United States Public Health Service

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United States Public Health Service
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Logo of the United States Public Health Service
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Flag of the U.S. Public Health Service
Agency overview
Formed1798 (reorganized/renamed: 1871/1889/1902/1912)
Jurisdiction Federal government of the United States
Headquarters Hubert H. Humphrey Building
Washington, D.C.
Agency executive
Parent agency Department of Health and Human Services
Website www.hhs.gov/ash
"Public Health Service March" [1]

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

United States Department of Health and Human Services Department of the US federal government

The United States Department of Health & Human Services (HHS), also known as the Health Department, is a cabinet-level department of the U.S. federal government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America". Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW).

Public health preventing disease, prolonging life and promoting health through organized efforts and informed choices of society and individuals

Public health has been defined as "the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the health of a population and the threats it faces is the basis for public health. The public can be as small as a handful of people or as large as a village or an entire city; in the case of a pandemic it may encompass several continents. The concept of health takes into account physical, psychological and social well-being. As such, according to the World Health Organization, it is not merely the absence of disease or infirmity.

United States Public Health Service Commissioned Corps federal uniformed service of the U.S. Public Health Service

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 is one of the seven uniformed services of the United States.

Contents

Its origins can be traced to the establishment in 1798 of a system of marine hospitals. In 1870 these were consolidated into the Marine Hospital Service, and the position of Surgeon General was established. In 1889, the PHSCC was established. As the system's scope grew, it was renamed the Public Health Service in 1912. The Public Health Service Act of 1944 consolidated and revised previous laws and is the current legal basis for the PHS. It became part of the Federal Security Agency and later the Department of Health, Education and Welfare, which became the Department of Health and Human Services in 1979. [2] [3]

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 into the U.S. Public Health Service Commissioned Corps.

Surgeon General of the United States Head of the U.S. Public Health Service Commissioned Corps

The surgeon general of the United States is the operational head of the U.S. Public Health Service Commissioned Corps (PHSCC) and thus the leading spokesperson on matters of public health in the federal government of the United States. The surgeon general's office and staff are known as the Office of the Surgeon General (OSG) which is housed within the Office of the Assistant Secretary for Health.

Public Health Service Act

The Public Health Service Act is a United States federal law enacted in 1944. The full act is captured under Title 42 of the United States Code, Chapter 6A.

Organization

Eight out of the eleven operating divisions of the Department of Health and Human Services are designated as part of the Public Health Service: [4]

National Institutes of Health Medical research organization in the United States

The National Institutes of Health (NIH) is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late 1870s, and is now part of the United States Department of Health and Human Services. The majority of NIH facilities are located in Bethesda, Maryland. The NIH conducts its own scientific research through its Intramural Research Program (IRP) and provides major biomedical research funding to non-NIH research facilities through its Extramural Research Program.

Centers for Disease Control and Prevention government agency

The Centers for Disease Control and Prevention (CDC) is the leading national public health institute of the United States. The CDC is a United States federal agency under the Department of Health and Human Services and is headquartered in Atlanta, Georgia.

Indian Health Service Branch of the United States Health Department regarding the health of Native Americans

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 Native American Tribes and Alaska Native people. IHS is the principal federal health care provider and health advocate for Indian people.

The three other divisions 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. [4] [5]

Centers for Medicare and Medicaid Services United States federal agency

The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), 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 Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards. In addition to these programs, CMS has other responsibilities, including the administrative simplification standards from the Health Insurance Portability and Accountability Act of 1996 (HIPAA), quality standards in long-term care facilities through its survey and certification process, clinical laboratory quality standards under the Clinical Laboratory Improvement Amendments, and oversight of HealthCare.gov.

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 Commissioner and Deputy Commissioner. It has a $49 billion budget for 60 programs that target children, youth and families. These programs include assistance with welfare, child support enforcement, adoption assistance, foster care, child care, and child abuse.

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, who reports directly to the Secretary of Health and Human Services (HHS). ACL’s Principal Deputy Administrator serves as Senior Advisor to the HHS Secretary for Disability Policy.

The Assistant Secretary for Health is the senior official in charge of the Public Health Service. The Office of the Assistant Secretary for Health contains the following core agencies: [6]

Assistant Secretary for Health USHHS primary advisor on US public health

The Assistant Secretary for Health (ASH) serves as the U.S. Secretary of Health and Human Services's primary advisor on matters involving the nation's public health and, if serving as an active member in the regular corps, is the highest ranking uniformed officer in the U.S. Public Health Service Commissioned Corps (PHSCC). The ASH oversees all matters pertaining to the U.S. Public Health Service (PHS), the main division of the U.S. Department of Health and Human Services (HHS), for the Secretary as well as provide strategic and policy direction for the PHSCC. The PHS comprises almost all the agency divisions of the HHS as well as the PHSCC, a uniformed service of more than 6,700 health professionals who serve at the HHS, other federal agencies, and/or are assigned details to the armed forces. The ASH is a civilian or a uniformed member of the regular corps and is nominated for appointment by the President. The nominee must also be confirmed by the Senate. The ASH serves a four-year term of office at the pleasure of the President. If the appointee is a serving member of the regular corps, he or she is also appointed as a four-star admiral in the regular corps. The President may also nominate a civilian appointee to also be appointed a direct commission into the regular corps if the nominee so chooses. As such the position of ASH is the only office in the PHS that merits a four-star grade in the regular corps. The Assistant Secretary's office and staff are known as the Office of the Assistant Secretary for Health (OASH). The current Assistant Secretary for Health is Admiral Brett Giroir.

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 direction of the Assistant Secretary for Health, who serves as the senior uniformed advisor on public health and science issues to the Department Secretary. The Office serves as the focal point for leadership and coordination across the Department in public health and science, provides direction to program offices within OASH, and provides advice and counsel on public health and science issues to the Secretary.

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 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.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. [7]

History

Marine Hospital Service

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. As the boundaries of the United States expanded, and harbors were built on other coasts, so too were marine hospitals. [8] 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. [9]

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. [9] 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.

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. [10] 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).

Consolidation and expansion

In 1939, the Public Health Service was transferred from the Department of the Treasury into the new Federal Security Agency. [11] At that time the National Institute of Health [sic] was already established as a division of the PHS. [9] In 1942 the Communicable Disease Center, which would become the Centers for Disease Control and Prevention, was established within the PHS. [12] 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. [9]

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. [13] The Food and Drug Administration, which traces its origins to 1862, became part of the PHS in 1968. [14]

In 1980 the Department of Health, Education and Welfare was renamed as the Department of Health and Human Services. The other four agencies of the PHS were formed between 1980 and 1992.

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. [15]

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 of 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. [16]

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 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". [17]

Syphilis studies in Guatemala

A USPHS physician who took part in the 19321972 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. [18]

See also

Related Research Articles

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Tuskegee syphilis experiment Human Experiment

The Tuskegee Study of Untreated Syphilis in the Negro Male was an infamous and unethical clinical study conducted between 1932 and 1972 by the U.S. Public Health Service. The purpose of this study was to observe the natural history of untreated syphilis; the African-American men in the study were only told they were receiving free health care from the United States government.

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Surgeon Generals Medallion

The Surgeon General’s Medallion is the third highest award of the Public Health Service and the United States Public Health Service Commissioned Corps. The medal is awarded in the name of the United States Surgeon General for actions of exceptional achievement to the cause of public health and medicine. It is awarded by the Surgeon General of the United States.

Awards and decorations of the Public Health Service

The United States Public Health Service Commissioned Corps (PHSCC), one of the seven uniformed services of the United States, has the authority to issue various awards, commendations, and other insignia to its members. These include individual honor awards, unit honor awards, service awards, training ribbons, special skill badges, and identification badges. The following PHSCC awards are listed in the service's order of precedence:

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Steven K. Galson American physician

Steven Kenneth Galson is an American public health physician. He is currently Senior Vice President for Global Regulatory Affairs & Safety at Amgen, the California-based biopharmaceutical company. He is also Professor-at-Large at the Keck Graduate Institute for Applied Life Sciences in Clarmont, California. He is a retired rear admiral in the United States Public Health Service Commissioned Corps and public health administrator who served as the acting Surgeon General of the United States from October 1, 2007 – October 1, 2009. He served concurrently as acting Assistant Secretary for Health from January 22, 2009 to June 25, 2009, and as the Deputy Director and Director of the Center for Drug Evaluation and Research (CDER) at the Food and Drug Administration from 2001 to 2007. As the Acting Surgeon General, he was the commander of the United States Public Health Service Commissioned Corps and, while serving as the Assistant Secretary for Health, was the operational head of the Public Health Service.

Boris Lushniak United States Surgeon General

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Dr. John Roderick 'Rod' Heller, was the head in 1943-1948 of what was then called the "Venereal Disease" section of the United States Public Health Service (PHS). He then became the director of the National Cancer Institute, and then president/chief executive officer of the Memorial Sloan-Kettering Cancer Center in New York City. He is best known for having been the assistant in charge of on-site medical operations in the Tuskegee syphilis study, a longitudinal clinical examination by PHS of untreated syphilis in U.S. African-American males. Very serious questions of medical ethics have been raised about this study and those involved in it.

La Follette-Bulwinkle Act

La Follette-Bulwinkle Act or Venereal Diseases Control and Prevention Act of 1938 sanctioned federal assistance to U.S. states establishing preventive healthcare for venereal diseases. The United States federal statute commissioned the United States Public Health Service for demonstrations, investigations, and studies as related to the control, prevention, and treatment of opportunistic infections. The public law amended the Army Appropriations Act of 1918 appending the judicial context which created the Division of Venereal Diseases within the Bureau of the Public Health Service.

This is a timeline of the United States Public Health Service Commissioned Corps and its predecessor, the Marine Hospital Service.

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. Organizational Chart of Health & Human Services, 2007
  3. US Department of Health and Human Services. Office of the Assistant Secretary for Health (ASH)
  4. 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.
  5. "HHS Organization Chart". U.S. Department of Health and Human Services. 2008-10-24. Retrieved 2018-10-17.
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  7. "Title 42 - The Public Health and Welfare" (PDF). US Government Printing Office.
  8. 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   0520253760 . Retrieved 2012-11-08.
  9. 1 2 3 4 "Images From the History of the Public Health Service: Introduction". www.nlm.nih.gov. Retrieved 2017-12-03.
  10. 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.
  11. "Message to Congress on the Reorganization Act". The American Presidency Project. 1939-04-25. Retrieved 2018-10-23.
  12. "Our History - Our Story | About | CDC". www.cdc.gov. 2018-07-20. Retrieved 2018-10-23.
  13. ""If You Knew the Conditions..." Health Care to Native Americans: Indian Health Service Today". www.nlm.nih.gov. Retrieved 2018-10-23.
  14. Commissioner, Office of the. "FDA's Evolving Regulatory Powers - FDA's Origin". www.fda.gov. Retrieved 2018-10-23.
  15. EPA Alumni Association: Senior EPA officials discuss early implementation of the Safe Drinking Water Act of 1974, Video, Transcript (see p4).
  16. “Early Implementation of the Clean Air Act of 1970 in California.” EPA Alumni Association. Video, Transcript (see p1). July 12, 2016.
  17. 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.
  18. McNeil, Donald G., Jr. (2010-10-01). "Syphilis Experiment Is Revealed, Prompting U.S. Apology to Guatemala". The New York Times.

Further reading

PD-icon.svg This article incorporates  public domain material from websites or documents ofthe United States Department of Health and Human Services .