U.S. Public Health Service reorganizations of 1966–1973

The initial reorganizations of the operating divisions was accomplished during 1966–1968 in two waves. An initial reorganization into a five-bureau structure was accomplished in 1967.[5] The new bureau system was oriented around "national centers", with larger divisions simply being renamed, and smaller divisions being combined as programs within the national centers.[6] For example, the Division of Radiological Health became the National Center for Radiological Health,[3] the Communicable Disease Center became the National Communicable Disease Center, and several divisions relating to environmental and occupational health were merged into the National Center for Urban and Industrial Health.[6]

However, this system would be short-lived as a more radical reorganization was carried out in 1968.[5] The purpose of the 1968 reorganization was to create agencies that could coordinate the relationships between divisions with similar focus, providing a holistic rather than fragmented approach.[7][8][9][10] HSMHA in particular was created with the recognition that, with the recent creation of Medicare and Medicaid increasing financing of healthcare, increased demand was straining healthcare delivery resources.[9] CPEHS stemmed from a belief that environmental health concerned not only a person's natural environment but also the products they consumed.[5][10]

Ultimately four discrete reorganization orders would occur during this period: Reorganization Plan No. 3 of 1966;[2][11] HEW reorganization order of April 1, 1968;[11] HEW reorganization order of July 1, 1968;[11][12] and HSMHA reorganization of October 31, 1968.[11] The collective effect of these reorganizations was to split BSS split three ways into an interim bureau structure, with each part having a different destination:[5]

• BSS's communicable disease control and environmental health divisions became part of the Bureau of Disease Prevention and Environmental Control.[2][11] This would absorb the Food and Drug Administration (which was previously part of HEW but not PHS)[12] and lose the National Communicable Disease Center to become the Consumer Protection and Environmental Health Service (CPEHS).[11]
• BSS's community health and hospital construction divisions would be absorbed by the Bureau of Medical Services to form the Bureau of Health Services. This would absorb the National Institute of Mental Health from NIH, as well as the National Communicable Disease Center to become the Health Services and Mental Health Administration (HSMHA).[2][11]
• BSS's training and professional development divisions became the Bureau of Health Manpower, which was absorbed by NIH.[2][11]

The rapid shifts in organizational names and structures did not go unnoticed. One employee recalled that a common joke at the time was, "If my boss calls me while I'm gone, find out who it is."[13] A 1969 publication about CPEHS contained the editor's note, "Another reorganization of the Food and Drug Administration has occurred since this paper was prepared. Even though these organizational details are no longer accurate, the paper is being published..."[7] The resulting organizations came to be seen as large and unwieldy.[5][14]

Another effect of the reorganizations was the creation of the position of Assistant Secretary for Health, a political appointee who supplanted the Surgeon General as the head of the PHS.[5][10][15][16] This was seen as undermining the chain of command of the PHS Commissioned Corps, beginning a long-term shift where Commissioned Corps officers were more responsible to the agencies they were stationed in than to the Corps itself.[16]

By the end of 1968, PHS's operating divisions were the National Institutes of Health, HSMHA, and CPEHS, the last two of which were organized as follows:

President Richard Nixon signing the Clean Air Amendments of 1970. Along with the National Environmental Policy Act, it provided the context in which Reorganization Plan No. 3 of 1970 was enacted, creating the Environmental Protection Agency and leading to the demise of CPEHS.

The breakup of CPEHS was largely a consequence of the formation of the Environmental Protection Agency (EPA) in 1970, as the result of a desire by the new Nixon administration to gather all federal environmental activities into a single autonomous regulatory body.[13] During 1970–1971, most of the CPEHS was moved out of PHS and HEW to form the core of the newly created EPA. This was accomplished in two phases, with the HEW reorganization order of January 16, 1970[12] and Reorganization Plan No. 3 of 1970.[12][17]

Some CPEHS components remained within PHS. The Food and Drug Administration had already become its own operating division within the PHS earlier in 1970, causing CPEHS to be briefly renamed simply the Environmental Health Service.[5][12] On the other hand, the entire National Air Pollution Control Administration was moved to EPA.[12]

The Environmental Control Administration's five bureaus were spit between PHS and EPA. PHS retained the Bureau of Occupational Safety and Health, which moved into HSMHA and soon became NIOSH;[1] part of the Bureau of Radiological Health, which moved into FDA;[3] and the Bureau of Community Environmental Management, which was later absorbed by EPA and CDC in 1973.[14][18] The Bureau of Solid Waste Management, Bureau of Water Hygiene, and the rest of the Bureau of Radiological Health were transferred to EPA in 1971.[12][17]

Center for Disease Control Director David Sencer in 1970. At this time he was also serving as the acting Administrator of HSMHA; he would preside over its breakup a few years later.

HSMHA was unpopular with many in PHS, as they felt that it shifted the focus from PHS physicians to department bureaucrats. In addition, National Communicable Disease Center Director David Sencer became acting HSMHA Administrator at the beginning of the Nixon Administration in 1969. HSMHA was reportedly referred to as "HSMA-ha-ha-ha" at NCDC headquarters, and Sencer was seeking to expand NCDC's scope by absorbing other components of HSMHA. As part of this, NCDC was renamed to Center for Disease Control in 1970.[18]

Under the HEW reorganization order of July 1, 1973, HSMHA was abolished. The Center for Disease Control became its own operating agency within the PHS, and absorbed NIOSH. The remaining functions of HSMHA were assigned to newly established Health Services Administration and Health Resources Administration, the latter of which also acquired the Bureau of Health Manpower from NIH.[11] Finally, under the HEW reorganization order of September 25, 1973, a new operating agency, the Alcohol, Drug Abuse, and Mental Health Administration, incorporated the National Institute of Mental Health as well as the recently created National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse.[5][19]