership and excellence in public health practices, and advancement of public health science.

As one of the United States eight uniformed services, the PHS Commissioned Corps fills public health leadership and service roles within federal government agencies and programs. The PHSCC includes officers drawn from many professions, including environmental and occupational health, medicine, nursing, dentistry, pharmacy, psychology, social work, hospital administration, health record administration, nutrition, engineering, science, veterinary, health information technology, and other health-related occupations.

Officers of the Corps wear uniforms similar to those of the United States Navy with special PHSCC insignia, and the Corps uses the same commissioned officer ranks as the U.S. Navy, the U.S. Coast Guard, and the NOAA Commissioned Officer Corps from ensign to admiral, uniformed services pay grades O-1 through O-10 respectively.

According to 5 U.S.C. § 8331, service in the PHSCC after June 30, 1960, is considered military service for retirement purposes. Under 42 U.S.C. § 213, active service in the PHSCC is considered active military service for the purposes of most veterans' benefits and for antidiscrimination laws.[5]

History

Modern public health began developing in the 19th century, as a response to advances in science that led to the understanding of the source and spread of disease. As the knowledge of contagious diseases increased, means to control them and prevent infection were soon developed. Once it became understood that these strategies would require community-wide participation, disease control began being viewed as a public responsibility. Various organizations and agencies were then created to implement these disease preventing strategies.[6] As the U.S. expanded, the scope of the governmental health agency expanded. Most of the Public health activity in the United States took place at the municipal level before the mid-20th century. There was some activity at the national and state level as well.[7]

Dramatic increases in average life span in the late 19th century and 20th century, is widely credited to public health achievements, such as vaccination programs and control of many infectious diseases including polio, diphtheria, yellow fever and smallpox; effective health and safety policies such as road traffic safety and occupational safety; improved family planning; tobacco control measures; and programs designed to decrease non-communicable diseases by acting on known risk factors such as a person's background, lifestyle and environment.

Another major public health improvement was the decline in the "urban penalty" brought about by improvements in sanitation. These improvements included chlorination of drinking water, filtration and sewage treatment which led to the decline in deaths caused by infectious waterborne diseases such as cholera and intestinal diseases.[8] The federal Office of Indian Affairs (OIA) operated a large-scale field nursing program. Field nurses targeted native women for health education, emphasizing personal hygiene and infant care and nutrition.[9]

Marine Hospital Service

In the administration of the second president of the United States John Adams, the Congress authorized the creation of hospitals for mariners. The origins of the Public Health Service can be traced to the passage, by the 5th Congress of the United States, of "An Act for the Relief of Sick and Disabled Seamen" in July of 1798.[10] This act created Marine Hospitals to care for sick seamen. They were initially located along the East Coast, at the harbors of the major port cities. As the boundaries of the United States expanded, and harbors were built on other coasts, so too were marine hospitals.[11] The Marine Hospital Service was placed under the Revenue Marine Service (a forerunner of the present-day Coast Guard) within the Department of the Treasury.[12]

A reorganization in 1870 converted the loose network of locally controlled marine hospitals into a centrally controlled Marine Hospital Service, with its headquarters in Washington, D.C. This reorganization made the Marine Hospital Service into its own bureau within the Department of the Treasury.[12] The position of Supervising Surgeon (later titled the Surgeon General) was created to administer the Service, and John Maynard Woodworth, (1837-1879), was appointed as the first incumbent in 1871.[13] He moved quickly to reform the system and adopted a military model for his medical staff; putting his physicians in uniforms, and instituting examinations for applicants. Woodworth created a cadre of mobile, career service physicians, who could be assigned as needed to the various Marine Hospitals. The commissioned officer corps was established by legislation in 1889, and signed by 22nd/24th President Grover Cleveland.

U. S. Public Health And Marine Hospital Service flag, 1902 to 1912

The scope of activities of the Marine Hospital Service also began to expand well beyond the care of merchant seamen in the closing decades of the nineteenth century, beginning with the control of infectious disease. The National Quarantine Act of 1878 vested quarantine authority to the Marine Hospital Service. and the National Board of Health.[14] The Marine Hospital Service was assigned the responsibility for the medical inspection of arriving immigrants at sites such as Ellis Island in New York Harbor. Because of the broadening responsibilities of the Service, its name was changed in 1902 to the "Public Health and Marine Hospital Service". As the emphasis of its responsibilities shifted from sailors to general public health and with the decommissioning of various old marine hospitals the name was changed again, in 1912, to just the "Public Health Service" (PHS).

Expansion

Between 1899 and 1943, the service's organization consisted of the Division of Marine Hospitals and Relief, Division of Domestic (Interstate) Quarantine, Division of Insular and Foreign Quarantine and Immigration, Division of Personnel and Accounts, Division of Sanitary Reports and Statistics, Division of Scientific Research and Sanitation, and Miscellaneous Division, although there were minor name changes throughout this time. The Division of Venereal Diseases was established in 1918, and the Narcotics Division (which would eventually become the National Institute of Mental Health) in 1929.[15]

PHS's headquarters were in the Butler Building, a converted mansion across the street from the United States Capitol, from 1891 until April 1929. It expanded into office space in Temporary Building C on the National Mall in July 1920, which became its temporary headquarters after the Butler Building was closed for demolition. In May 1933, the new Public Health Service Building opened.[16]

In 1939, the Public Health Service was transferred from the Department of the Treasury into the new Federal Security Agency.[17] At that time the National Institute of Health [sic] was already established as a division of the PHS.[12] In 1946 the Communicable Disease Center, which would become the Centers for Disease Control and Prevention, was established within the PHS.[18]

In 1943, the PHS was reorganized, with its divisions placed into the Bureau of Medical Services, the Bureau of State Services, or the Office of the Surgeon General, but with the National Institute of Health remaining independent.[15] All of the laws affecting the functions of the public health agencies were consolidated for the first time in the Public Health Service Act of 1944.[12]

In 1953 the Federal Security Agency was abolished and most of its functions, including the PHS, were transferred to the newly formed Department of Health, Education and Welfare. In 1955 the Indian Health Service was established upon transfer of these functions from the Bureau of Indian Affairs.[19]

Reorganization

Between 1966 and 1973, a series of reorganizations and realignments led to the end of the bureau structure.[15][20] In 1968, the position of Assistant Secretary for Health was created, supplanting the Surgeon General as the top leader of the Public Health Service, although the Surgeon General was retained in a subordinate role.[21] Also in 1968, the Food and Drug Administration, which traces its origins to 1862, became part of the PHS.[22] PHS's environmental health functions were transferred to the newly formed Environmental Protection Agency in 1970.[20][23]

Recent history

By 1973, PHS's main divisions had been established in a structure substantially similar to today's. The main changes since then have been the Health Resources Administration and Health Services Administration merging into the Health Resources and Services Administration in 1982,[20] and the Alcohol, Drug Abuse, and Mental Health Administration broken up in 1992, with its research functions transferred to the National Institutes of Health, and its services components becoming the Substance Abuse and Mental Health Services Administration.[24]

On May 4, 1980, the Department of Health, Education and Welfare was renamed as the Department of Health and Human Services.[25] In 1995, supervision of the agencies within the Public Health service was shifted from the assistant secretary for health to the secretary of health and human services.[21]

Public health worker Sara Josephine Baker, M.D. established many programs to help the poor in New York City keep their infants healthy, leading teams of nurses into the crowded neighborhoods of Hell's Kitchen and teaching mothers how to dress, feed, and bathe their babies. Another key pioneer of public health in the U.S. was Lillian Wald, who founded the Henry Street Settlement house in New York. The Visiting Nurse Service of New York was a significant organization for bringing health care to the urban poor.

Activities

In the area of environmental protection and public health, a Public Health Service 1969 community water survey that looked at more than a thousand drinking water systems across the United States drew two important conclusions that supported a growing demand for stronger protections that were adopted in the 1974 Safe Drinking Water Act. The survey concluded, first, that the state supervision programs were very uneven and often lax, and, second, that the bacteriological quality of the water, particularly among small systems, was of concern.[26]

The 1963 Clean Air Act gave the Public Health Service in the Department of Health, Education, and Welfare the authority to take abatement action against industries if it could be demonstrated that they were polluting across state lines, or if a governor requested. Some of these actions involved the Ohio River Valley, New York, and New Jersey. The service also began monitoring air pollution. the 1967 Clean Air Act redirected attention to larger air quality control regions.[27]

Controversies

Tuskegee Study of Untreated Syphilis in the Negro Male

In 1932, the Public Health Service, working with the Tuskegee Institute in Tuskegee, Alabama, began a study to record the natural history of syphilis in hopes of justifying treatment programs for blacks. It was titled the Tuskegee Study of Untreated Syphilis in the Negro Male.

The study initially involved 600 black men—399 with syphilis, 201 who did not have the disease. The study was conducted without the benefit of patients' informed consent. Researchers told the men they were being treated for "bad blood", a local term referring to several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness. In exchange for taking part in the study, the men received free medical exams, free meals, and burial insurance. Although originally projected to last six months, the study actually went on for 40 years. Penicillin—which can be used to treat syphilis—was discovered in the 1940s. However, the study continued and treatment was never given to the subjects. Because of this, it has been called "arguably the most 'infamous' biomedical research study in U.S. history".[28]

Syphilis studies in Guatemala

A USPHS physician who took part in the 1932–1972 Tuskegee program, John Charles Cutler, was in charge of the U.S. government's syphilis experiments in Guatemala, in which in the Central American Republic of Guatemala, Guatemalan prisoners, soldiers, orphaned children, and others were deliberately infected with syphilis and other sexually-transmitted diseases from 1946 to 1948, in order to scientifically study the disease, in a project funded by a grant from the National Institutes of Health of the United States in Bethesda, Maryland.

Secretary of State Hillary Clinton apologized to the Republic of Guatemala for this program in 2010, in light of the serious ethical lapses in moral judgement which occurred.[29]

See also

References

This article is based on the public domain text History of the Commissioned Corps, PHS

  1. ↑ other(s), Jarminator CMS 3.0 created by Dwayne Jarman, DVM, MPH - page ontent created by. "Ensemble". dcp.psc.gov. Retrieved 26 February 2018.
  2. 1 2 Redhead, C. Stephen; Dabrowska, Agata (2015-10-13). "Public Health Service Agencies: Overview and Funding (FY2010–FY2016)" (PDF). U.S. Congressional Research Service. Retrieved 2018-10-16.
  3. 1 2 "HHS Organization Chart". U.S. Department of Health and Human Services. 2008-10-24. Retrieved 2018-10-17.
  4. ↑ "Public Health Offices". U.S. Department of Health and Human Services. 2016-03-21. Retrieved 2018-10-17.
  5. ↑ "Title 42 - The Public Health and Welfare" (PDF). US Government Printing Office.
  6. ↑ Health, Institute of Medicine (US) Committee for the Study of the Future of Public (1988). A History of the Public Health System. National Academies Press (US).
  7. ↑ John Duffy, The sanitarians: a history of American public health (1992).
  8. ↑ Cutler, David; Grant Miller (February 2004). "The Role of Public Health Improvements in Health Advances: The Twentieth Century United States". Demography. 42 (1): 1–22. doi:10.1353/dem.2005.0002. OCLC 703811616. PMID 15782893. S2CID 35536095.
  9. ↑ Hancock Christin L (2001). "Healthy Vocatoons: Field Nursing and the Religious Overtones of Public Health". Journal of Women's History. 23 (3): 113–137. doi:10.1353/jowh.2011.0035. PMID 22145184. S2CID 13226474.
  10. ↑ Ungar, Rich (17 January 2011). "Congress Passes Socialized Medicine and Mandates Health Insurance - In 1798". Forbes. Retrieved 25 February 2020.
  11. ↑ Gostin, Lawrence O. (2008). "Box 8: The Federal Presence in Public Health". Public Health Law: Power, Duty, Restraint, Revised and Expanded (2nd ed.). University of California Press. p. 156. ISBN 978-0520253766. Retrieved 2012-11-08.
  12. 1 2 3 4 "Images From the History of the Public Health Service: Introduction". nlm.nih.gov. Retrieved 2017-12-03.
  13. ↑ Christopher, Dean (5 October 2007). "20 Things You Didn't Know About... The Surgeon General". Discover. Retrieved 25 February 2020.
  14. ↑ Smillie, W. G. "The National Board of Health, 1879-1883" American Journal of Public Health and The Nation's Health (1943) 33(8):925-930.
  15. 1 2 3 "Records of the Public Health Service [PHS], 1912-1968". National Archives. 2016-08-15. Sections 90.3, 90.7, 90.8. Retrieved 2020-08-28.
  16. ↑ Williams, Ralph Chester (1951). The United States Public Health Service, 1798–1950. Commissioned Officers Association of the United States Public Health Service. pp. 520–521.
  17. ↑ "Message to Congress on the Reorganization Act". The American Presidency Project. 1939-04-25. Retrieved 2018-10-23.
  18. ↑ "Our History - Our Story | About | CDC". cdc.gov. 2021-08-05. Retrieved 2021-08-05.
  19. ↑ ""If You Knew the Conditions..." Health Care to Native Americans: Indian Health Service Today". nlm.nih.gov. Retrieved 2018-10-23.
  20. 1 2 3 "Records of the Health Resources and Services Administration [HRSA]". National Archives. 2016-08-15. Section 512.2. Retrieved 2020-08-28.
  21. 1 2 Landman, Keren (2019-06-24). "For America's Public Health Officers, Questions of Duty and Purpose". Undark Magazine. Retrieved 2020-07-11.
  22. ↑ Commissioner, Office of the. "FDA's Evolving Regulatory Powers - FDA's Origin". fda.gov. Retrieved 2018-10-23.
  23. ↑ "Records of the Environmental Protection Agency [EPA]". National Archives. 2016-08-15. Section 412.2. Retrieved 2020-08-28.
  24. ↑ "Records of the Alcohol, Drug Abuse, and Mental Health Administration [ADAMHA] (Record Group 511), 1929-93". National Archives. U.S. National Archives and Records Administration. Retrieved 18 July 2012.
  25. ↑ "HHS Historical Highlights". United States Department of Health and Human Services. 19 June 2006. Retrieved 25 February 2020.
  26. ↑ EPA Alumni Association: Senior EPA officials discuss early implementation of the Safe Drinking Water Act of 1974, Video, Transcript (see p4).
  27. ↑ “Early Implementation of the Clean Air Act of 1970 in California.” EPA Alumni Association. Video, Transcript (see p1). July 12, 2016.
  28. ↑ Katz RV, Kegeles SS, Kressin NR, et al. (November 2006). "The Tuskegee Legacy Project: willingness of minorities to participate in biomedical research". J Health Care Poor Underserved. 17 (4): 698–715. doi:10.1353/hpu.2006.0126. PMC 1780164. PMID 17242525.
  29. ↑ McNeil, Donald G., Jr. (2010-10-01). "Syphilis Experiment Is Revealed, Prompting U.S. Apology to Guatemala". The New York Times.

Further reading

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