The Public Health Service Act of 1944 structured the United States Public Health Service (PHS), founded in 1798, as the primary division of the U.S. Department of Health, Education and Welfare (HEW; which was established in 1953), which later became the United States Department of Health and Human Services in 1979–1980 (when the Education agencies were separated into their own U.S. Department of Education). The Office of the Surgeon General was created in 1871. The PHS comprises all Agency Divisions of Health and Human Services and the Commissioned Corps. The Assistant Secretary for Health (ASH) oversees the PHS and the United States Public Health Service Commissioned Corps.
Agencies that are components of the Public Health Service
The following Staff Offices report directly to the Surgeon General:
The following Operating Divisions report directly to the Secretary:
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.
As one of the United States seven uniformed services, the PHS Commissioned Corps fills public health leadership and service roles within federal government agencies and programs. The PHS Commissioned Corps 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. Code § 8331 – Definitions:
(13) “military service” means honorable active service (A) in the armed forces; (B) in the Regular or Reserve Corps of the Public Health Service after June 30, 1960
With regard to 42 U.S. Code § 213 – Military Benefits:
(d) Active service deemed active military service with respect to laws administered by Secretary of Veterans Affairs
Active service of commissioned officers of the [United States Public Health] Service shall be deemed to be active military service in the Armed Forces of the United States for the purposes of all laws administered by the Secretary of Veterans Affairs (except the Servicemen’s Indemnity Act of 1951) and section 417 of this title.
(e) Active service deemed active military service with respect to Servicemembers Civil Relief Act
Active service of commissioned officers of the Service shall be deemed to be active military service in the Armed Forces of the United States for the purposes of all rights, privileges, immunities, and benefits now or hereafter provided under the Service members Civil Relief Act (50 App. U.S.C. 501 et seq.) [now 50 U.S.C. 3901 et seq.].
(f) Active service deemed active military service with respect to anti-discrimination laws
Active service of commissioned officers of the Service shall be deemed to be active military service in the Armed Forces of the United States for purposes of all laws related to discrimination on the basis of race, color, sex, ethnicity, age, religion, and disability.
The mission of the U.S. Public Health Service Commissioned Corps is to protect, promote, and advance the health and safety 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.
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 1798. 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, with Boston being the site of the first such facility, followed later by others including in the Baltimore vicinity at Curtis Bay.
At the time this act was passed the east coast was the only shore with harbors. As the boundaries of the United States expanded, and harbors were built on other coasts, so too were marine hospitals. In the 1830s and 1840s they were built along inland waterways, the Great Lakes, and the Gulf of Mexico. After the acquisition of the Oregon Territory (1846) and California (1848) hospitals were built in 1850s at Pacific Coast harbors.
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. 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. 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. At first open only to physicians, over the course of the 20th Century, the Corps expanded to include veterinarians, dentists, physician assistants, sanitary engineers, pharmacists, nurses, environmental health officers, scientists, and other types of health professionals. It is now known as the Commissioned Corps of the U.S. Public Health Service.
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. Starting in the mid-14th century, ships entering harbors were quarantined when any of the crew was sick. This practice was normal procedure at United States harbors, with quarantine originally a function of the individual states, rather than of the Federal Government. The National Quarantine Act of 1878 vested quarantine authority to the Marine Hospital Service. and the National Board of Health. The National Board was not reauthorized by Congress in 1883 and its powers reverted to the Marine Hospital Service. Over the next half a century, the Marine Hospital Service increasingly took over quarantine functions from individual state authorities.
As immigration increased dramatically in the late 19th Century, the Federal Government also took over the processing of immigrants from the individual states, beginning in 1891. 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. Commissioned officers played a major role in fulfilling the Service's commitment to prevent disease from entering the country.
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). The Service continued to expand its public health activities as the Nation entered the 20th Century, with the PHS's Commissioned Corps leading the way. As the century progressed, commissioned officers of the PHS served their country by controlling the spread of contagious diseases such as smallpox and yellow fever, conducting important biomedical research, regulating the food and drug supply, providing health care to underserved groups, supplying medical assistance in the aftermath of disasters, and in numerous other ways.
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.
Today the mission of the Commissioned Corps of the PHS is "Protecting, promoting, and advancing the health and safety of the Nation."
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 6 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".
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.
Commissioned Corps emergency response teams are managed by the Office of the Surgeon General. They are trained and equipped to respond to public health crises and national emergencies, such as natural disasters, disease outbreaks, or terrorist attacks. The teams are multidisciplinary and are capable of responding to domestic and international humanitarian missions. Officers have responded to many such emergencies in the past, including:
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