United States Public Health Service

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 eight 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.[5]

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 July of 1798.[6] 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.[7] 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.[8]

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.[8] 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.[9] 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).

Between 1899 and 1943, the service's organization consisted of the Division of Marine Hospitals and Relief, Division of Domestic (Interstate) Quarantine, Division of Insular and Foreign Quarantine and Immigration, Division of Personnel and Accounts, Division of Sanitary Reports and Statistics, Division of Scientific Research and Sanitation, and Miscellaneous Division, although there were minor name changes throughout this time. The Division of Venereal Diseases was established in 1918, and the Narcotics Division (which would eventually become the National Institute of Mental Health) in 1929.[11]

In 1939, the Public Health Service was transferred from the Department of the Treasury into the new Federal Security Agency.[12] At that time the National Institute of Health [sic] was already established as a division of the PHS.[8] In 1942 the Communicable Disease Center, which would become the Centers for Disease Control and Prevention, was established within the PHS.[13]

In 1943, the PHS was reorganized, with its divisions placed into the Bureau of Medical Services, the Bureau of State Services, or the Office of the Surgeon General, but with the National Institute of Health remaining independent.[11] 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.[8]

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.[14]

Between 1966 and 1973, a series of reorganizations and realignments led to the end of the bureau structure.[11][15] In 1968, the position of Assistant Secretary for Health was created, supplanting the Surgeon General as the top leader of the Public Health Service, although the Surgeon General was retained in a subordinate role.[16] Also in 1968, the Food and Drug Administration, which traces its origins to 1862, became part of the PHS.[17] PHS's environmental health functions were transferred to the newly formed Environmental Protection Agency in 1970.[15][18]

By 1973, PHS's main divisions had been established in a structure substantially similar to today's. The main changes since then have been the Health Resources Administration and Health Services Administration merging into the Health Resources and Services Administration in 1982,[15] and the Alcohol, Drug Abuse, and Mental Health Administration broken up in 1992, with its research functions transferred to the National Institutes of Health, and its services components becoming the Substance Abuse and Mental Health Services Administration.[19]

On May 4, 1980, the Department of Health, Education and Welfare was renamed as the Department of Health and Human Services.[20] In 1995, supervision of the agencies within the Public Health service was shifted from the Assistant Secretary for Health to the Secretary of Health and Human Services.[16]

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".[23]

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.

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.[24]