Health Wanted Show Notes: The U.S. Public Health Service Commissioned Corps

Public health is facing huge challenges at the moment, so it’s more important than ever to honor the field and the people who dedicate their lives and careers to improving health for all.

• This year marks the 30th anniversary of National Public Health Week, which was started in 1995 under the Clinton administration and is run by the American Public Health Association (APHA).
• This year’s theme is “It Starts Here” and it’s focused on the ways individuals, communities, cities, states, and the nation can take steps to address key issues like personal health, climate action, health equity, advocacy, and the future of public health.
• While the ethos of this year’s theme is essentially that there’s no time like the present to begin to play a role in improved health for all, public health capacity has actually been building for hundreds of years in the background.

Take, for example, the APHA itself.

• The association's original purpose at its establishment in 1872 was “the advancement of sanitary science and the promotion of organizations and measures for the practical application of public hygiene.”
• Basically, the streets and waterways of America were disgusting - filled with excrement, sewage, garbage, and even blood from local slaughterhouses.
• The APHA not only wanted to collect information on these foul conditions in order to improve them, but also to create formal organizations to continue to address issues as they appeared.
• They realized their strengths would be advocacy to inform policy and education to inform the public.
• Turns out, it was a popular concept. Within just seven years their membership had grown to nearly 600 persons, including two whole women.
• Over the last 153 years the APHA has been instrumental in such activities as:
  • Establishing national birth and death registries and standardizing death certificates
  • Getting universities to offer a Doctor of Public Health degree
  • Advocating for federal departments of public health
  • Milk pasteurization
  • Racial integration of health facilities
  • Promoting the use of seat belts
  • Advocating for the establishment of the Environmental Protection Agency and Occupational Safety and Health Administration
  • Creation and passage of the Safe Drinking Water Act
  • Supporting assault weapons ban
• The list goes on and on and on. They’ve been very busy over the last century and a half. And it shows—over this time, average life expectancy in the U.S. has increased by 35 years.

Public health used to be seen as not only a popular cause, but an essential one.

• It was seen as so integral to our nation's development that there’s actually a branch of the uniformed services devoted to it.
• You may have never considered it, so I’ll ask you to ponder it now: when you hear the term Surgeon General, do you interpret that as a “surgeon, general?” Like a surgeon whose practice is general?
• Or did you always know it was the Surgeon General, as in a surgeon with the military-like rank of General?
• They have this rank because they are the head of the public health branch of the uniformed services, called the United States Public Health Services Commissioned Corps.

The USPHS may not be an armed force, but it’s still critical to the safety and defense of the country.

• The original act established a tax on seamen’s wages in order to rent or build hospitals dedicated to the care of maritime maladies, called the Marine Hospital Service.
• Then, as now, running a hospital is a lucrative business, and the sites for these medical centers and their staff were often picked for reasons of personal or political gain, rather than merit.
• So in the 1870s, a man by the name of John Maynard Woodworth was brought on to the Marine Hospital Service to tighten ship.
• Woodworth possessed an acute skill for organization and structure. He was a retired surgeon for the Union army and decided to not only put physicians interested in the service through a rigorous application process but also structure the program like the military.
• And since he was at the top of the rank, he took the title Surgeon General, which is why the title persists today, despite only two trained surgeons ever holding the position.
• Woodworth was so committed to the cause of public health, he also co-founded the previously mentioned American Public Health Association in 1872.
• His dedication paid off and he was truly able to turn that ship around: by improving the caliber of physicians and organizing them into military-like ranks, he created a service that was ready to mobilize to meet health emergencies where they were.
• This reorganization is why he’s credited with the creation of the USPHS Commissioned Corps, which was formally established by congress in 1889.

Though it was originally part of the Marine Hospital Service caring for seamen, USPHS gradually expanded its duties.

• A yellow fever outbreak in Louisiana that spread up the Mississippi valley inspired the passage of the Quarantine Act of 1878, which tasked the Marine Hospital Service with the job of preventing infectious disease from coming ashore with travelers.
• This duty expanded to preventing disease spread between states and making the USPHS responsible for medical inspection of immigrants at ports of entry.
• Eventually, the scope of work began to include research into the causes of disease.
• The “hygienic laboratory” was a one-room facility established in 1891 under the USPHS to research pathogens responsible for disease.
• But as the work of the USPHS grew, so did the lab, eventually becoming the National Institutes of Health which, until very recently, was the largest public funder of biomedical research.

Surgeons General throughout history have acted as key leaders in the fight against disease, earning the nickname “America’s Doctor.”

• In 1936, Surgeon General Thomas Parran led the crusade against venereal disease (what we used to call sexually transmitted infections), which would become increasingly important in WWII soldiers.
• In 1963, Surgeon General Luther Terry released the first comprehensive report that definitively tied smoking to an increased risk of lung cancer.
• In 1986, Surgeon General C. Everett Koop wrote the USPHS brochure “Understanding AIDS,” which was mailed to all 107 million U.S. households, to educate the public about the AIDS crisis.

The USPHS Today

• Today, the USPHS is the largest public health service in the world and includes professionals from a variety of scientific and health backgrounds who are trained and employed throughout the department of Health and Human Services and ready to be deployed to emergencies like disease outbreaks and natural disasters.
• Successful applicants even go through a two-week basic training program, which, in addition to lectures, includes activities such as flag folding, formation drills, and mandatory group exercise.
• Successful applicants commit to eight years in the service (four if you’re a physician, dentist, or veterinarian) and get to choose their placement among the HHS departments.
• Placements can be found in every department, from the Centers for Disease Control and Prevention and Food and Drug Administration to departments outside of HHS like the National Parks Service and Department of Defense.
• When the world faces great challenges, public health rises to meet them. In a time of misinformation and increased rates of disease, trained public health professionals aren’t optional—they’re essential.
• Clean water, safe and healthy food, preventive health care, mental health resources, a safe environment—these are all things that the field of public health works to provide for communities locally and around the globe.
• And USPHS has the skills and training to provide those things even under the most dire circumstances.