The duties of carrying out the many services required to keep the population healthy and to prevent serious outbreaks of disease are divided among local, state, and federal government agencies. They provide health officers and nurses for the schools and visiting nurses for the home. They oversee the water supply, the disposal of sewage, the production and distribution of milk, and the proper handling of food in restaurants. Public health agencies impose standards of public health on local communities when needed; they give financial and technical assistance to local communities in time of crisis, such as that caused by epidemics, hurricanes, and floods.
The principal federal health agency in the U.S. today is the Public Health Services division of the Department of Health and Human Services. It consists of five agencies including the National Institutes of Health, its research arm, which conducts extensive research into neurology, blindness, AIDS, immunology, and heart disease. The Centers for Disease Control and Prevention, another agency under the Public Health Service, maintains statistical data on all diseases; it was instrumental in showing the relationship between tampons and toxic shock syndrome, as well as pinpointing the source of Legionnaire's disease to a new water-borne organism. The Food and Drug Administration is the arm charged with assuring the effectiveness and purity of food, drugs, and cosmetics. The Alcohol, Drug Abuse and Mental Health Administration was established by Congress more recently to address substance abuse and mental health problems. To carry out all these activities the public health services employ large numbers of physicians, dentists, veterinarians, laboratory technicians, nurses, sanitary engineers, health educators, psychologists, and social workers (see also Surgeon General, United States).
Because of the frequent and rapid transportation of people and disease vectors by air there has been a growing need for the monitoring of public health on a global level. This is done by the UN's World Health Organization.
See studies by J. Leavitt and R. Numbers, ed. (1978), R. Bayer et al., ed. (1983), and O. Anderson (1985).
Agencies within the Public Health Service
As one of America's 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, diet, engineering, science, veterinary, and other health-related occupations.
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 physicians 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 physicians, over the course of the twentieth century, the Corps expanded to include dentists, physician assistants, sanitary engineers, pharmacists, nurses, sanitarians, scientists, and other health professionals.
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. 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 failed National Board of Health. 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 1932, the Public Health Service, working with the Tuskegee Institute, began a study to record the natural history of 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."
Officers of the Public Health Service Commissioned Corps wear uniforms similar to those of the United States Navy or, when serving with the United States Coast Guard, Coast Guard uniforms, but with unique and distinctive PHS Corps devices and use rank insignia identical to that of Naval officers. Two different sets of rank titles are used. Most commonly used are the standard Navy rank titles. Also used are the historical titles that identify the specialty of the officer in the title. An officer in the grade of O-5 / Commander is a "Senior Surgeon." An officer in the grade of O-3 / Lieutenant is "Senior Assistant".
The headquarters of the U.S. Public Health Service are located in Washington D.C., and Rockville, 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:
1999—hospital center at Fort Dix, NJ, for Kosovo refugees
2004/2005—tsunami and earthquake in Indonesia
2005—hurricanes Katrina and Rita
2006—earthquake in Hawaii
2006—medicine contamination in Panama