United States Public Health Service
Encyclopedia
The Public Health Service Act
of 1944 structured the United States Public Health Service (PHS) as the primary division of the Department of Health, Education and Welfare (HEW), which later became the United States Department of Health and Human Services
. 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
.
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 United States Navy
, Coast Guard
and NOAA Corps
from ensign
to admiral
, uniformed services pay grades O-1 through O-10 respectively.
, with Boston
being the site of the first such facility; later they were also established along inland waterways, the Great Lakes
, and the Gulf of Mexico
and Pacific Coasts. Funding for the hospitals was provided by a mandatory tax of about 1% of the wages of all maritime sailors.
A reorganization in 1870 converted the loose network of locally controlled hospitals into a centrally controlled Marine Hospital Service
, with its headquarters in Washington, D.C.
The position of Supervising Surgeon (later Surgeon General
) was created to administer the Service, and John Maynard Woodworth
was appointed as the first incumbent in 1871. He moved quickly to reform the system and adopted a military
model for his medical staff, instituting examinations for applicants and putting his physician
s in uniforms. Woodworth created a cadre of mobile, career service physicians who could be assigned as needed to the various marine hospitals. The commissioned officer corps (now known as the Commissioned Corps of the U.S. Public Health Service or the Public Health Service Commissioned Corps
) was established by legislation in 1889. At first open only to physician
s, over the course of the twentieth century, the Corps expanded to include veterinarian
s, dentist
s, Physician Assistants, sanitary engineers, pharmacist
s, nurses, sanitarians, scientist
s, and other health professionals.
The scope of activities of the Marine Hospital Service also bdsadegan to expand well beyond the care of merchant seamen in the closing decades of the nineteenth century, beginning with the control of infectious disease
. Quarantine
was originally a state function rather than federal, but 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 state authorities.
As immigration
increased dramatically in the late nineteenth century, the Federal Government also took over the processing of immigrants from the 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
. 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, and again in 1912 to just the Public Health Service. The Service continued to expand its public health
activities as the nation entered the twentieth century, with the Commissioned Corps leading the way. As the century progressed, PHS commissioned officers 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.
Today the mission of the Commissioned Corps of the PHS is "Protecting, promoting, and advancing the health and safety of the Nation."
in hopes of justifying treatment programs for blacks. It was called 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 used to describe 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. It has been called "arguably the most infamous biomedical research study in U.S. history."
Note that a USPHS physician who took part in the Tuskegee program, John Charles Cutler
, was in charge of the US government's syphilis experiments in Guatemala, in which Guatemalan prisoners, soldiers, orphaned children, and others were deliberately infected with syphilis and other sexually-transmitted diseases from 1946-1948 in order to study the disease, in a project funded by a grant from the National Institutes of Health
. President Obama apologized to Guatemala for this program in 2010.
1999—hospital center at Fort Dix, NJ, for Kosovo refugees
2001—terrorist attacks
2001—anthrax attacks
2004/2005—tsunami and earthquake in Indonesia
2005—hurricanes Katrina and Rita
2006—earthquake in Hawaii
2006—medicine contamination in Panama
2008- Hurricanes Gustav and Ike
2009- Tsunami and earthquake in American Samoa
2010- Earthquake in Haiti
2010- Deepwater Horizon oil spill response
2011- Tsunami in Japan
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 "The Public Health and Welfare", Chapter 6A "Public Health Service"....
of 1944 structured the United States Public Health Service (PHS) as the primary division of the Department of Health, Education and Welfare (HEW), which later became the United States Department of Health and Human Services
United States Department of Health and Human Services
The United States Department of Health and Human Services is a Cabinet department of the United States 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"...
. The PHS comprises all Agency Divisions of Health and Human Services and the Commissioned Corps. The Assistant Secretary for Health
United States Assistant Secretary for Health
The United States Assistant Secretary for Health serves as the 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 Public Health Service...
(ASH) oversees the PHS and the United States Public Health Service Commissioned Corps
Public Health Service Commissioned Corps
The United States Public Health Service Commissioned Corps is the federal uniformed service of the United States Public Health Service and is one of the seven uniformed services of the United States....
.
Agencies
Agencies within the Public Health Service- Administration for Children and FamiliesAdministration for Children and FamiliesThe Administration for Children and Families is a division of the United States Department of Health and Human Services . It is headed by the Assistant Secretary for Children and Families. It has a $58.8 billion budget for 65 programs that target children, youth and families...
(ACF) - Administration on AgingAdministration on AgingThe Administration on Aging is an agency of the United States Department of Health and Human Services. AoA awards annual grants to State government agencies on aging and Native American tribal organizations to support programs mandated by the Congress in the Older Americans Act...
(AoA) - Agency for Healthcare Research and QualityAgency for Healthcare Research and QualityThe Agency for Healthcare Research and Quality is a part of the United States Department of Health and Human Services, which supports research designed to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective...
(AHRQ) - Agency for Toxic Substances and Disease RegistryAgency for Toxic Substances and Disease RegistryThe Agency for Toxic Substances and Disease Registry 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 hazardous substances...
(ATSDR) - Centers for Disease Control and PreventionCenters for Disease Control and PreventionThe Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
(CDC) - Centers for Medicare & Medicaid Services (CMS)
- Federal Occupational HealthFederal Occupational HealthFederal Occupational Health is a service unit within the United States Department of Health and Human Services program's support center and a component of the U.S. Public Health Service. It helps maintain the health of 2.9 million U.S...
(FOH) - Food and Drug AdministrationFood and Drug AdministrationThe Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
(FDA) - Health Resources and Services AdministrationHealth Resources and Services AdministrationThe Health Resources and Services Administration , is an agency of the U.S. Department of Health and Human Services located in Rockville, Maryland...
(HRSA) - Indian Health ServiceIndian Health ServiceIndian Health Service is an Operating Division within the U.S. Department of Health and Human Services . IHS is responsible for providing medical and public health services to members of federally recognized Tribes and Alaska Natives...
(IHS) - National Institutes of HealthNational Institutes of HealthThe National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
(NIH) - Substance Abuse and Mental Health Services AdministrationSubstance Abuse and Mental Health Services AdministrationThe Substance Abuse and Mental Health Services Administration is a branch of the U.S. Department of Health and Human Services. It is charged with improving the quality and availability of prevention, treatment, and rehabilitative services in order to reduce illness, death, disability, and cost to...
(SAMHSA)
United States Public Health Service Commissioned Corps
The United States Public Health Service Commissioned Corps employs more than 6,000 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
Uniformed services of the United States
The United States has seven federal uniformed services that commission officers as defined by Title 10, and subsequently structured and organized by Title 10, Title 14, Title 33 and Title 42 of the United States Code.-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
United States Navy
The United States Navy is the naval warfare service branch of the United States Armed Forces and one of the seven uniformed services of the United States. The U.S. Navy is the largest in the world; its battle fleet tonnage is greater than that of the next 13 largest navies combined. The U.S...
with special PHSCC insignia, and the Corps uses the same commissioned officer ranks
Military rank
Military rank is a system of hierarchical relationships in armed forces or civil institutions organized along military lines. Usually, uniforms denote the bearer's rank by particular insignia affixed to the uniforms...
as the United States Navy
United States Navy
The United States Navy is the naval warfare service branch of the United States Armed Forces and one of the seven uniformed services of the United States. The U.S. Navy is the largest in the world; its battle fleet tonnage is greater than that of the next 13 largest navies combined. The U.S...
, Coast Guard
United States Coast Guard
The United States Coast Guard is a branch of the United States Armed Forces and one of the seven U.S. uniformed services. The Coast Guard is a maritime, military, multi-mission service unique among the military branches for having a maritime law enforcement mission and a federal regulatory agency...
and NOAA Corps
NOAA Corps
The National Oceanic and Atmospheric Administration Commissioned Corps is one of seven federal uniformed services of the United States, which operates under the National Oceanic and Atmospheric Administration , a scientific agency within the Department of Commerce...
from ensign
Ensign (rank)
Ensign is a junior rank of a commissioned officer in the armed forces of some countries, normally in the infantry or navy. As the junior officer in an infantry regiment was traditionally the carrier of the ensign flag, the rank itself acquired the name....
to admiral
Admiral (United States)
In the United States Navy, the United States Coast Guard and the United States Public Health Service Commissioned Corps, admiral is a four-star flag officer rank, with the pay grade of O-10. Admiral ranks above vice admiral and below Fleet Admiral in the Navy; the Coast Guard and the Public Health...
, uniformed services pay grades O-1 through O-10 respectively.
Mission
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.History
The origins of the Public Health Service can be traced to the passage of an act in 1798 that provided for the care and relief of sick and injured merchant seamen. The earliest marine hospitals created to care for the seamen were located along the East CoastEast Coast of the United States
The East Coast of the United States, also known as the Eastern Seaboard, refers to the easternmost coastal states in the United States, which touch the Atlantic Ocean and stretch up to Canada. The term includes the U.S...
, with Boston
Boston
Boston is the capital of and largest city in Massachusetts, and is one of the oldest cities in the United States. The largest city in New England, Boston is regarded as the unofficial "Capital of New England" for its economic and cultural impact on the entire New England region. The city proper had...
being the site of the first such facility; later they were also established along inland waterways, the Great Lakes
Great Lakes
The Great Lakes are a collection of freshwater lakes located in northeastern North America, on the Canada – United States border. Consisting of Lakes Superior, Michigan, Huron, Erie, and Ontario, they form the largest group of freshwater lakes on Earth by total surface, coming in second by volume...
, and the Gulf of Mexico
Gulf of Mexico
The Gulf of Mexico is a partially landlocked ocean basin largely surrounded by the North American continent and the island of Cuba. It is bounded on the northeast, north and northwest by the Gulf Coast of the United States, on the southwest and south by Mexico, and on the southeast by Cuba. In...
and Pacific Coasts. Funding for the hospitals was provided by a mandatory tax of about 1% of the wages of all maritime sailors.
A reorganization in 1870 converted the loose network of locally controlled hospitals into a centrally controlled Marine Hospital Service
Marine Hospital Service
The Marine-Hospital Service was an organization of Marine Hospitals dedicated to the care of ill and disabled seamen in the U.S. Merchant Marine, U.S. Coast Guard and other federal beneficiaries....
, with its headquarters in Washington, D.C.
Washington, D.C.
Washington, D.C., formally the District of Columbia and commonly referred to as Washington, "the District", or simply D.C., is the capital of the United States. On July 16, 1790, the United States Congress approved the creation of a permanent national capital as permitted by the U.S. Constitution....
The position of Supervising Surgeon (later Surgeon General
Surgeon General of the United States
The Surgeon General of the United States is the operational head of the Public Health Service Commissioned Corps and thus the leading spokesperson on matters of public health in the federal government...
) was created to administer the Service, and John Maynard Woodworth
John Maynard Woodworth
John Maynard Woodworth was an American physician and member of the Woodworth political family. He served as the first Supervising-Surgeon General under U.S. president Ulysses S. Grant, then changed to Surgeon General of the United States Marine Hospital Service from 1871 to 1879.-Early...
was appointed as the first incumbent in 1871. He moved quickly to reform the system and adopted a military
Military
A military is an organization authorized by its greater society to use lethal force, usually including use of weapons, in defending its country by combating actual or perceived threats. The military may have additional functions of use to its greater society, such as advancing a political agenda e.g...
model for his medical staff, instituting examinations for applicants and putting his physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s in uniforms. Woodworth created a cadre of mobile, career service physicians who could be assigned as needed to the various marine hospitals. The commissioned officer corps (now known as the Commissioned Corps of the U.S. Public Health Service or the Public Health Service Commissioned Corps
Public Health Service Commissioned Corps
The United States Public Health Service Commissioned Corps is the federal uniformed service of the United States Public Health Service and is one of the seven uniformed services of the United States....
) was established by legislation in 1889. At first open only to physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, over the course of the twentieth century, the Corps expanded to include veterinarian
Veterinarian
A veterinary physician, colloquially called a vet, shortened from veterinarian or veterinary surgeon , is a professional who treats disease, disorder and injury in animals....
s, dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
s, Physician Assistants, sanitary engineers, pharmacist
Pharmacist
Pharmacists are allied health professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use...
s, nurses, sanitarians, scientist
Scientist
A scientist in a broad sense is one engaging in a systematic activity to acquire knowledge. In a more restricted sense, a scientist is an individual who uses the scientific method. The person may be an expert in one or more areas of science. This article focuses on the more restricted use of the word...
s, and other health professionals.
The scope of activities of the Marine Hospital Service also bdsadegan to expand well beyond the care of merchant seamen in the closing decades of the nineteenth century, beginning with the control of infectious disease
Infectious disease
Infectious diseases, also known as communicable diseases, contagious diseases or transmissible diseases comprise clinically evident illness resulting from the infection, presence and growth of pathogenic biological agents in an individual host organism...
. Quarantine
Quarantine
Quarantine is compulsory isolation, typically to contain the spread of something considered dangerous, often but not always disease. The word comes from the Italian quarantena, meaning forty-day period....
was originally a state function rather than federal, but the National Quarantine Act of 1878 vested quarantine authority to the Marine Hospital Service
Marine Hospital Service
The Marine-Hospital Service was an organization of Marine Hospitals dedicated to the care of ill and disabled seamen in the U.S. Merchant Marine, U.S. Coast Guard and other federal beneficiaries....
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 state authorities.
As immigration
Immigration
Immigration is the act of foreigners passing or coming into a country for the purpose of permanent residence...
increased dramatically in the late nineteenth century, the Federal Government also took over the processing of immigrants from the 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
Ellis Island
Ellis Island in New York Harbor was the gateway for millions of immigrants to the United States. It was the nation's busiest immigrant inspection station from 1892 until 1954. The island was greatly expanded with landfill between 1892 and 1934. Before that, the much smaller original island was the...
in New York
New York
New York is a state in the Northeastern region of the United States. It is the nation's third most populous state. New York is bordered by New Jersey and Pennsylvania to the south, and by Connecticut, Massachusetts and Vermont to the east...
. 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, and again in 1912 to just the Public Health Service. The Service continued to expand its public health
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" . It is concerned with threats to health based on population health...
activities as the nation entered the twentieth century, with the Commissioned Corps leading the way. As the century progressed, PHS commissioned officers served their country by controlling the spread of contagious diseases such as smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
and yellow fever
Yellow fever
Yellow fever is an acute viral hemorrhagic disease. The virus is a 40 to 50 nm enveloped RNA virus with positive sense of the Flaviviridae family....
, conducting important biomedical research, regulating the food
Food
Food is any substance consumed to provide nutritional support for the body. It is usually of plant or animal origin, and contains essential nutrients, such as carbohydrates, fats, proteins, vitamins, or minerals...
and drug
Approved drug
In the United States, the FDA approves drugs. Before a drug can be prescribed, it must undergo an extensive FDA approval process. This process involves first testing the drug on animals or in medical labs. If found to be safe by the FDA and approved for the next phase of study, the drug is then...
supply, providing health care to underserved groups, supplying medical assistance in the aftermath of disasters, and in numerous other ways.
Today the mission of the Commissioned Corps of the PHS is "Protecting, promoting, and advancing the health and safety of the Nation."
Tuskegee Study of Untreated Syphilis in the Black Male
In 1932, the Public Health Service, working with the Tuskegee Institute, began a study to record the natural history of syphilisSyphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
in hopes of justifying treatment programs for blacks. It was called 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 used to describe 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. It has been called "arguably the most infamous biomedical research study in U.S. history."
Note that a USPHS physician who took part in the Tuskegee program, John Charles Cutler
John Charles Cutler
John Charles Cutler, M.D. was a senior surgeon, and the acting chief of the venereal disease program in the United States Public Health Service....
, was in charge of the US government's syphilis experiments in Guatemala, in which Guatemalan prisoners, soldiers, orphaned children, and others were deliberately infected with syphilis and other sexually-transmitted diseases from 1946-1948 in order to study the disease, in a project funded by a grant from the National Institutes of Health
National Institutes of Health
The National Institutes of Health are an agency of the United States Department of Health and Human Services and are the primary agency of the United States government responsible for biomedical and health-related research. Its science and engineering counterpart is the National Science Foundation...
. President Obama apologized to Guatemala for this program in 2010.
Emergency response since 1999
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:1999—hospital center at Fort Dix, NJ, for Kosovo refugees
2001—terrorist attacks
2001—anthrax attacks
2004/2005—tsunami and earthquake in Indonesia
2005—hurricanes Katrina and Rita
2006—earthquake in Hawaii
2006—medicine contamination in Panama
2008- Hurricanes Gustav and Ike
2009- Tsunami and earthquake in American Samoa
2010- Earthquake in Haiti
2010- Deepwater Horizon oil spill response
2011- Tsunami in Japan
Further reading
External links
- U.S. Public Health Service
- Office of the Surgeon General
- Office of the Public Health Service Historian
- PHS history and WWII women's uniforms in color WWII US women's service organizations (WAC, WAVES, ANC, NNC, USMCWR, PHS, SPARS, ARC and WASP)