PUBLIC HEALTH SERVICE

The Public Health Service (PHS) is the operating division of the health and human services department (HHS) responsible for promoting the protection and advancement of the American population's physical and mental well-being.

The Public Health Service was first established by Act of July 16, 1798 (ch. 77, 1 Stat. 605), which authorized the creation of hospitals to care for U.S. merchant seamen. Subsequent legislation has substantially broadened the scope of its activities, and as of 2003 the Public Health Service accomplishes its goals through a number of agencies and programs. These entities coordinate and implement national health policy on the state and local levels, conduct medical and biomedical research, and enforce laws to ensure the safety of drugs and medical devices and to protect the public against impure foods and cosmetics. There are several sub PHS agencies or Operating Divisions, as follows.

Agency for Health Care Policy and Research

The Agency for Health Care Policy and Research was established by the Omnibus Budget Reconciliation Act of 1989 (42 U.S.C.A. § 299 et seq.). As the federal government's focal point for health services research, the agency produces and disseminates information about the quality, medical effectiveness, and cost of healthcare. The agency's research is geared toward producing useful and accurate data concerning the design and performance of the national healthcare system, data that can be used to help improve healthcare at the federal, state, and local levels.

Agency for Healthcare Research and Quality (AHRQ)

AHRQ supports research designed to improve the outcomes and quality of health-care, reduce its costs, address patient safety and medical errors, and broaden access to effective services. The research sponsored, conducted, and disseminated by AHRQ provides information that helps people make better decisions about healthcare.

Agency for Toxic Substances and Disease Registry (ATSDR)

The Agency for Toxic Substances and Disease Registry was established on April 19, 1983, by the secretary of HHS. The agency is charged with carrying out the health-related responsibilities of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C.A. § 9601 et seq.) and other federal laws concerned with the release of toxic substances into the environment. It directs programs designed to protect workers and the general public from exposure to hazardous substances and their adverse health effects; collects, analyzes, and disseminates data relating to serious diseases resulting from exposure to toxic or hazardous substances; establishes and maintains listings of areas either closed to the public or restricted in use because of toxic substance contamination; and helps the environmental protection agency identify hazardous waste substances requiring regulation. It also works with private and public healthcare organizations to provide medical care and testing to individuals who may have been exposed to hazardous substances.

Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) was established as an operating health agency within the Public Health Service by the secretary of health, education, and welfare (the predecessor agency of HHS) on July 1, 1973. The CDC is responsible for providing leadership in the prevention and control of diseases and for responding to public health emergencies. In consultation with state and local healthcare authorities, the CDC develops and administers national programs to help prevent and control the spread of communicable and preventable diseases and to prevent chronic diseases. The agency also directs and enforces foreign quarantine activities and provides consultation to other nations on the control of preventable diseases. Since the early 1980s, the CDC has been at the forefront of the federal government's efforts to control the spread of AIDS, uncovering vital information about the disease, discovering effective treatments, and working toward a cure.

Food and Drug Administration

The food and drug administration (FDA), in existence under various other titles since 1907, is one of the oldest and most influential health-related agencies within the Public Health Service. The FDA is charged with protecting the health of the nation against unsafe foods, drugs, medical devices, and cosmetics. The FDA carries out its mission through a number of centers and offices that perform a large variety of tasks, including testing and evaluating drug products for safety and effectiveness; developing standards ensuring the quality and nutritional value of foods; and testing and labeling medical devices before they are made available for use by the public.

Health Resources and Services Administration (HRSA)

The Health Resources and Services Administration is responsible for addressing, within the Public Health Service, issues related to the access, quality, and cost of healthcare. The administration works with states and communities to help deliver healthcare to underserved areas and groups with special needs, including migrant workers, mothers and children, homeless people, immigrant populations, and individuals living in rural areas. In addition, the administration plays a key role in the federal government's campaign against AIDS, administering provisions of the Ryan White Comprehensive AIDS Research Emergency Act of 1990 (Ryan White CARE Act) (Pub. L. No. 101-381, 104 Stat. 576 [codified in scattered sections of 42 U.S.C.A.]). Through the act, the administration funds the establishment of centers to train health service professionals caring for people with AIDS and supports the renovation of health facilities serving AIDS patients. The administration also administers the National Organ Transplant Act, 42 U.S.C.A. §§201 note, 273, 274, 274a to 274e, serving as a resource for individuals seeking information about the availability and procurement of donor organs and bone marrow.

A number of bureaus within the Health Resources and Services Administration provide additional services. The Bureau of Primary Health Care administers a variety of programs related to the recruitment and training of health professionals to work in areas traditionally underserved by doctors, nurses, and other medical personnel. For example, the bureau administers the National Health Service Corps Scholarship and Loan Repayment programs, which provide financial assistance to medical, dental, and nursing students in exchange for service in areas where there is a shortage of health professionals. The Maternal and Child Health Bureau (MCH) develops and coordinates federal policies to improve healthcare delivery and services for mothers and children. MCH also administers grants to implement maternal and child health service programs on the state level, as well as other programs to help reduce infant mortality.

Indian Health Service

The health status of American Indians and Alaska Natives is the concern of the Indian Health Service, which is the principal federal healthcare advocate for these groups. The Indian Health Service administers a comprehensive healthcare delivery system for these groups, developing and managing programs to meet their health needs. The service also helps Native American tribes obtain and use healthcare through other federal, state, and local programs.

National Institutes of Health

The National Institutes of Health (NIH) is the principal biomedical research agency of the federal government. Within the NIH, a number of institutes conduct research in specific areas. The National Cancer Institute was created to carry out the objectives of the National Cancer Act, 42 U.S.C.A. §§ 201 note, 218, 241, 281 note, 282 to 284, 286 note, 286a to 286g, which made the conquest of cancer a national goal. The laboratories of the Cancer Institute conduct research directed toward finding effective methods for the prevention, treatment, and eventual cure of all types of cancers. The National Heart, Lung, and Blood Institute conducts research into the uses of blood and the management of blood resources, in addition to administering programs related to the prevention and treatment of hypertension, stroke, respiratory illnesses, and sickle cell anemia. Other institutes conduct research in the areas of alcohol and drug abuse, mental health, communication and neurological disorders, and aging. The National Library of Medicine is the nation's chief source of medical information. The library makes medical research databases such as MEDLINE and TOXLINE, as well as other resources, available to public and private agencies, organizations, and individuals.

further readings

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

Mullan, Fitzhugh. 1989. Plagues and Politics: The History of the United States Public Health Service. New York: Basic.

U.S. Government Manual Website. Available online at <www.gpoaccess.gov/gmanual> (accessed November 10, 2003).

cross-references

Acquired Immune Deficiency Syndrome; Drugs and Narcotics; Environmental Law; Health Care Law; Immunization Programs.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA works to improve the quality of and availability of prevention, treatment, and rehabilitative services in order to reduce illness, disability, and death, and cost to society resulting from substance abuse and mental illnesses.