History(cont.)

Interestingly enough, the major health event of the 1960s, the passage of Medicare and Medicaid, had little influence on the PHS.  When these programs became law in 1965, they were placed elsewhere within DHEW.   Many within the PHS saw Medicare and Medicaid as essentially insurance programs with which the Service need not involve itself.

Although its responsibilities had expanded in a number of areas, one field in which the PHS saw its activities circumscribed in this period was environmental health.  In the 1960s, water pollution control was moved from the PHS to the department level in DHEW, and was then eventually transferred to the Department of the Interior.  The creation of the Environmental Protection Agency (EPA) in 1970 led to the loss of PHS programs in such areas as air pollution and solid waste to the new agency.  Although some PHS Officers continued to be detailed to EPA to assist it in its work, the Service had lost its role as the leader of the Federal environmental movement.

Concerns on the part of some political leaders that the PHS needed to be more responsive to the policies of elected officials and more of a modern political bureaucracy led to a major reorganization of the Service in 1968 which dramatically changed its leadership structure.  Up through the middle 1960s, the PHS was led almost entirely by career Commissioned Officers (who represented less that 20% of PHS employees by the 1960s).  The Surgeon General, although appointed by the President, had always been a career member of the Commissioned Corps.  The 1968 reorganization transferred the responsibility for directing the PHS from the Surgeon General to the Assistant Secretary for Health, a political appointee.  For the first time, a non-career official became the top official in the PHS.  Although the Assistant Secretary for Health could come from the ranks of the Commissioned Corps, this has not typically been the case.  In general, beginning in this period the heads of PHS bureaus or agencies were also increasingly not members of the Commissioned Corps.  The Surgeon General was no longer responsible for the management of the PHS but became largely an advisor and spokesperson on public health matters.  He or she was no longer necessarily chosen from the Corps, but was often appointed from outside the PHS and then commissioned upon appointment.

A series of further reorganizations over the next three decades continued to reshape the structure, but not the basic functions, of the PHS.   Some new programs were added.  For example, the National Health Service Corps (NHSC) was created in 1970.  Under this program, the PHS sent physicians, nurse practitioners, and other health professionals into clinical practice in areas where there were critical health manpower shortages.  Beginning in 1972, the PHS could offer health professions students scholarships in exchange for a commitment to serve in the NHSC.  A decade later, however, the PHS lost the responsibility of caring for a particular group of patients when the health care entitlement for merchant seamen was terminated.  By that time the provision of health care to seamen represented only a small fraction of the work of the PHS, but nevertheless the closing of the remaining eight marine hospitals and 27 clinics in 1981 represented the end of the activity for which the Service had originally been created.

There has been no lack of challenges for the PHS since that time.  Diseases from AIDS to SARS are just one example of the health issues that have confronted the Service in recent times.  Today the PHS remains a component of the Department of Health and Human Services (DHHS), as DHEW was renamed in 1980.  A major reorganization in 1995 once again changed the leadership structure of the PHS.  The PHS agencies, by this time numbering eight, no longer reported to the Assistant Secretary for Health, but directly to the Secretary of DHHS.  The agencies, now called operating divisions, are as follows: Agency for Healthcare Research and Quality; Agency for Toxic Substances and Disease Registry; Centers for Disease Control and Prevention; Food and Drug Administration; Health Resources and Services Administration; Indian Health Service; National Institutes for Health; Substance Abuse and Mental Health Services Administration.  These divisions, together with the Office of Public Health and Science (which is headed by the Assistant Secretary for Health and includes the Surgeon General) and the Department’s regional health administrators, comprise today’s Public Health Service.  It is an organization of about 56,000 employees, including some 6,000 members of the Commissioned Corps (which is led by the Surgeon General).

Suggestions for Further Reading

Elizabeth Etheridge, Sentinel for Health: A History of the Centers for Disease Control(Berkeley and Los Angeles: University of California Press, 1992).

Bess Furman, A Profile of the United States Public Health Service, 1798-1948 (Bethesda, MD: National Library of Medicine, 1973)

Victoria Harden, Inventing the NIH: Federal Biomedical Research Policy, 1887-1937 (Baltimore: Johns Hopkins University Press, 1986)

Alan Kraut, Goldberger's War: The Life and Work of a Public Health Crusader (New York : Hill and Wang, 2003)

Fitzhugh Mullan, Plagues and Politics: The Story of the United States Public Health Service (New York: Basic Books, 1989)

Ralph Williams, The United States Public Health Service, 1798-1950(Washington, DC: Commissioned Officers Association of the United States Public Health Service, 1951)

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