View source for United States Public Health Service

{{short description|Division of the U.S. Department of Health and Human Services which manages public health}}
{{Use American English|date=July 2022}}
{{Use mdy dates|date=July 2022}}
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{{Infobox government agency
| agency_name     = United States Public Health Service
| logo            = United States Public Health Service (seal).svg
| logo_size       = 150px
| logo_caption    = Logo of the United States<br>Public Health Service
| picture         = Flag of the United States Public Health Service.svg
| image_size      = 150px
| picture_caption = Flag of the U.S. Public Health Service
| formed          = {{Start date and age|1798}}<br />(reorganized/renamed: 1871/1902/1912)
| preceding1      =
| preceding2      =
| dissolved       =
| superseding     =
| jurisdiction    = [[Federal government of the United States]]
| headquarters    = [[Hubert H. Humphrey Building]]<br>[[Washington, D.C.]], U.S.
| employees       =
| budget          =
| chief1_name     = Admiral [[Brian Christine]], MD
| chief1_position = [[Assistant Secretary for Health]]
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| parent_department =
| parent_agency   = [[Department of Health and Human Services]]
| website         = https://www.hhs.gov/ash
| footnotes       =
| embed           = "Public Health Service March"<ref>{{cite web | vauthors = King III G | title = Public Health Service March Lyrics | url = https://dcp.psc.gov/OSG/ensemble/listen-march-lyrics.aspx | work = Commissioned Corps of the U.S. Public Health Service | access-date = 26 February 2018 | archive-date = February 9, 2023 | archive-url = https://web.archive.org/web/20230209002238/https://dcp.psc.gov/OSG/ensemble/listen-march-lyrics.aspx | url-status = dead }}</ref>[[File:"Public Health Service March", performed by the United States Coast Guard Band.oga]]
}}

The '''United States Public Health Service''' ('''USPHS''' or '''PHS''') 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|assistant secretary for health]] oversees the PHS. The [[United States Public Health Service Commissioned Corps|Public Health Service Commissioned Corps]] (PHSCC) 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 [[List of U.S. Marine Hospitals|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 of the United States|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 [[United States Public Health Service reorganizations of 1966–1973|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 [[United States Secretary of Health and Human Services|secretary of health and human services]] rather the assistant secretary for health, eliminating PHS as an administrative level in the organizational hierarchy.

== <span id='Agencies'>Organization</span> ==
Ten of the thirteen operating agencies within the Department of Health and Human Services (HHS) are designated as part of the Public Health Service:<ref name="Redhead_2015">{{Cite web | vauthors = Redhead CS, Dabrowska A |date=2015-10-13 |title=Public Health Service Agencies: Overview and Funding (FY2010–FY2016) |url=https://fas.org/sgp/crs/misc/R43304.pdf |access-date=2018-10-16 |website=[[U.S. Congressional Research Service]]}}</ref><ref name="U.S. Department of Health and Human Services_2008">{{Cite news |date=2008-10-24 |title=HHS Organization Chart |language=en |work=U.S. Department of Health and Human Services |url=https://www.hhs.gov/about/agencies/orgchart/index.html?language=en |access-date=2018-10-17}}</ref>
* [[National Institutes of Health]]
* [[Food and Drug Administration]]
* [[Centers for Disease Control and Prevention]]
* [[Health Resources and Services Administration]]
* [[Agency for Toxic Substances and Disease Registry]]
* [[Indian Health Service]]
* [[Agency for Healthcare Research and Quality]]
* [[Substance Abuse and Mental Health Services Administration]]
* [[Administration for Strategic Preparedness and Response]]
* [[Advanced Research Projects Agency for Health]]
The other three agencies are the [[Centers for Medicare and Medicaid Services]], [[Administration for Children and Families]], and [[Administration for Community Living]].<ref name="Redhead_2015" /><ref name="U.S. Department of Health and Human Services_2008" />

The Public Health Service also encompasses two staff offices:<ref name="Redhead_2015" /><ref name="U.S. Department of Health and Human Services_2008" />
* [[Office of the Assistant Secretary for Health]]<ref>{{Cite news|url=https://www.hhs.gov/ash/public-health-offices/index.html|archive-url=https://web.archive.org/web/20160522133134/http://www.hhs.gov/ash/public-health-offices/index.html|url-status=dead|archive-date=May 22, 2016|title=Public Health Offices|date=2016-03-21|work=U.S. Department of Health and Human Services|access-date=2018-10-17|language=en}}</ref>
* [[Office of Global Affairs]]

===United States Public Health Service Commissioned Corps===
{{main|United States Public Health Service Commissioned Corps}}
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 [[preventive healthcare|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.{{cn|date=June 2024}}

As one of the United States eight [[Uniformed services of the United States|uniformed services]], the PHS Commissioned Corps fills public health leadership and service roles within [[Federal government of the United States|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.{{cn|date=June 2024}}

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 [[military rank|ranks]] as the [[United States Navy|U.S. Navy]], the [[United States Coast Guard|U.S. Coast Guard]], and the [[NOAA Commissioned Officer Corps]] from [[Ensign (rank)|ensign]] to [[Admiral (United States)|admiral]], [[U.S. uniformed services pay grades|uniformed services pay grades]] O-1 through O-10 respectively.{{cn|date=June 2024}}

According to {{USC|5|8331}}, service in the PHSCC after June 30, 1960, is considered military service for retirement purposes.  Under {{USC|42|213}}, active service in the PHSCC is considered active military service for the purposes of most veterans' benefits and for antidiscrimination laws.<ref>{{cite web|url=https://www.gpo.gov/fdsys/pkg/USCODE-2010-title42/pdf/USCODE-2010-title42-chap6A-subchapI-partA-sec212b.pdf|title=Title 42 – The Public Health and Welfare|publisher=US Government Printing Office}}</ref>

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(a)(5), the PHSCC is defined as a uniformed service; by regulation (CCIs/Navy customs), '''officers render military salutes & courtesies'''.
* Under 26 U.S. Code § 414(u)(5), 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(a) Sec. 3.7, PHSCC is considered '''military for computing Pension, Compensation, and Dependency and Indemnity Compensation'''.
* Under 38 U.S.C. 501(a) Sec. 3.750 (a) 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 (e.g., Coast Guard ODU; DoD field uniform such as OCP/legacy BDU/DCU) 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 ==
{{Further| History of public health in the United States }}
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.<ref>{{Cite book | author = Institute of Medicine (US) Committee for the Study of the Future of Public Health |url=https://www.ncbi.nlm.nih.gov/books/NBK218224/ |title=A History of the Public Health System |date=1988 |publisher=National Academies Press (US)}}</ref>  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.<ref>{{cite book | vauthors = Duffy J |title=The sanitarians: a history of American public health |date=1992 |publisher=University of Illinois Press |location=Urbana |isbn=978-0-252-06276-6}}</ref>

=== Marine Hospital Service ===
{{Main|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 [[An Act for the relief of sick and disabled seamen|Act for the Relief of Sick and Disabled Seamen]].<ref>{{cite web|url=https://www.forbes.com/sites/rickungar/2011/01/17/congress-passes-socialized-medicine-and-mandates-health-insurance-in-1798/|title=Congress Passes Socialized Medicine and Mandates Health Insurance – In 1798| vauthors = Ungar R |work=[[Forbes]]|date=17 January 2011|access-date=25 February 2020}}</ref>  They were initially located along the [[East Coast of the United States|East Coast]], and as the boundaries of the [[United States territorial acquisitions|United States expanded]], so too were marine hospitals.<ref name="Gostin_2008">
{{cite book|url=https://archive.org/details/publich_gos_2008_00_0323|url-access=registration|title=Public Health Law: Power, Duty, Restraint, Revised and Expanded| vauthors = Gostin LO |publisher=University of California Press|year=2008|isbn=978-0520253766|edition=2nd|page=[https://archive.org/details/publich_gos_2008_00_0323/page/156 156]|chapter=Box 8: The Federal Presence in Public Health|access-date=2012-11-08}}</ref>  The Marine Hospital Service was placed under the [[United States Revenue Cutter Service|Revenue Marine Service]] (a forerunner of the present-day [[United States Coast Guard|Coast Guard]]) within the [[United States Department of the Treasury|Department of the Treasury]].<ref name="nlm.nih.gov">{{Cite web|url=https://www.nlm.nih.gov/exhibition/phs_history/intro.html|title=Images From the History of the Public Health Service: Introduction|website=nlm.nih.gov|access-date=2017-12-03}}</ref>

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.<ref name="nlm.nih.gov" />  The position of Supervising Surgeon (later titled the [[Surgeon General of the United States|Surgeon General]]) was created to administer the Service, and [[John Maynard Woodworth]] was appointed as the first incumbent in 1871.<ref>{{cite web|url=https://www.discovermagazine.com/health/20-things-you-didnt-know-about-the-surgeon-general|title=20 Things You Didn't Know About... The Surgeon General| vauthors = Christopher D |publisher=[[Discover (magazine)|Discover]]|date=5 October 2007|access-date=25 February 2020}}</ref> He moved quickly to reform the system and adopted a [[military]] model for his medical staff; putting his [[physician]]s 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]].{{cn|date=June 2024}}

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.<ref name="Smillie2">{{cite journal | vauthors = Smillie WG | title = The National Board of Health 1879-1883 | journal = American Journal of Public Health and the Nation's Health | volume = 33 | issue = 8 | pages = 925–930 | date = August 1943 | pmid = 18015860 | pmc = 1527526 | doi = 10.2105/ajph.33.8.925 }}</ref> 

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 [[Public health surveillance|surveillance]] of the incidence and distribution of diseases; these programs would eventually become the [[National Center for Health Statistics]].<ref>{{Cite book |url=https://www.ncbi.nlm.nih.gov/books/NBK234719/ |title=Toward a National Health Care Survey: A Data System for the 21st Century |date=1992 |publisher=National Research Council |isbn=978-0-309-04692-3 |language=en |chapter=Federal Health Data Sources |doi=10.17226/1941|pmid=25121299 }}</ref>  In 1887, the Hygienic Laboratory, the predecessor of the [[National Institutes of Health]], began as a single-room laboratory for bacteriological investigation at the [[Bayley Seton Hospital|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.<ref name="National Archives_2016a">{{Cite web |date=2016-08-15 |title=Records of the Public Health Service [PHS], 1912–1968 |url=https://www.archives.gov/research/guide-fed-records/groups/090.html |access-date=2020-08-28 |website=National Archives |at=Sections 90.3, 90.7, 90.8 |language=en}}</ref>

=== Development as the Public Health Service ===
[[File:Marine_Hospital_(NYPL_b15279351-104767).tiff|thumb|The [[Bayley Seton Hospital|Staten Island PHS Hospital]] is an example of the large hospital buildings constructed by PHS in the early 20th century. It was built adjacent to the smaller 19th-century hospital.<ref>[http://www.rootsweb.ancestry.com/~nyrichmo/history.shtml "Top 100 Historical Events in Staten Island, Richmond County, NY"], ''[[Staten Island Advance]]''.</ref><ref>{{cite news |date=October 20, 1991 |title=Clifton Hospital's Former Staff Holds Dinner for 10th Reunion Recalling Times at Public Health |work=[[Staten Island Advance]]}}</ref>]]

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 (PHS) to express the enlarged scope of its work.

The 1912 PHS law ({{USPL|62|265}}) expanded the agency's mission from communicable to include [[non-communicable disease]]s.<ref name="Rogers_2013">{{Cite book | vauthors = Rogers JR, Symons JM, Sorg TJ |title=World Environmental and Water Resources Congress 2013 |chapter=The History of Environmental Research in Cincinnati, Ohio: (From the U.S. Public Health Service to the U.S. Environmental Protection Agency) |date=2013-05-28  |language=en |publisher=American Society of Civil Engineers |pages=33–37 |doi=10.1061/9780784412947.004 |isbn=978-0-7844-1294-7}}</ref>  In 1913, the former [[United States Marine Hospital (Cincinnati)|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 [[United States Environmental Protection Agency|Environmental Protection Agency]].<ref name="Rogers_2013" /><ref>{{Cite book | vauthors = Furman B  |url=https://books.google.com/books?id=Ern1MvGtMrgC&pg=PA295 |title=A Profile of the United States Public Health Service, 1798–1948 |publisher=U.S. Department of Health, Education, and Welfare |year=1973 |pages=295–298 |language=en}}</ref><ref>{{Cite web |date=1990-04-01 |title=Andrew W. Breidenbach Environmental Research Center |url=https://nepis.epa.gov/Exe/ZyPURL.cgi?Dockey=91022SRK.TXT |url-status=live |archive-url=https://web.archive.org/web/20210421194512/https://nepis.epa.gov/Exe/ZyPURL.cgi?Dockey=91022SRK.TXT |archive-date=2021-04-21 |access-date=2021-04-23 |website=U.S. Environmental Protection Agency |pages=2–3}}</ref> 

In 1914, the [[Division of Industrial Hygiene|Office of Industrial Hygiene and Sanitation]], the direct predecessor of the [[National Institute for Occupational Safety and Health]], was founded at the [[United States Marine Hospital (Pittsburgh)|Pittsburgh Marine Hospital]].<ref name="Doyle_1977">{{cite web | vauthors = Doyle HN |date=1977 |title=The federal industrial hygiene agency: a history of the Division of Occupational Health, United States Public Health Service |url=https://commons.wikimedia.org/wiki/File:The_Federal_Industrial_Hygiene_Agency.pdf |url-status=live |archive-url=https://web.archive.org/web/20211013081215/https://commons.wikimedia.org/wiki/File:The_Federal_Industrial_Hygiene_Agency.pdf |archive-date=2021-10-13 |access-date=2020-09-03 |website=American Conference of Governmental Industrial Hygienists}}</ref><ref>{{cite book |url=https://books.google.com/books?id=-aERAQAAMAAJ&pg=PA153 |title=The President's Report on Occupational Safety and Health |date=1972 |publisher=Commerce Clearing House |isbn= |location= |pages=153–154 |language=en}}</ref>  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 (it eventually became the [[National Institute of Mental Health]]).<ref name="National Archives_2016a" />  In 1930, the Hygienic Laboratory was redesignated as the (singular) [[National Institutes of Health|National Institute of Health]] (NIH) 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 [[National Institutes of Health campus|its current campus]] in [[Bethesda, Maryland]].<ref name="National Archives_2016a" /><ref name="Doyle_1977" /><ref name="NIH Almanac 2011">{{cite web|url=https://www.nih.gov/about-nih/nih-almanac/chronology-events|title=The NIH Almanac: Chronology of Events|access-date=February 13, 2025}}</ref>  In 1939, PHS as a whole was transferred from the Department of the Treasury into the new [[Federal Security Agency]].<ref>{{Cite web|url=https://www.presidency.ucsb.edu/node/209555|title=Message to Congress on the Reorganization Act|date=1939-04-25|website=The American Presidency Project|language=en|access-date=2018-10-23}}</ref>  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]].<ref>{{Cite web|url=https://www.cdc.gov/about/history/index.html|title=Our History – Our Story {{!}} About {{!}} CDC|date=2021-08-05|website=cdc.gov|language=en-us|access-date=2021-08-05}}</ref>

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.<ref>{{Cite web | vauthors = Burke ES |date=2015-05-22 |title=Designation Report: 210 State Street |url=https://www.nola.gov/getattachment//HDLC/Calendar/Agendas/New-Orleans-Agendas/Commission/2015-(1)/6-11-2015-1-00-39-AM/Designation-Report-210-State-Street.pdf |access-date=2020-09-20 |website=City of New Orleans}}</ref>  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 buildings of the National Mall|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 [[United States Public Health Service Building|Public Health Service Building]] opened on the [[National Mall]].<ref name="Williams_1951">{{Cite book | vauthors = Williams RC |url=http://archive.org/details/unitedstatespubl00will/page/520 |title=The United States Public Health Service, 1798–1950 |date=1951 |publisher=Commissioned Officers Association of the United States Public Health Service |pages=327, 520–521}}</ref>

=== Mid-20th century ===
[[File:National Institutes of Health Campus (29791758961).jpg|thumb|The [[National Institutes of Health campus]] in [[Bethesda, Maryland]] in 1949]]
[[File:Taft Laboratory Cincinnati 1957.tif|thumb|The [[Environmental Health Divisions]]' Robert A. Taft Sanitary Engineering Center in [[Cincinnati]] in 1957]]By 1943, PHS contained eight administrative divisions, plus the [[National Cancer Institute]], [[St. Elizabeths Hospital]], and [[Freedmen's Hospital]] under the direct supervision of the [[Surgeon General of the United States|Surgeon General]].  These divisions often had overlapping scopes, which was seen as administratively unwieldy.  Additionally, some of these had been created and specified through several pieces of legislation that were inconsistent in their scope, while some had been created internally by PHS or delegated from the parent Federal Security Agency.<ref name="United States Senate_1943">{{Cite web |date=1943 |title=Reorganization and functions of the Public Health Service |url=https://archive.org/details/reorganizationfu00unit/page/4 |access-date=2020-09-15 |publisher=United States Senate |pages=4–6 |via=Internet Archive}} [https://commons.wikimedia.org/wiki/File:Reorganization_and_functions_of_the_Public_Health_Service_..._Report._-To_accompany_S._400-_(IA_reorganizationfu00unit).pdf Alt URL]</ref>

In 1943, PHS's divisions were collected into three operating agencies by law ({{USStat|57|587}}).<ref name="United States Senate_1943" />  The [[Bureau of State Services]] administered cooperative services to [[U.S. state]]s through technical and financial assistance, the [[Bureau of Medical Services]] provided direct patient care through hospitals and clinics as well as foreign quarantine facilities, and the National Institute of Health remained independent to perform laboratory research activities.<ref name="United States Senate_1943" /><ref>{{Cite book |url=https://archive.org/details/executivereferen1957unit |title=Executive Reference Book (Public Health Service Portion) |publisher=U.S. Department of Health, Education, and Welfare |year=1957}}</ref><ref name="National Archives_2016a" />  Additionally, all of the laws affecting the functions of the public health agencies were consolidated for the first time in the [[Public Health Service Act|Public Health Service Act of 1944]].<ref name="nlm.nih.gov" />

The mid-20th century was a time of expansion for both NIH and the PHS environmental health programs.  In 1948, NIH's name was changed to the plural National Institutes of Health, and by the end of 1950 six new institutes had been created within it.<ref name="NIH Almanac 2011"/>  The environmental health programs expanded from water pollution into air, industrial, and chemical pollution and radiological health research during and after World War II,<ref name="Williams_1951" /><ref>{{cite journal | vauthors = Walsh J | title = Environmental Health: Taft Center in Cincinnati Has Been the PHS Mainstay in Pollution Research | journal = Science | volume = 145 | issue = 3627 | pages = 31–33 | date = July 1964 | pmid = 14162688 | doi = 10.1126/science.145.3627.31 | bibcode = 1964Sci...145...31W }}</ref> and in 1954 they moved across town from the former Cincinnati Marine Hospital to the newly constructed Robert A. Taft Sanitary Engineering Center.<ref name="Rogers_2013" /><ref>{{cite journal | vauthors =  | title = LABORATORY research, field investigation, and training program of the Robert A. Taft Sanitary Engineering Center at Cincinnati, Ohio | journal = Public Health Reports | volume = 69 | issue = 5 | pages = 507–512 | date = May 1954 | pmid = 13167275 | pmc = 2024349 }}</ref>

However, the period was one of decline for the marine hospital system.  In 1943, the hospital system had reached its peak of 30 hospitals.<ref name="U.S. House of Representatives_1965">{{Cite book |url=https://books.google.com/books?id=aQG6xwEACAAJ&pg=PA3 |title=Public Health Service Hospital Closings |date=1965 |publisher=U.S. House of Representatives |pages=3 |language=en}}</ref>  During 1944–1953, a wave of closings eliminated nine of the ten Marine Hospitals that had not been upgraded since the 1920s, as well as three newer general hospitals and the tuberculosis sanatorium at [[Fort Stanton (New Mexico)|Fort Stanton]].<ref name="SNAC">{{Cite web |title=United States. Public Health Service. Division of Hospitals |url=https://snaccooperative.org/ark:/99166/w61p43pr |access-date=2020-08-31 |website=SNAC}}</ref>  However, PHS funded construction of hospitals by the states through the 1946 [[Hill–Burton Act]].<ref>{{Cite book |url=https://archive.org/details/executivereferen1957unit/page/4 |title=Executive Reference Book (Public Health Service Portion) |publisher=U.S. Department of Health, Education, and Welfare |year=1957 |pages=4–19}}</ref>

In 1953 the Federal Security Agency was abolished and most of its functions, including the PHS, were transferred to the newly formed [[United States Department of Health and Human Services|Department of Health, Education and Welfare]].  In 1955 the [[Indian Health Service|Division of Indian Health]] was established upon transfer of these functions from the [[Bureau of Indian Affairs]] in the [[U.S. Department of the Interior|Department of the Interior]].<ref>{{Cite web|url=https://www.nlm.nih.gov/exhibition/if_you_knew/ifyouknew_09.html|title="If You Knew the Conditions..." Health Care to Native Americans: Indian Health Service Today|website=nlm.nih.gov|access-date=2018-10-23}}</ref>

=== Reorganization era ===
{{Main|U.S. Public Health Service reorganizations of 1966–1973}}
Between 1966 and 1973, a series of reorganizations and realignments led to the end of the bureau structure.<ref name="National Archives_2016a" /><ref name="National Archives_2016b">{{Cite web|date=2016-08-15|title=Records of the Health Resources and Services Administration [HRSA]|url=https://www.archives.gov/research/guide-fed-records/groups/512.html|access-date=2020-08-28|website=National Archives|at=Section 512.2|language=en}}</ref>  The reorganization by 1968 replaced PHS's old bureau structure with two new operating agencies: the Health Services and Mental Health Administration (HSMHA) and the Consumer Protection and Environmental Health Service (CPEHS), with NIH remaining independent and less affected by the organization.  In 1968, the position of [[Assistant Secretary for Health]] was created, supplanting the [[Surgeon General of the United States|Surgeon General]] as the top leader of the Public Health Service, although the Surgeon General was retained in a subordinate role.<ref name="Landman_2019">{{Cite web| vauthors = Landman K |date=2019-06-24|title=For America's Public Health Officers, Questions of Duty and Purpose|url=https://undark.org/2019/06/24/public-health-service-commissioned-corps/|access-date=2020-07-11|website=Undark Magazine|language=en-US}}</ref>  Also in 1968, the [[Food and Drug Administration]], which traced its origins to 1862, became part of the PHS.<ref>{{Cite web|url=https://www.fda.gov/AboutFDA/History/FOrgsHistory/EvolvingPowers/ucm124403.htm|archive-url=https://web.archive.org/web/20180726190341/https://www.fda.gov/AboutFDA/History/FOrgsHistory/EvolvingPowers/ucm124403.htm|url-status=dead|archive-date=July 26, 2018|title=FDA's Evolving Regulatory Powers – FDA's Origin | author = Office of the Commissioner |website=fda.gov|language=en|access-date=2018-10-23}}</ref>  The goal of the reorganizations was to coordinate the previously fragmented divisions to provide a holistic approach to large, overarching problems.

Additionally, a second wave of hospital closings during 1965–1970 closed the three remaining general hospitals at inland locations along the [[Mississippi River]] and [[Great Lakes]], as well as the 19th-century Savannah hospital.  In addition, [[St. Elizabeths Hospital]] and the psychiatric hospitals at [[Federal Medical Center, Lexington|Lexington]] and [[Federal Medical Center, Fort Worth|Fort Worth]] were transferred to other agencies, and the [[Galveston, Texas|Galveston]] hospital was replaced with one acquired by PHS in nearby [[Nassau Bay, Texas|Nassau Bay]].  This left eight general hospitals plus the [[Carville Historic District|National Leprosarium]] in the system.<ref name="U.S. House of Representatives_1965" /><ref name="SNAC"/><ref>{{Cite book |url=https://books.google.com/books?id=vZ8Vp55YEtcC&pg=PA4 |title=Public Health Service Hospital Closings |date=1972 |publisher=U.S. House of Representatives |pages=4, 10 |language=en}}</ref>

The new agencies came to be seen as unwieldy and bureaucratic, and they would turn out to be short-lived.  CPEHS was broken up in 1970, as much of it was transferred out of PHS to form the core of the new [[United States Environmental Protection Agency|Environmental Protection Agency]].<ref name="National Archives_2016b" /><ref>{{Cite web |date=2016-08-15 |title=Records of the Environmental Protection Agency [EPA] |url=https://www.archives.gov/research/guide-fed-records/groups/412.html |access-date=2020-08-28 |website=National Archives |at=Section 412.2 |language=en}}</ref>   Around the same time, the [[National Institute for Occupational Safety and Health]] was created out of the former Division of Industrial Hygiene by the [[Occupational Safety and Health Act (United States)|Occupational Safety and Health Act of 1970]].<ref>{{cite web | vauthors = Snyder LP |date=1998 |title=The National Institute for Occupational Safety and Health, 1971–1996: A Brief History |url=https://commons.wikimedia.org/wiki/File:NIOSH_-_A_Brief_History.pdf |access-date=2021-05-05}}</ref>  HSMHA was broken up into four successor agencies in 1973.

=== Modern period ===

====Late 20th century====
Since 1973, PHS has encompassed between six and ten operating agencies anchored by NIH, FDA, and CDC.  The organizational changes in the 20th century after 1973 have been:
* Creation of the [[Agency for Toxic Substances and Disease Registry]] in 1980<ref>{{Cite web |date=2018-12-11 |title=Background and Congressional Mandates |url=https://www.atsdr.cdc.gov/about/congress.html |access-date=2020-08-29 |website=ATSDR |language=en-us |archive-date=May 14, 2020 |archive-url=https://web.archive.org/web/20200514231545/https://www.atsdr.cdc.gov/about/congress.html |url-status=dead }}</ref>
* Merging of the Health Resources Administration and Health Services Administration into the [[Health Resources and Services Administration]] (HRSA) in 1982<ref name="National Archives_2016b" />
* The [[Indian Health Service]] being split from HRSA in 1988<ref>{{Cite web |date=2016-08-15 |title=Records of the Indian Health Service |url=https://www.archives.gov/research/guide-fed-records/groups/513.html |access-date=2020-08-29 |website=National Archives |language=en}}</ref>
* The [[Agency for Healthcare Research and Quality|Agency for Health Care Policy and Research]] being split from the [[Office of the Assistant Secretary for Health]] in 1989<ref>{{Cite web |date=2016-08-15 |title=Records of the Agency for Health Care Policy and Research |url=https://www.archives.gov/research/guide-fed-records/groups/510.html |access-date=2020-08-29 |website=National Archives |language=en}}</ref>
* Breakup of the Alcohol, Drug Abuse, and Mental Health Administration in 1992, with its research functions returning to the National Institutes of Health, and its services components becoming the [[Substance Abuse and Mental Health Services Administration]]<ref name="ADAMHArecord">{{cite web|title=Records of the Alcohol, Drug Abuse, and Mental Health Administration [ADAMHA] (Record Group 511), 1929–93|url=https://www.archives.gov/research/guide-fed-records/groups/511.html|access-date=18 July 2012|website=National Archives|publisher=[[National Archives and Records Administration|U.S. National Archives and Records Administration]]}}</ref>

The PHS hospital system had been the target of efforts to close the entire system since the mid-1970s.<ref name="Driscoll_1986">{{cite journal | vauthors = Driscoll RS | title = What happened to the U.S. Public Health Service Hospital? | journal = Military Medicine | volume = 151 | issue = 2 | pages = 128–129 | date = February 1986 | pmid = 3083292 | doi = 10.1093/milmed/151.2.128 | doi-access = free }}</ref><ref>{{Cite news | vauthors = Herbers J |date=1981-10-27 |title=U.S. Seamen's Hospitals Still Open in Many Cities |language=en-US |work=The New York Times |url=https://www.nytimes.com/1981/10/27/us/us-seamen-s-hospitals-still-open-in-many-cities.html |access-date=2020-09-20 |issn=0362-4331}}</ref>  As the result of pressure from the [[Presidency of Ronald Reagan|Reagan administration]],<ref name="Driscoll_1986" /> the PHS hospital system was abolished in 1981, with the last eight hospitals transferred to other organizations:<ref name="Driscoll_1986" /><ref name="SNAC"/> five to non-governmental entities, two to the [[United States Department of Defense|Department of Defense]], and one to the State of [[Louisiana]].<ref name="Driscoll_1986" /><ref name="SNAC" />  PHS would however continue to operate the [[Carville Historic District|National Leprosarium]] until 1999.<ref name="History2">{{cite web |title=History of the National Hansen's Disease (Leprosy) Program |url=http://www.hrsa.gov/hansensdisease/history.html |access-date=2011-07-27 |publisher=HHS-Health Resources and Services Administration}}</ref>

In 1995, supervision of the agencies within PHS was shifted from the Assistant Secretary for Health to report directly to the [[United States Secretary of Health and Human Services|Secretary of Health and Human Services]], eliminating PHS as an administrative level in the organizational hierarchy, although the agencies and offices are still legally designated as part of PHS.<ref name="Landman_2019" />

==== 21st century ====
The [[Office of Global Affairs]] was formed from two components within the Office of the Secretary and Office of the Assistant Secretary for Health in 2002.<ref>{{Cite journal | vauthors = Bliss KE |date=2014-01-01 |title=Global Health within a Domestic Agency: The Transformation of the Office of Global Affairs at HHS |url=https://www.csis.org/analysis/global-health-within-domestic-agency |access-date=2022-07-01 |website=Center for Strategic & International Studies |pages=3–4 |language=en}}</ref>

The Office of Public Health Emergency Preparedness was created in 2002, which in 2022 became the [[Administration for Strategic Preparedness and Response]].

The [[Advanced Research Projects Agency for Health]] was created by the [[Consolidated Appropriations Act, 2022]].

==Activities==
Public health worker [[Sara Josephine Baker]], M.D. established many programs to help the poor in New York City keep their infants healthy, leading teams of nurses into the crowded neighborhoods of [[Hell's Kitchen, Manhattan|Hell's Kitchen]] and teaching mothers how to dress, feed, and bathe their babies. Another key pioneer of public health in the U.S. was [[Lillian Wald]], who founded the [[Henry Street Settlement]] house in New York. The [[Visiting Nurse Service of New York]] was a significant organization for bringing health care to the urban poor.

In the area of environmental protection and public health, a Public Health Service 1969 community water survey that looked at more than a thousand drinking water systems across the United States drew two important conclusions that supported a growing demand for stronger protections that were adopted in the 1974 [[Safe Drinking Water Act]]. The survey concluded, first, that the state supervision programs were very uneven and often lax, and, second, that the bacteriological quality of the water, particularly among small systems, was of concern.<ref>EPA Alumni Association: Senior EPA officials discuss early implementation of the Safe Drinking Water Act of 1974, [http://www.epaalumni.org/history/video/interview.cfm?id=13 Video], [http://www.epaalumni.org/userdata/pdf/6014106B36AE81EB.pdf#page=3 Transcript] (see p4).</ref>

The 1963 [[Clean Air Act (United States)|Clean Air Act]] gave the Public Health Service in the Department of Health, Education, and Welfare the authority to take abatement action against industries if it could be demonstrated that they were polluting across state lines, or if a governor requested. Some of these actions involved the Ohio River Valley, New York, and New Jersey. The service also began monitoring air pollution. the 1967 Clean Air Act redirected attention to larger air quality control regions.<ref>"Early Implementation of the Clean Air Act of 1970 in California." EPA Alumni Association. [http://www.epaalumni.org/history/video/interview.cfm?id=38 Video], [https://www.epaalumni.org/userdata/pdf/2B9E3C6816EC9466.pdf#page=1 Transcript] (see p1). July 12, 2016.</ref>

== Controversies ==
===''Tuskegee Study of Untreated Syphilis in the Negro Male''===
{{main|Tuskegee syphilis experiment}}
In 1932, the Public Health Service, working with the [[Tuskegee University|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 six 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".<ref>{{cite journal | vauthors = Katz RV, Kegeles SS, Kressin NR, Green BL, Wang MQ, James SA, Russell SL, Claudio C | title = The Tuskegee Legacy Project: willingness of minorities to participate in biomedical research | journal = Journal of Health Care for the Poor and Underserved | volume = 17 | issue = 4 | pages = 698–715 | date = November 2006 | pmid = 17242525 | pmc = 1780164 | doi = 10.1353/hpu.2006.0126 }}</ref>

===Syphilis studies in Guatemala===
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 [[Guatemala|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]].

[[United States Secretary of State|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.<ref>{{cite news| url=https://www.nytimes.com/2010/10/02/health/research/02infect.html?_r=0 | work=The New York Times | vauthors = McNeil Jr DG | title=Syphilis Experiment Is Revealed, Prompting U.S. Apology to Guatemala | date=2010-10-01}}</ref>

== See also ==
{{Portal|Medicine}}
* [[Cadet Nurse Corps]]
* [[Commissioned Officers Association of the U.S. Public Health Service]]
* [[Health belief model]]
* [[History of public health in the United States]]
* [[Human experimentation in the United States]]
* [[Lucy Minnigerode]], first superintendent of the U. S. Public Health Service Nursing Corps
* [[Narcotic Farms Act of 1929]]
* [[Public Health Service Act]]
* [[Title 42 appointment]]

== References ==
{{source-attribution|[https://www.usphs.gov/html/history.html History of the Commissioned Corps, PHS]}}
{{Reflist|2}}

== Further reading ==
{{Refbegin}}
* {{cite journal | vauthors = Blue R |date=September 1917 |title=Conserving The Nation's Man Power: How The Government Is Sanitating The Civil Zones Around Cantonment Areas. A Nationwide Campaign For Health |journal=[[National Geographic Magazine]] |volume=XXXII |issue=3 |pages=255–278 |url=https://books.google.com/books?id=edYKAAAAYAAJ&pg=RA1-PA255 }}
* {{cite journal | vauthors = Hendrick BJ |date=April 1916  |title=The Mastery of Pellagra: How the Doctors of the United States Public Health Service Have Found a Way of Curing and Preventing It |journal=[[World's Work|The World's Work: A History of Our Time]] |volume=XXXI |pages=633–639 |url=https://books.google.com/books?id=09_Sr9emceQC&pg=PA633 |access-date=2009-08-04 }}
* {{cite journal | vauthors = Leupp CD |date=August 1914  |title=Removing The Blinding Curse of the Mountains: How Dr. McMullen, of the Public Health Service Is Organizing ahe War against Trachoma in the Appalachians |journal=[[World's Work|"The World's Work: A History of Our Time"]] |volume=XLIV |issue=2 |pages=426–430 |url=https://books.google.com/books?id=zegeQtMn9JsC&pg=PA426 |access-date=2009-08-04 }}
* {{cite book |title=Annual Report of the Surgeon General of the Public Health |year=1911 |publisher=Government Printing Office |location=Washington, D.C. |url=https://archive.org/details/annualreportsur06servgoog}}
** Selected Years: [https://archive.org/details/annualreportsur03servgoog 1902], [https://books.google.com/books?id=y8osAAAAYAAJ 1903], [https://archive.org/details/annualreportsur01servgoog 1904], [https://archive.org/details/annualreportsur10servgoog 1905], [https://archive.org/details/annualreportsur02servgoog 1906], [https://archive.org/details/annualreportsur00servgoog 1907], 1908, [https://archive.org/details/annualreportsur11servgoog 1909], [https://books.google.com/books?id=L_UTAAAAIAAJ 1910], [https://archive.org/details/annualreportsur12servgoog 1911]
{{Refend}}

== External links ==
{{Commons category}}
* [https://web.archive.org/web/20101009000654/http://www.hhs.gov/ash/index.html Office of the Assistant Secretary for Health]
* [https://www.federalregister.gov/agencies/public-health-service Public Health Service] in the ''[[Federal Register]]''
* [http://www.surgeongeneral.gov/ Office of the Surgeon General]
* [https://www.nlm.nih.gov/hmd/phs/index.html Office of the Public Health Service Historian] (part of the National Institutes for Health)
* [http://www.blitzkriegbaby.de/ PHS history and WWII women's uniforms in color]{{spaced ndash}} World War II US women's service organizations (WAC, WAVES, ANC, NNC, USMCWR, PHS, SPARS, ARC and WASP)
* [https://web.archive.org/web/20160919072304/http://www.wnyc.org/shows/vd-radio-project/ The V.D. Radio Project] at [http://www.wnyc.org/archives The WNYC Archives]
* {{Gutenberg author | id=32334}}
* {{Internet Archive author |search=("Public Health Service")}}

{{HHS content}}
{{HHS agencies}}
{{Public health}}
{{authority control}}

[[Category:United States Public Health Service| ]]
[[Category:History of medicine in the United States]]