United States Public Health Service


The United States Public Health Service is a collection of agencies of the Department of Health and Human Services which manages public health, containing nine out of the department's twelve operating divisions. The assistant secretary for health oversees the PHS. The Public Health Service Commissioned Corps is the federal uniformed service of the PHS, and is one of the eight uniformed services of the United States.
PHS had its origins in the system of marine hospitals that originated in 1798. In 1871, these were consolidated into the Marine Hospital Service, and shortly afterwards the position of Surgeon General and the PHSCC were established. As the system's scope grew to include quarantine authority and research, it was renamed the Public Health Service in 1912.
A series of reorganizations in 1966–1973 began a shift where PHS' divisions were promoted into departmental operating agencies. PHS was established as a thin layer of hierarchy above them rather than an operating agency in its own right.
In 1995, PHS agencies were shifted to report directly to the secretary of health and human services rather the assistant secretary for health, eliminating PHS as an administrative level in the organizational hierarchy.

Organization

Ten of the thirteen operating agencies within the Department of Health and Human Services are designated as part of the Public Health Service:
The other three agencies are the Centers for Medicare and Medicaid Services, Administration for Children and Families, and Administration for Community Living.
The Public Health Service also encompasses two staff offices:
The United States Public Health Service Commissioned Corps 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.
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 PHSCC 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, service in the PHSCC after June 30, 1960, is considered military service for retirement purposes. Under, active service in the PHSCC is considered active military service for the purposes of most veterans' benefits and for antidiscrimination laws.
The PHSCC is considered "military" under United States Code here:
  • Under 5 U.S.C. § 8331, PHSCC after June 30, 1960, is considered military service for retirement purposes.
  • Under 10 U.S.C. § 101, the PHSCC is defined as a uniformed service; by regulation, officers render military salutes & courtesies.
  • Under 26 U.S. Code § 414, the PHSCC is considered qualified military service  for Internal Revenue purposes.
  • Under 29 CFR § 825.102, the PHSCC is considered military for caregiver purposes.
  • Under 32 CFR § 1630.12 Class 1-C, the PHSCC is considered military for selective service registration purposes.
  • Under 32 CFR § 1630.40 - Class 4-A, the PHSCC is considered military for selective service fulfillment purposes.
  • Under 34 CFR § 685.219, the PHSCC is considered military for Public Service Loan Forgiveness  purposes.
  • Under 37 U.S. Code § 205, the PHSCC is considered military for pay purposes.
  • Under 38 CFR § 3.6, PHSCC is considered military for VA disability purposes.
  • Under 38 CFR § 3.750, PHSCC is considered military for computing entitlement to concurrent receipt of military retired pay and disability compensation.
  • Under 38CFR501 Sec. 3.7, PHSCC is considered military for computing Pension, Compensation, and Dependency and Indemnity Compensation.
  • Under 38 U.S.C. 501 Sec. 3.750 PHSCC is considered military for defining retired pay.
  • Under 42 U.S.C. § 213, PHSCC is considered active military service for the veterans' benefits and for antidiscrimination laws.
  • Under 42 U.S.C. §§ 213d & 216 PHSCC is authorized to wear uniforms that have been and are currently styled after military uniforms of other services. When detailed, PHSCC Officers wear the gaining service’s uniform with USPHS identification in accordance with CCIs and inter-service agreements.
  • Under 50 U.S.C. App. §§501-597b, PHSCC is considered active military under the Servicemembers Civil Relief Act.

    History

Modern public health began developing in the 19th century, as a response to advances in science that led to the understanding of the source and spread of disease. As the knowledge of contagious diseases increased, means to control them and prevent infection were soon developed. Once it became understood that these strategies would require community-wide participation, disease control began being viewed as a public responsibility. Various organizations and agencies were then created to implement these disease preventing strategies. As the U.S. expanded, the scope of the governmental health agency expanded. Most of the Public health activity in the United States took place at the municipal level before the mid-20th century. There was some activity at the national and state level as well.

Marine Hospital Service

In the administration of the second president of the United States John Adams, Congress authorized the creation of hospitals for mariners through the 1798 Act for the Relief of Sick and Disabled Seamen. They were initially located along the East Coast, and as the boundaries of the United States expanded, so too were marine hospitals. The Marine Hospital Service was placed under the Revenue Marine Service within the Department of the Treasury.
A reorganization in 1871 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 established the Marine Hospital Service as its own bureau within the Department of the Treasury. The position of Supervising Surgeon 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; 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 formally established by legislation after the fact in 1889, and signed by President Grover Cleveland.
The scope of activities of the Marine Hospital Service began to expand well beyond the care of merchant seamen in the closing decades of the nineteenth century, into control of infectious disease, collection of health statistics, and basic science research. Following cholera epidemics in the US in 1873, the National Quarantine Act of 1878 vested quarantine authority to the Marine Hospital Service. Under the Public Health Act of 1879, this authority was temporarily shared with the U.S. Army and Navy through the National Board of Health, until 1883.
Given the prevalence of infectious disease among immigrants arriving from famine and war areas of Europe, the Marine Hospital Service was assigned to medically inspect immigrants at such sites as Ellis Island in New York Harbor. In 1878, an act of Congress enabled the Marine Hospital Service to collect data on communicable diseases and perform surveillance of the incidence and distribution of diseases; these programs would eventually become the National Center for Health Statistics. In 1887, the Hygienic Laboratory, the predecessor of the National Institutes of Health, began as a single-room laboratory for bacteriological investigation at the Staten Island Marine Hospital, and moved to Washington, D.C. in 1891.
In 1899, internal divisions were formed for the first time, specifically the Divisions of Marine Hospitals, Domestic Quarantine, Foreign Quarantine, Sanitary Reports and Statistics, Scientific Research, and Personnel and Accounts. These original divisions would remain through 1943, although there were minor name changes throughout this time, and a few new divisions would be created.

Development as the Public Health Service

Because the Service took on broader responsibilities, in 1902 it was renamed as the Public Health and Marine Hospital Service. In 1912, under new authorizing legislation, it was established as the Public Health Service to express the enlarged scope of its work.
The 1912 PHS law expanded the agency's mission from communicable to include non-communicable diseases. In 1913, the former Cincinnati Marine Hospital building was reopened as a Field Investigation Station for water pollution research. This was the beginning of the PHS Environmental Health Divisions, a precursor to the Environmental Protection Agency.
In 1914, the Office of Industrial Hygiene and Sanitation, the direct predecessor of the National Institute for Occupational Safety and Health, was founded at the Pittsburgh Marine Hospital. Both of these offices were within the Division of Scientific Research.
The Division of Venereal Diseases was established in 1918, and the Narcotics Division in 1929. In 1930, the Hygienic Laboratory was redesignated as the National Institute of Health by the Ransdell Act; in 1937, it absorbed the rest of the Division of Scientific Research, of which it was formerly part, and in 1938 it moved to its current campus in Bethesda, Maryland. In 1939, PHS as a whole was transferred from the Department of the Treasury into the new Federal Security Agency. In 1942, the Office of Malaria Control in War Areas was created, which in 1946 became the Communicable Disease Center, which would eventually become the Centers for Disease Control and Prevention.
Beginning in the late 1920s and continuing through the New Deal era, a significant building campaign upgraded several marine hospitals into large, monumental buildings, in contrast with the smaller buildings common for the 19th-century buildings. PHS's headquarters were in the Butler Building, a converted mansion across the street from the United States Capitol, from 1891 until April 1929. It expanded into office space in Temporary Building C on the National Mall in July 1920, which became its temporary headquarters after the Butler Building was closed for demolition. In May 1933, the new Public Health Service Building opened on the National Mall.