The United States Public Health Service (USPHS or PHS) is a collection of agencies of the
Department of Health and Human Services
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is " ...
concerned with
public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
, containing nine out of the department's twelve operating divisions. The
Assistant Secretary for Health
The assistant secretary for health (ASH) is a senior U.S. government official within the United States Department of Health and Human Services (HHS). The position is a statutory office () and the holder of the office serves as the United State ...
oversees the PHS. The
Public Health Service Commissioned Corps
The United States Public Health Service Commissioned Corps (PHSCC), also referred to as the Commissioned Corps of the United States Public Health Service, is the federal uniformed service of the U.S. Public Health Service (PHS) and one of the ei ...
(PHSCC) is the federal uniformed service of the PHS, and is one of the eight
uniformed services of the United States
The United States has eight federal uniformed services that commission officers as defined by Title 10 and subsequently structured and organized by Titles 10, 14, 32, 33 and 42 of the U.S. Code.
Uniformed services
The uniformed services a ...
.
PHS had its origins in
the system of marine hospitals that originated in 1798. In 1871 these were consolidated into the
Marine Hospital Service
The Marine Hospital Service was an organization of Marine Hospitals dedicated to the care of ill and disabled seamen in the United States Merchant Marine, the U.S. Coast Guard and other federal beneficiaries. The Marine Hospital Service evolved ...
, 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. PHS was established as 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
The United States secretary of health and human services is the head of the United States Department of Health and Human Services, and serves as the principal advisor to the president of the United States on all health matters. The secretary is ...
rather the Assistant Secretary for Health, eliminating PHS as an administrative level in the organizational hierarchy.
Organization
Nine of the twelve operating agencies within the Department of Health and Human Services (HHS) are designated as part of the Public Health Service:
*
National Institutes of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
*
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
*
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
*
Health Resources and Services Administration
The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services located in North Bethesda, Maryland. It is the primary federal agency for improving access to health care services for peop ...
*
Agency for Toxic Substances and Disease Registry
The Agency for Toxic Substances and Disease Registry (ATSDR) is a federal public health agency within the United States Department of Health and Human Services. The agency focuses on minimizing human health risks associated with exposure to haza ...
*
Indian Health Service
The Indian Health Service (IHS) is an operating division (OPDIV) within the U.S. Department of Health and Human Services (HHS). IHS is responsible for providing direct medical and public health services to members of federally-recognized Nativ ...
*
Agency for Healthcare Research and Quality
The Agency for Healthcare Research and Quality (AHRQ; pronounced "ark" by initiates and often "A-H-R-Q" by the public) is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered i ...
*
Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration (SAMHSA; pronounced ) is a branch of the U.S. Department of Health and Human Services. It is charged with improving the quality and availability of treatment and rehabilitative services ...
*
Administration for Strategic Preparedness and Response
The Administration for Strategic Preparedness and Response (ASPR) is an operating agency of the U.S. Public Health Service within the Department of Health and Human Services that focuses preventing, preparing for, and responding to the adverse h ...
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
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
,
Administration for Children and Families
The Administration for Children and Families (ACF) is a division of the United States Department of Health and Human Services (HHS). It is headed by the Assistant Secretary of Health and Human Services for Children and Families. It has a $49 billi ...
, and
Administration for Community Living
The Administration for Community Living (ACL) is part of the United States Department of Health and Human Services. It is headed by the Administrator and Assistant Secretary for Aging, who reports directly to the Secretary of Health and Human ...
.
The Public Health Service also encompasses two staff offices:
*
Office of the Assistant Secretary for Health
The Office of the Assistant Secretary for Health (OASH) is an operating agency of the United States Department of Health and Human Services and the managing personnel body for the United States Public Health Service. The office is under the directi ...
*
Office of Global Affairs
An office is a space where an organization's employees perform administrative work in order to support and realize objects and goals of the organization. The word "office" may also denote a position within an organization with specific d ...
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
Preventive healthcare, or prophylaxis, consists of measures taken for the purposes of disease prevention.Hugh R. Leavell and E. Gurney Clark as "the science and art of preventing disease, prolonging life, and promoting physical and mental hea ...
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
Uniformed services is an abstract term that are generally bodies of people in employment of a state who wear a distinct uniform that differentiates them from the public and private sector. Their purpose is to maintain the peace, security, safety, ...
, the PHS Commissioned Corps fills public health leadership and service roles within
federal government
A federation (also known as a federal state) is a political entity characterized by a union of partially self-governing provinces, states, or other regions under a central federal government (federalism). In a federation, the self-governin ...
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
The United States Navy (USN) is the maritime service branch of the United States Armed Forces and one of the eight uniformed services of the United States. It is the largest and most powerful navy in the world, with the estimated tonnage ...
with special PHSCC insignia, and the Corps uses the same commissioned officer
ranks as the
U.S. Navy
The United States Navy (USN) is the maritime service branch of the United States Armed Forces and one of the eight uniformed services of the United States. It is the largest and most powerful navy in the world, with the estimated tonnage o ...
, the
U.S. Coast Guard
The United States Coast Guard (USCG) is the maritime security, search and rescue, and law enforcement service branch of the United States Armed Forces and one of the country's eight uniformed services. The service is a maritime, military, mul ...
, and the
NOAA Commissioned Officer Corps
The National Oceanic and Atmospheric Administration Commissioned Officer Corps, known informally as the NOAA Corps, is one of eight federal uniformed services of the United States, and operates under the National Oceanic and Atmospheric Administ ...
from
ensign
An ensign is the national flag flown on a vessel to indicate nationality. The ensign is the largest flag, generally flown at the stern (rear) of the ship while in port. The naval ensign (also known as war ensign), used on warships, may be diffe ...
to
admiral
Admiral is one of the highest ranks in some navies. In the Commonwealth nations and the United States, a "full" admiral is equivalent to a "full" general in the army or the air force, and is above vice admiral and below admiral of the fleet, ...
,
uniformed services pay grades O-1 through O-10 respectively.
According to , service in the PHSCC after June 30, 1960, is considered military service for retirement purposes. Under , active service in the PHSCC is considered active military service for the purposes of most veterans' benefits and for antidiscrimination laws.
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. 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.
Marine Hospital Service
In the administration of the second president of the United States
John Adams
John Adams (October 30, 1735 – July 4, 1826) was an American statesman, attorney, diplomat, writer, and Founding Fathers of the United States, Founding Father who served as the second president of the United States from 1797 to 1801. Befor ...
, Congress authorized the creation of hospitals for mariners through the 1798
Act for the Relief of Sick and Disabled Seamen. They were initially located along the
East Coast
East Coast may refer to:
Entertainment
* East Coast hip hop, a subgenre of hip hop
* East Coast (ASAP Ferg song), "East Coast" (ASAP Ferg song), 2017
* East Coast (Saves the Day song), "East Coast" (Saves the Day song), 2004
* East Coast FM, a ra ...
, and as the boundaries of the
United States expanded, so too were marine hospitals.
[
] The Marine Hospital Service was placed under the
Revenue Marine Service (a forerunner of the present-day
Coast Guard
A coast guard or coastguard is a maritime security organization of a particular country. The term embraces wide range of responsibilities in different countries, from being a heavily armed military force with customs and security duties to ...
) within the
Department of the Treasury.
A reorganization in 1871 converted the loose network of locally controlled marine hospitals into a centrally controlled
Marine Hospital Service
The Marine Hospital Service was an organization of Marine Hospitals dedicated to the care of ill and disabled seamen in the United States Merchant Marine, the U.S. Coast Guard and other federal beneficiaries. The Marine Hospital Service evolved ...
, with its headquarters in
Washington, D.C.
)
, image_skyline =
, image_caption = Clockwise from top left: the Washington Monument and Lincoln Memorial on the National Mall, United States Capitol, Logan Circle, Jefferson Memorial, White House, Adams Morgan, ...
This reorganization established the Marine Hospital Service as its own bureau within the Department of the Treasury.
The position of Supervising Surgeon (later titled the
Surgeon General) was created to administer the Service, and
John Maynard Woodworth
John Maynard Woodworth (August 15, 1837 – March 14, 1879) was an American physician and member of the Woodworth political family. He served as the first Supervising-Surgeon General under president Ulysses S. Grant, then changed to Surgeon Gene ...
was appointed as the first incumbent in 1871. He moved quickly to reform the system and adopted a
military
A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...
model for his medical staff; putting his
physician
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
s 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 formally established by legislation after the fact in 1889, and signed by President
Grover Cleveland
Stephen Grover Cleveland (March 18, 1837June 24, 1908) was an American lawyer and politician who served as the 22nd and 24th president of the United States from 1885 to 1889 and from 1893 to 1897. Cleveland is the only president in American ...
.
The scope of activities of the Marine Hospital Service began to expand well beyond the care of merchant seamen in the closing decades of the nineteenth century, into control of
infectious disease
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
, collection of health statistics, and basic science research. Following cholera epidemics in the US in 1873, the
National Quarantine Act of 1878 vested quarantine authority to the Marine Hospital Service. Under the
Public Health Act of 1879, this authority was temporarily shared with the U.S. Army and Navy through the
National Board of Health
The National Board of Health (NBH) was a short lived institution that operated from 1879 to 1883 in the United States. It was created during the third Session of the 45th Congress, listed as chapter 202 better known as the Public Health Act of 18 ...
, until 1883.
Given the prevalence of infectious disease among immigrants arriving from famine and war areas of Europe, the Marine Hospital Service was assigned to medically inspect immigrants at such sites as
Ellis Island
Ellis Island is a federally owned island in New York Harbor, situated within the U.S. states of New York and New Jersey, that was the busiest immigrant inspection and processing station in the United States. From 1892 to 1954, nearly 12 mi ...
in
New York Harbor
New York Harbor is at the mouth of the Hudson River where it empties into New York Bay near the East River tidal estuary, and then into the Atlantic Ocean on the east coast of the United States. It is one of the largest natural harbors in t ...
. In 1878, an act of Congress enabled the Marine Hospital Service to collect data on communicable diseases and perform
surveillance
Surveillance is the monitoring of behavior, many activities, or information for the purpose of information gathering, influencing, managing or directing. This can include observation from a distance by means of electronic equipment, such as c ...
of the incidence and distribution of diseases; these programs would eventually become the
National Center for Health Statistics
The National Center for Health Statistics (NCHS) is a U.S. government agency that provides statistical information to guide actions and policies to improve the public health of the American people. It is a unit of the Centers for Disease Control ...
. In 1887, the Hygienic Laboratory, the predecessor of the
National Institutes of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
, began as a single-room laboratory for bacteriological investigation at the
Staten Island Marine Hospital, and moved to Washington, D.C. in 1891.
In 1899, internal divisions were formed for the first time, specifically the Divisions of Marine Hospitals, Domestic Quarantine, Foreign Quarantine, Sanitary Reports and Statistics, Scientific Research, and Personnel and Accounts. These original divisions would remain through 1943, although there were minor name changes throughout this time, and a few new divisions would be created.
Development as the Public Health Service
Because the Service took on broader responsibilities, in 1902 it was renamed as the Public Health and Marine Hospital Service. In 1912, under new authorizing legislation, it was established as the Public Health Service (PHS) to express the enlarged scope of its work.
The 1912 PHS law () expanded the agency's mission from communicable to include
non-communicable disease
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, os ...
s.
In 1913, the former
Cincinnati Marine Hospital
Two buildings in Cincinnati were known as the United States Marine Hospital. They were part of the U.S. Marine Hospital system, which was run by the Marine Hospital Service and its successor the Public Health Service, primarily for the benefit ...
building was reopened as a Field Investigation Station for water pollution research. This was the beginning of the PHS
Environmental Health Divisions
The Environmental Health Divisions was a unit of the U.S. Public Health Service (PHS) that focused on environmental health, existing in various forms from 1913 until 1970. It is the primary direct predecessor of the U.S. Environmental Protection A ...
, a precursor to the
Environmental Protection Agency
A biophysical environment is a biotic and abiotic surrounding of an organism or population, and consequently includes the factors that have an influence in their survival, development, and evolution. A biophysical environment can vary in scale f ...
.
In 1914, the
Office of Industrial Hygiene and Sanitation, the direct predecessor of the
National Institute for Occupational Safety and Health
The National Institute for Occupational Safety and Health (NIOSH, ) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the C ...
, was founded at the
Pittsburgh Marine Hospital.
Both of these offices were within the Division of Scientific Research.
The Division of Venereal Diseases was established in 1918, and the Narcotics Division in 1929 (it eventually became the
National Institute of Mental Health
The National Institute of Mental Health (NIMH) is one of 27 institutes and centers that make up the National Institutes of Health (NIH). The NIH, in turn, is an agency of the United States Department of Health and Human Services and is the prima ...
).
In 1930, the Hygienic Laboratory was redesignated as the (singular)
National Institute of Health
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late 1 ...
(NIH) by the
Ransdell Act
The Ransdell Act (ch. 251, , codified as amended at , , ), reorganized, expanded and redesignated the ''Laboratory of Hygiene'' (created in 1887) as the National Institute of Health.
Congress appropriated $750,000 in the bill for construction of ...
; in 1937, it absorbed the rest of the Division of Scientific Research, of which it was formerly part, and in 1938 it moved to
its current campus in
Bethesda, Maryland
Bethesda () is an unincorporated, census-designated place in southern Montgomery County, Maryland. It is located just northwest of Washington, D.C. It takes its name from a local church, the Bethesda Meeting House (1820, rebuilt 1849), which in ...
.
In 1939, PHS as a whole was transferred from the Department of the Treasury into the new
Federal Security Agency
The Federal Security Agency (FSA) was an Independent agencies of the United States government, independent agency of the United States government established in 1939 pursuant to the Reorganization Act of 1939. For a time, the agency oversaw food a ...
. In 1942, the Office of Malaria Control in War Areas was created, which in 1946 became the Communicable Disease Center, which would eventually become the
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention (CDC) is the national public health agency of the United States. It is a United States federal agency, under the Department of Health and Human Services, and is headquartered in Atlanta, Georgi ...
.
Beginning in the late 1920s and continuing through the
New Deal
The New Deal was a series of programs, public work projects, financial reforms, and regulations enacted by President Franklin D. Roosevelt in the United States between 1933 and 1939. Major federal programs agencies included the Civilian Cons ...
era, a significant building campaign upgraded several marine hospitals into large, monumental buildings, in contrast with the smaller buildings common for the 19th-century buildings.
PHS's headquarters were in the
Butler Building
The Butler Building was a mansion in Washington, D.C., constructed by Benjamin Franklin Butler. It served as the headquarters of the U.S. Marine Hospital Service, and its successor the Public Health Service, from 1891 until 1929. It also contai ...
, a converted mansion across the street from the
United States Capitol
The United States Capitol, often called The Capitol or the Capitol Building, is the seat of the legislative branch of the United States federal government, which is formally known as the United States Congress. It is located on Capitol Hill ...
, from 1891 until April 1929. It expanded into office space in
Temporary Building C on the
National Mall
The National Mall is a Landscape architecture, landscaped park near the Downtown, Washington, D.C., downtown area of Washington, D.C., the capital city of the United States. It contains and borders a number of museums of the Smithsonian Institut ...
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 on the
National Mall
The National Mall is a Landscape architecture, landscaped park near the Downtown, Washington, D.C., downtown area of Washington, D.C., the capital city of the United States. It contains and borders a number of museums of the Smithsonian Institut ...
.
Mid-20th century
![National Institutes of Health Campus (29791758961)](https://upload.wikimedia.org/wikipedia/commons/6/63/National_Institutes_of_Health_Campus_%2829791758961%29.jpg)
By 1943, PHS contained eight administrative divisions, plus the
National Cancer Institute
The National Cancer Institute (NCI) coordinates the United States National Cancer Program and is part of the National Institutes of Health (NIH), which is one of eleven agencies that are part of the U.S. Department of Health and Human Services. ...
,
St. Elizabeths Hospital, and
Freedmen's Hospital
Howard University Hospital, previously known as Freedmen's Hospital, is a major hospital located in Washington, D.C., built on the site of the previous Griffith Stadium. The hospital has served the African-American community in the area for over ...
under the direct supervision of the
Surgeon General. These divisions often had overlapping scopes, which was seen as administratively unwieldy. Additionally, some of these had been created and specified through several pieces of legislation that were inconsistent in their scope, while some had been created internally by PHS or delegated from the parent Federal Security Agency.
In 1943, PHS's divisions were collected into three operating agencies by law ().
The
Bureau of State Services
The Bureau of State Services (BSS) was one of three principal operating agencies of the United States Public Health Service (PHS) from 1943 until 1966. The bureau contained the PHS divisions that administered cooperative services to U.S. states ...
administered cooperative services to
U.S. state
In the United States, a state is a constituent political entity, of which there are 50. Bound together in a political union, each state holds governmental jurisdiction over a separate and defined geographic territory where it shares its sover ...
s through technical and financial assistance, the
Bureau of Medical Services
The Bureau of Medical Services (BMS) was a unit of the United States Public Health Service (PHS) that existed in two incarnations. The first was one of three principal operating agencies of PHS from 1943 until 1966, while the second was a divis ...
provided direct patient care through hospitals and clinics as well as foreign quarantine facilities, and the National Institute of Health remained independent to perform laboratory research activities.
Additionally, 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.
The mid-20th century was a time of expansion for both NIH and the PHS environmental health programs. In 1948, NIH's name was changed to the plural National Institutes of Health, and by the end of 1950 six new institutes had been created within it.
The environmental health programs expanded from water pollution into air, industrial, and chemical pollution and radiological health research during and after World War II,
and in 1954 they moved across town from the former Cincinnati Marine Hospital to the newly constructed Robert A. Taft Sanitary Engineering Center.
However, the period was one of decline for the marine hospital system. In 1943, the hospital system had reached its peak of 30 hospitals.
During 1944–1953, a wave of closings eliminated nine of the ten Marine Hospitals that had not been upgraded since the 1920s, as well as three newer general hospitals and the tuberculosis sanatorium at
Fort Stanton
Fort Stanton was a United States Army fort near Lincoln, New Mexico.
Army Fort
It was built in 1855 by the 1st Dragoon and the 3rd and 8th Infantry Regiments to serve as a base of military operations against the Mescalero Apaches. Numerous cam ...
.
However, PHS funded construction of hospitals by the states through the 1946
Hill–Burton Act
The Hospital Survey and Construction Act (), commonly known as the Hill–Burton Act, is a U.S. federal law passed in 1946, during the 79th United States Congress. It was sponsored by Senator Harold Burton of Ohio and Senator Lister Hill of Alab ...
.
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
The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
. In 1955 the
Division of Indian Health was established upon transfer of these functions from the
Bureau of Indian Affairs
The Bureau of Indian Affairs (BIA), also known as Indian Affairs (IA), is a United States federal agency within the Department of the Interior. It is responsible for implementing federal laws and policies related to American Indians and A ...
in the
Department of the Interior
The United States Department of the Interior (DOI) is one of the executive departments of the U.S. federal government headquartered at the Main Interior Building, located at 1849 C Street NW in Washington, D.C. It is responsible for the mana ...
.
Reorganization era
Between 1966 and 1973, a series of reorganizations and realignments led to the end of the bureau structure.
The reorganization by 1968 replaced PHS's old bureau structure with two new operating agencies: the Health Services and Mental Health Administration (HSMHA) and the Consumer Protection and Environmental Health Service (CPEHS), with NIH remaining independent and less affected by the organization. In 1968, the position of
Assistant Secretary for Health
The assistant secretary for health (ASH) is a senior U.S. government official within the United States Department of Health and Human Services (HHS). The position is a statutory office () and the holder of the office serves as the United State ...
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.
Also in 1968, the
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
, which traced its origins to 1862, became part of the PHS. The goal of the reorganizations was to coordinate the previously fragmented divisions to provide a holistic approach to large, overarching problems.
Additionally, a second wave of hospital closings during 1965–1970 closed the three remaining general hospitals at inland locations along the
Mississippi River
The Mississippi River is the second-longest river and chief river of the second-largest drainage system in North America, second only to the Hudson Bay drainage system. From its traditional source of Lake Itasca in northern Minnesota, it f ...
and
Great Lakes
The Great Lakes, also called the Great Lakes of North America, are a series of large interconnected freshwater lakes in the mid-east region of North America that connect to the Atlantic Ocean via the Saint Lawrence River. There are five lakes ...
, as well as the 19th-century Savannah hospital. In addition,
St. Elizabeths Hospital and the psychiatric hospitals at
Lexington and
Fort Worth
Fort Worth is the fifth-largest city in the U.S. state of Texas and the 13th-largest city in the United States. It is the county seat of Tarrant County, covering nearly into four other counties: Denton, Johnson, Parker, and Wise. According ...
were transferred to other agencies, and the
Galveston
Galveston ( ) is a coastal resort city and port off the Southeast Texas coast on Galveston Island and Pelican Island in the U.S. state of Texas. The community of , with a population of 47,743 in 2010, is the county seat of surrounding Galvesto ...
hospital was replaced with one acquired by PHS in nearby
Nassau Bay. This left eight general hospitals plus the
National Leprosarium in the system.
The new agencies came to be seen as unwieldy and bureaucratic, and they would turn out to be short-lived. CPEHS was broken up in 1970, as much of it was transferred out of PHS to form the core of the new
Environmental Protection Agency
A biophysical environment is a biotic and abiotic surrounding of an organism or population, and consequently includes the factors that have an influence in their survival, development, and evolution. A biophysical environment can vary in scale f ...
.
Around the same time, the
National Institute for Occupational Safety and Health
The National Institute for Occupational Safety and Health (NIOSH, ) is the United States federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness. NIOSH is part of the C ...
was created out of the former Division of Industrial Hygiene by the
Occupational Safety and Health Act of 1970
The Occupational Safety and Health Act of 1970 is a US labor law governing the federal law of occupational health and safety in the private sector and federal government in the United States. It was enacted by Congress in 1970 and was signed by P ...
.
HSMHA was broken up into four successor agencies in 1973.
Modern period
Since 1973, PHS has encompassed between six and nine operating agencies anchored by NIH, FDA, and CDC. The organizational changes since 1973 have been:
* Creation of the
Agency for Toxic Substances and Disease Registry
The Agency for Toxic Substances and Disease Registry (ATSDR) is a federal public health agency within the United States Department of Health and Human Services. The agency focuses on minimizing human health risks associated with exposure to haza ...
in 1980
* Merging of the Health Resources Administration and Health Services Administration into the
Health Resources and Services Administration
The Health Resources and Services Administration (HRSA) is an agency of the U.S. Department of Health and Human Services located in North Bethesda, Maryland. It is the primary federal agency for improving access to health care services for peop ...
(HRSA) in 1982
* The
Indian Health Service
The Indian Health Service (IHS) is an operating division (OPDIV) within the U.S. Department of Health and Human Services (HHS). IHS is responsible for providing direct medical and public health services to members of federally-recognized Nativ ...
being split from HRSA in 1988
* The
Agency for Health Care Policy and Research
The Agency for Healthcare Research and Quality (AHRQ; pronounced "ark" by initiates and often "A-H-R-Q" by the public) is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered i ...
being split from the
Office of the Assistant Secretary for Health
The Office of the Assistant Secretary for Health (OASH) is an operating agency of the United States Department of Health and Human Services and the managing personnel body for the United States Public Health Service. The office is under the directi ...
in 1989
* Breakup of the Alcohol, Drug Abuse, and Mental Health Administration in 1992, with its research functions returning to the National Institutes of Health, and its services components becoming the
Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration (SAMHSA; pronounced ) is a branch of the U.S. Department of Health and Human Services. It is charged with improving the quality and availability of treatment and rehabilitative services ...
* Formation of the
Office of Global Affairs
An office is a space where an organization's employees perform administrative work in order to support and realize objects and goals of the organization. The word "office" may also denote a position within an organization with specific d ...
from two components within the Office of the Secretary and Office of the Assistant Secretary for Health in 2002
* Creation of the Office of Public Health Emergency Preparedness in 2002, which later became the
Administration for Strategic Preparedness and Response
The Administration for Strategic Preparedness and Response (ASPR) is an operating agency of the U.S. Public Health Service within the Department of Health and Human Services that focuses preventing, preparing for, and responding to the adverse h ...
The PHS hospital system had been the target of efforts to close the entire system since the mid-1970s.
As the result of pressure from the
Reagan administration
Ronald Reagan's tenure as the 40th president of the United States began with his first inauguration on January 20, 1981, and ended on January 20, 1989. Reagan, a Republican from California, took office following a landslide victory over D ...
,
the PHS hospital system was abolished in 1981, with the last eight hospitals transferred to other organizations:
five to non-governmental entities, two to the
Department of Defense Department of Defence or Department of Defense may refer to:
Current departments of defence
* Department of Defence (Australia)
* Department of National Defence (Canada)
* Department of Defence (Ireland)
* Department of National Defense (Philipp ...
, and one to the State of
Louisiana
Louisiana , group=pronunciation (French: ''La Louisiane'') is a state in the Deep South and South Central regions of the United States. It is the 20th-smallest by area and the 25th most populous of the 50 U.S. states. Louisiana is borde ...
.
PHS would however continue to operate the
National Leprosarium until 1999.
In 1995, supervision of the agencies within PHS was shifted from the Assistant Secretary for Health to report directly to the
Secretary of Health and Human Services
The United States secretary of health and human services is the head of the United States Department of Health and Human Services, and serves as the principal advisor to the president of the United States on all health matters. The secretary is ...
, eliminating PHS as an administrative level in the organizational hierarchy, although the agencies and offices are still legally designated as part of PHS.
Activities
Public health worker
Sara Josephine Baker
Sara Josephine Baker (November 15, 1873 – February 22, 1945) was an American physician notable for making contributions to public health, especially in the immigrant communities of New York City. Her fight against the damage that widespread ur ...
, 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
Hell's Kitchen, also known as Clinton, is a neighborhood on the West Side of Midtown Manhattan in New York City. It is considered to be bordered by 34th Street (or 41st Street) to the south, 59th Street to the north, Eighth Avenue to the eas ...
and teaching mothers how to dress, feed, and bathe their babies. Another key pioneer of public health in the U.S. was
Lillian Wald
Lillian D. Wald (March 10, 1867 – September 1, 1940) was an American nurse, humanitarian and author. She was known for contributions to human rights and was the founder of American community nursing. She founded the Henry Street Settlement in N ...
, who founded the
Henry Street Settlement
The Henry Street Settlement is a not-for-profit social service agency in the Lower East Side neighborhood of Manhattan, New York City that provides social services, arts programs and health care services to New Yorkers of all ages. It was founde ...
house in New York. The
Visiting Nurse Service of New York
Founded in 1893 by nursing pioneer Lillian D. Wald and Mary M. Brewster, VNS Health is one of the largest not-for-profit home- and community-based health care organizations in the United States, serving the five boroughs of New York City; Nassau ...
was a significant organization for bringing health care to the urban poor.
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 Safe Drinking Water Act (SDWA) is the principal federal law in the United States intended to ensure safe drinking water for the public. Pursuant to the act, the Environmental Protection Agency (EPA) is required to set standards for drinking w ...
. 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.
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.
Controversies
''Tuskegee Study of Untreated Syphilis in the Negro Male''
In 1932, the Public Health Service, working with the
Tuskegee Institute
Tuskegee University (Tuskegee or TU), formerly known as the Tuskegee Institute, is a private, historically black land-grant university in Tuskegee, Alabama. It was founded on Independence Day in 1881 by the state legislature.
The campus was de ...
in Tuskegee, Alabama, began a study to record the natural history of
syphilis
Syphilis () is a sexually transmitted infection caused by the bacterium ''Treponema pallidum'' subspecies ''pallidum''. The signs and symptoms of syphilis vary depending in which of the four stages it presents (primary, secondary, latent, an ...
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
Penicillins (P, PCN or PEN) are a group of β-lactam antibiotics originally obtained from ''Penicillium'' moulds, principally '' P. chrysogenum'' and '' P. rubens''. Most penicillins in clinical use are synthesised by P. chrysogenum using ...
—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".
Syphilis studies in Guatemala
A USPHS physician who took part in the 1932–1972 Tuskegee program,
John Charles Cutler
John Charles Cutler (June 29, 1915 – February 8, 2003) was a senior surgeon, and the acting chief of the venereal disease program in the United States Public Health Service. After his death, his involvement in several controversial and unethi ...
, was in charge of the U.S. government's
syphilis experiments in Guatemala
The Guatemala syphilis experiments were United States-led Human subject research, human experiments conducted in Guatemala from 1946 to 1948. The experiments were led by physician John Charles Cutler, who also participated in the late stages of th ...
, in which in the Central American
Republic of Guatemala
Guatemala ( ; ), officially the Republic of Guatemala ( es, República de Guatemala, links=no), is a country in Central America. It is bordered to the north and west by Mexico; to the northeast by Belize and the Caribbean; to the east by H ...
, 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
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
of the United States in
Bethesda, Maryland
Bethesda () is an unincorporated, census-designated place in southern Montgomery County, Maryland. It is located just northwest of Washington, D.C. It takes its name from a local church, the Bethesda Meeting House (1820, rebuilt 1849), which in ...
.
Secretary of State Hillary Clinton
Hillary Diane Rodham Clinton ( Rodham; born October 26, 1947) is an American politician, diplomat, and former lawyer who served as the 67th United States Secretary of State for President Barack Obama from 2009 to 2013, as a United States sen ...
apologized to the Republic of Guatemala for this program in 2010, in light of the serious ethical lapses in moral judgement which occurred.
See also
*
Cadet Nurse Corps
*
Human experimentation in the United States
Humans (''Homo sapiens'') are the most abundant and widespread species of primate, characterized by bipedalism and exceptional cognitive skills due to a large and complex brain. This has enabled the development of advanced tools, culture, a ...
*
Lucy Minnigerode, first superintendent of the U. S. Public Health Service Nursing Corps
*
Narcotic Farms Act of 1929
The Narcotic Farms Act of 1929 is a United States federal statute authorizing the establishment of two narcotic farms for the preventive custody and remedial care of individuals acquiring a sedative dependence for habit-forming narcotic drugs. Th ...
*
Public Health Service Act
The Public Health Service Act is a United States federal law enacted in 1944. The full act is codified in Title 42 of the United States Code (The Public Health and Welfare), Chapter 6A (Public Health Service).
Contents
The act clearly establis ...
*
Title 42 appointment
References
''This article is based on the
public domain
The public domain (PD) consists of all the creative work
A creative work is a manifestation of creative effort including fine artwork (sculpture, paintings, drawing, sketching, performance art), dance, writing (literature), filmmaking, ...
tex
History of the Commissioned Corps, PHS'
Further reading
*
*
*
*
** Selected Years
190219031904190519061907 1908
190919101911
External links
Public Health Servicein the ''
Federal Register
The ''Federal Register'' (FR or sometimes Fed. Reg.) is the official journal of the federal government of the United States that contains government agency rules, proposed rules, and public notices. It is published every weekday, except on feder ...
''
Office of the Surgeon General(part of the National Institutes for Health)
PHS history and WWII women's uniforms in colorWorld War II US women's service organizations (WAC, WAVES, ANC, NNC, USMCWR, PHS, SPARS, ARC and WASP)
The V.D. Radio Projecta
The WNYC Archives*
*
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