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ADDRESS
By

C. Everett Koop. M.D., Sc.D.
- SURGEON GENERAL
OF THE
U.S. PuBLic HEALTH SERVICE
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

;
PRESENTED TO FIRST-YEAR MEDICAL STUDENTS
F, EpwarD HEBERT SCHOOL OF MEDICINE
UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES

BETHESDA, MARYLAND
June 8, 1988
1
(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC.)

I’M DELIGHTED TO JOIN YOU THIS AFTERNOON TO TALK ABOUT ONE
OF MY FAVORITE SUBJECTS: THE U.S. PUBLIC HEALTH SERVICE,

I MUST CONFESS THAT 10 YEARS AGO I WOULD NOT HAVE LISTED THE
P.H.S. AS A FAVORITE TOPIC. LIKE MOST AMERICANS, I HAD HEARD OF
THE PUBLIC HEALTH SERVICE AND TOOK FOR GRANTED THAT -- WHATEVER
IT WAS -- IT WAS JUST FINE.

BUT ONCE I BECAME SURGEON GENERAL I NATURALLY BEGAN TO LEARN
QUITE A BIT ABOUT BOTH THE HISTORY AND THE CURRENT WORK OF THE
P.H.S,
2
I DON’T SUPPOSE YOU ARE TOO DIFFERENT FROM WHAT I USED TO

BE, B.S.G. THAT IS, “BEFORE SURGEON GENERAL.” THEREFORE, I'D
LIKE TO GIVE YOU A LITTLE SNAPSHOT OF THE ORGANIZATION NOW...
TELL A LITTLE ABOUT ITS MISSION ... SKETCH OUT ITS PRESENT .
ORGANIZATION ... MENTION ITS PAST ... AND OFFER AN EDUCATED GUESS
OR TWO ABOUT ITS FUTURE.

FIRST, YOU OUGHT TO KNOW THAT THE “U.S. PUBLIC HEALTH
SERVICE” IS NOT A SINGLE MONOLITHIC ORGANIZATION, RATHER, IT’S
MORE LIKE A “FEDERATION” OF 7 HIGHLY INDIVIDUAL AGENCIES, EACH
WITH ITS OWN SPECIAL EXPERTISE, CONSTITUENCIES, SPHERE OF
INFLUENCE, AND RECORD OF ACHIEVEMENTS ON BEHALF OF THE PUBLIC
HEALTH OF OUR COUNTRY. |
3
YOU SHOULD KNOW THAT THE LINE OF AUTHORITY BEGINS WITH THE

ASSISTANT SECRETARY FOR HEALTH, OR THE “ASH.” THIS INDIVIDUAL IS
NOMINALLY THE CHIEF HEALTH ADVISOR TO THE SECRETARY OF HEALTH AND
HUMAN SERVICES. THEREFORE, IN OUR CABINET FORM OF GOVERNMENT,
THE “ASH” IS OUR COUNTRY’S HIGHEST RANKING HEALTH OFFICER,

ALTHOUGH HE OR SHE MAY BE THE HIGHEST RANKING HEALTH
OFFICER WITH LINE AUTHORITY OVER THE U.S. PUBLIC HEALTH SERVICE,
THE “ASH” IN REALITY EXERCISES COMMAND MORE BY CONSENSUS AND
COLLEGIALITY THAN BY EXECUTIVE FIAT.
4
IT'S A SOMEWHAT THANKLESS JOB, SINCE TO THE AVERAGE AMERICAN

THE TITLE OF “ASSISTANT SECRETARY OF HEALTH” IS HARDLY A
HOUSEHOLD PHRASE.

BUT IF YOU ASK PEOPLE WHO THE SURGEON GENERAL IS, THEY COME
UP WITH ALL KINDS OF ANSWERS -- INCLUDING MY NAME, THE TITLE OF
“SURGEON GENERAL” HAS A HISTORY THAT AMERICANS SEEM TO RECOGNIZE.

THEY ALSO SEE THE POSITION AS BEING PRIMARILY PROFESSIONAL,
WHILE THEY SEE THE “ASH” -- LIKE ALL OTHER ASSISTANT SECRETARIES
THROUGHOUT THE EXECUTIVE BRANCH -- AS ESSENTIALLY POLITICAL.
5
AND, WITHOUT MAKING JUDGMENTS OF ANY KIND, I THINK THAT’S

MORE OR LESS HOW THINGS DO, IN FACT, SHAKE OUT.

AS THE TOP LINE OFFICER IN PUBLIC HEALTH AND AS A POLITICAL
OFFICER OF THE ADMINISTRATION, THE “ASH” GETS INVOLVED IN THE
DAY-TO-DAY PROBLEMS OF BUDGET AND LEGISLATION AND PERSONNEL.

ON THE OTHER HAND, THE SURGEON GENERAL -- BY TRADITION AND
USUALLY BY TEMPERAMENT, ALSO --- IS MORE LIKELY TO BE SPENDING
HIS TIME INFORMING AND EDUCATING THE HEALTH PROFESSIONS AND THE
GENERAL PUBLIC ABOUT ONE OR ANOTHER PUBLIC HEALTH ISSUE.
6
THUS FAR, DURING MY TERM OF OFFICE, WHICH BEGAN IN NOVEMBER

OF 1981, I’VE BEEN MORE OR LESS THE “POINT MAN” ON THE FOLLOWING
ISSUES:

* SMOKING. THIS WAS WAITING FOR ME WHEN I ARRIVED. THE
SURGEON GENERAL -- BY LAW -- IS SUPPOSED TO REPORT TO THE
CONGRESS AND THE NATION EACH YEAR ON THE RELATIONSHIP
BETWEEN SMOKING AND HEALTH AND, IF NEED BE, MAKE
RECOMMENDATIONS AS TO WHAT THE COUNTRY OUGHT TO DO NEXT.
7
BETWEEN 1964, WHEN THE FIRST SMOKING REPORT WAS ISSUED, AND

1981, FOUR SURGEONS GENERAL PRODUCED 13 REPORTS TO THE
CONGRESS. DURING MY WATCH I‘VE PRODUCED 6 ... THE LAST ONE
APPEARING JUST LAST MONTH. IT DOCUMENTED THE ADDICTIVE
NATURE OF NICOTINE. PERSONALLY, I THINK THIS LAST REPORT
MAY BE THE MOST IMPORTANT ONE SINCE SURGEON GENERAL LUTHER
TERRY RELEASED THE FIRST HISTORY-MAKING REPORT IN 1964,

T’VE BEEN INTENSELY AND CONTINUOUSLY INVOLVED IN THIS TOPIC
FOR 7 YEARS. HOWEVER, IN 1984 I THINK I MADE MY STRONGEST
CONTRIBUTION WHEN I CALLED FOR THE UNITED STATES TO BECOME A
“SMOKE-FREE SOCIETY BY THE YEAR 2000.” AND WE JUST MIGHT
DO THAT, 100.
8
* ANOTHER ISSUE INVOLVES THE HANDICAPPED. I‘VE BEEN THE

PRINCIPLE PUBLIC HEALTH SPOKESPERSON DEALING WITH THIS
ISSUE ... ESPECIALLY HANDICAPPED CHILDREN. FOR A COUPLE OF
YEARS I WAS ON THE FRONT-LINE TRYING TO GET BETTER PROTEC-
TION FOR DISABLED NEONATES, AN ISSUE SET OFF BY “BABY DOE.”
THIS WAS A LITTLE BOY WHO WAS BORN WITH DOWN SYNDROME AND
ESOPHAGEAL ATRESIA. ON THE THEN-LEGAL INSTRUCTIONS OF HIS
PARENTS “BABY DOE” WAS ALLOWED TO DIE ... A WEEK AFTER HE
WAS BORN. WE NOW HAVE THE LAW TO MAKE SURE SUCH A TRAGEDY —
NEVER HAPPENS AGAIN,
9
* I HAVE ALSO BEEN A PUBLIC HEALTH ADVOCATE FOR THE

ELDERLY. FRANKLY, I SEE THE “BABY DOE” ISSUE RE-SURFACING
IN THE GUISE OF “GRANNY DOE,” AND I WORRY ABOUT THE WAY
AMERICANS WILL RESPOND.

* AND FOR THE PAST NEARLY TWO YEARS I‘VE BEEN DEEPLY
INVOLVED IN TELLING THE AMERICAN PEOPLE THE FACTS ABOUT
AIDS. 1 AM ALSO TRYING TO PREPARE THEM FOR THE DAY WHEN
THEY WILL HAVE TO MAKE SOME TRULY DIFFICULT DECISIONS
REGARDING THE ALLOCATION OF RESOURCES THAT WE’LL NEED TO
KEEP UP THE FIGHT AGAINST THIS LETHAL DISEASE,
10
THIS IS WHAT I DO. BUT WHERE DOES THE SURGEON GENERAL EIT?

I’M AN EMPLOYEE OF THE DEPARTMENT OF HEALTH AND HUMAN
SERVICES ... 140,000 STRONG. OF THAT NUMBER, ABOUT 40,000 ARE
PUBLIC HEALTH SERVICE EMPLOYEES. OF THAT NUMBER, ABOUT 5,890
ARE IN THE UNIFORMED COMMISSIONED OFFICERS CORPS.

] AM ONE OF THE LATTER. AS SURGEON GENERAL, I AM THE
HIGHEST-RANKING ACTIVE DUTY OFFICER IN THE UNIFORMED COM-
MISSIONED CORPS OF THE U.S. PUBLIC HEALTH SERVICE. AND JUST WHAT
IS IT THAT WE DO?
11
I WON’T GO INTO A GREAT LONG LIST AT THIS TIME BECAUSE |

STILL HAVE A LOT OF THINGS TO COVER. BUT LET ME TOUCH ON A FEW
SPECIAL ASSIGNMENTS:

* AS A UNIFORMED SERVICE, WE ARE AVAILABLE FOR SPECIAL
HEALTH ASSIGNMENTS ANYWHERE IN THE WORLD, WHEREVER THERE'S A
PUBLIC HEALTH EMERGENCY AND WE’RE ASKED TO COME IN AND HELP.
FOR EXAMPLE, HERE IN THE U.S. «..
WE STAFF THE HOSPITALS AND CLINICS OF THE INDIAN HEALTH
SERVICE...
12
WE PROVIDE CONTRACT HEALTH CARE FOR THE U.S. COAST

GUARD AND THE FEDERAL PRISON SYSTEM ...

OUR MEDICAL OFFICERS WERE FIRST ON THE SCENE AT THE

LOVE CANAL AND TIMES BEACH ENVIRONMENTAL
EMERGENCIES ...

AND WE PROVIDE PRIMARY HEALTH CARE FOR THOUSANDS OF
FAMILIES IN RURAL AND INNER CITY GHETTOS, MIGRANT
LABOR CAMPS, IN COAL MINING COUNTRY, AND ON THE
SEACOASTS AND WATERWAYS OF AMERICA.

WE ALSO SERVE OUTSIDE THE BORDERS OF THE UNITED STATES, ON
REQUEST.
13
FOR EXAMPLE ...

WE‘VE BEEN IN THE MIDDLE EAST AND CENTRAL AMERICA ... WE'VE
BEEN IN SUB-SAHARA AFRICA AND BHOPAL, INDIA... WE’VE BEEN IN
ETHIOPIA, SPAIN, AND SOUTHEAST ASIA ... WE’VE SCREENED
REFUGEES ON THE WAY TO THIS COUNTRY ... AND WE PLAYED A
LEADING ROLE IN THE SUCCESSFUL CAMPAIGN TO RID THE HUMAN
RACE OF SMALLPOX,

AND NOW COMMISSIONED OFFICERS OF THE U.S. PUBLIC HEALTH
SERVICE -- IN N.I.H. ACROSS THE STREET, AT C.D.C. IN ATLANTA, AND
IN KINSHASA, ZAIRE ~~ ARE AMONG THOSE MAKING MAJOR CONTRIBUTIONS
TO THE WORLD'S UNDERSTANDING OF AIDS.
14
THESE SCRAPS OF INFORMATION MAY SOUND A BIT RANDOM, BUT

ACTUALLY THEY ARE ALL PART OF THE OVERALL MISSION OF ONE OR
ANOTHER OF THE 7 P.H.S. COMPONENTS. LET ME BRIEFLY RUN THROUGH
THEM FOR YOU NOW, |

I’LL TAKE THEM ALPHABETICALLY, BEGINNING WITH THE ALCOHOL,
DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION,

] THINK THE TITLE TELLS THE STORY. THIS AGENCY HAS THREE
INSTITUTES -- OF MENTAL HEALTH, OF DRUG ABUSE, AND OF ALCOHOLISM
AND ALCOHOL ABUSE. THE COMBINED A.D.A.M.H.A. BUDGET FOR THE
CURRENT FISCAL YEAR IS $1.3 BILLION,
15
A.D.A.M.H.A. CARRIES OUT RESEARCH AND PUBLIC EDUCATION

PROGRAMS. HALF ITS BUDGET, HOWEVER, IS IN THE FORM OF “BLOCK
GRANTS” TO THE STATES. THESE GRANTS HELP SUPPORT COMMUNITY
MENTAL HEALTH CLINICS AND DRUG ABUSE AND ALCOHOLISM TREATMENT
CENTERS.

NEXT ARE THE CENTERS FOR DISEASE CONTROL, OR C.D.C. THE
CENTERS ARE HEADQUARTERED IN ATLANTA, GEORGIA. AS THE NAME

IMPLIES, C.D.C.’S PRIMARY MISSION IS TO CONTROL OR PREVENT
COMMUNICABLE OR VECTOR-BORNE DISEASES: MEASLES, MUMPS, SYPHILIS,
T.B., AND SO ON,
16
C.D.C. ALSO CARRIES OUT RESEARCH AND SURVEILLANCE OF A RANGE

OF CHRONIC, ENVIRONMENTAL, AND OCCUPATIONAL DISEASES AND
CONDITIONS: DIABETES, BIRTH DEFECTS, WORKPLACE INJURIES,
MALNUTRITION, ETC. THE OFFICE ON SMOKING AND HEALTH, WHICH
PRODUCES THE ANNUAL REPORT OF THE SURGEON GENERAL, IS ALSO PART
OF C.D.C.

THE NATIONAL CENTER FOR HEALTH STATISTICS IS THE NEWEST OF
THE C.D.C. “CENTERS.” THIS IS THE ACKNOWLEDGED NATIONAL
REPOSITORY OF DATA REGARDING MORTALITY AND MORBIDITY, ILLNESS AND
DISABILITY, HEALTH STATUS, NUTRITIONAL STATUS, MARRIAGE AND
DIVORCE, AND HEALTH CARE COSTS IN OUR SOCIETY.
17
THIS FISCAL YEAR, C.D.C HAD JUST OVER A HALF-BILLION DOLLARS

TO DO ALL THAT WORK. BUT IT ALSO HAD ANOTHER $400 MILLION TO
SUPPORT ITS WORK AS THE GOVERNMENT'S LEAD AGENCY IN THE FIGHT
AGAINST AIDS. THE AIDS BROCHURE BEING MAILED T0 107 MILLION
AMERICAN HOUSEHOLDS THIS MONTH AND NEXT IS A C.D.C. PROJECT, FOR
EXAMPLE.

THE FOOD AND DRUG ADMINISTRATION -- OR THE E,D.A. ~- HAS
BEEN, FOR MOST OF ITS 82 YEARS, ONE OF THE MOST WIDELY

PUBLICIZED, DEEPLY RESPECTED, AND ROUNDLY HATED AGENCIES OF THE
FEDERAL GOVERNMENT.
18
THE TWO WATCHWORDS OF ITS LAW -- SAFETY AND EFFICACY -- MAKE

THE F.D.A. THE MARKETPLACE ARBITER OF PUBLIC HEALTH FOR HUMAN AND
VETERINARY DRUGS, VACCINES, MEDICAL DEVICES, PROCESSED FOODS AND
FOOD SUPPLEMENTS, HEALTH SUPPLIES, AND RADIOLOGICAL GEAR.

THE F.D.A.‘s BUDGET IS UNDER A HALF-BILLION DOLLARS A YEAR,
BUT ITS ACTIONS AFFECT A_HALF TRILLION DOLLARS WORTH OF GOODS AND
SERVICES MOVING IN INTERSTATE COMMERCE.

NEXT IS THE HEALTH RESOURCES AND SERVICES ADMINISTRATION, OR
"HRSA ' a“
19
“HRSA” IS AN AMALGAM OF A DOZEN OR SO PUBLIC HEALTH

PROGRAMS, FROM THE HUGE HALF~BILLION-DOLLAR BLOCK GRANT PROGRAM
FOR MATERNAL AND CHILD HEALTH TO THE SMALL 3-MILLION-DOLLAR
PROGRAM TO SUPPORT BLACK LUNG CLINICS.

A NUMBER OF “HRSA” PROGRAMS PROVIDE ESSENTIAL PRIMARY
HEALTH CARE SERVICES TO UNDERSERVED AND DISADVANTAGED
POPULATIONS, SUCH AS MIGRANT WORKERS AND THE HOMELESS,

A SECOND MAJOR GROUPING IS COMPRISED OF GRANT AND LOAN
PROGRAMS TO STRENGTHEN THOSE CRITICAL HEALTH PROFESSIONS SHOWING
SERIOUS PERSONNEL SHORTAGES. THESE INCLUDE FAMILY MEDICINE,
GERIATRIC HEALTH CARE, AND PROFESSIONAL NURSING.
20
“HRSA” HAS ALSO BEEN THE HOME BASE FOR THE NATIONAL HEALTH

SERVICE CORPS. AND, BEGINNING NEXT YEAR, THIS AGENCY WILL BE
ASSEMBLING THE “HEALTH CARE QUALITY IMPROVEMENT DATA BANK,” A
NATIONAL NETWORK THAT WILL COLLECT INFORMATION REGARDING MEDICAL
MALPRACTICE CLAIMS AND DISCIPLINARY ACTIONS TAKEN AGAINST HEALTH
PROFESSIONALS BY STATE LICENSING AUTHORITIES.

ALL TOGETHER THE “HRSA” PROGRAMS ARE SUPPORTED BY A BUDGET
OF CLOSE TO $1.4 BILLION THIS FISCAL YEAR.

THE NEWEST FREE-STANDING AGENCY OF THE PUBLIC HEALTH
SERVICE IS THE INDIAN HEALTH SERVICE.
21
THE I.H.S. PROVIDES A BILLION DOLLARS’ WORTH OF HEALTH CARE

TO OVER A MILLION NATIVE AMERICANS AND ALASKAN NATIVES THROUGH A
COMBINED DELIVERY SYSTEM OF 51 HOSPITALS, 135 HEALTH CENTERS, 529
SMALLER HEALTH STATIONS AND SATELLITE CLINICS, 33 URBAN HEALTH
PROJECTS, AND 7 SCHOOL HEALTH CENTERS. I AM PLEASED TO SAY THAT
THE I.H.S. FACILITIES WERE THE FIRST FEDERAL FACILITIES TO BECOME
“SMOKE-FREE .”

THE SYSTEM IS NOT AS MONOLITHIC AS THE NUMBERS MAY IMPLY,
HOWEVER. IT IS ACTUALLY A COMBINATION OF DIRECT HEALTH CARE
DELIVERED BY THE I.H.S., A TRIBAL HEALTH CARE DELIVERY SYSTEM
ADMINISTERED BY THE TRIBES THEMSELVES UNDER I.H.S. CONTRACTS, AND
A NETWORK OF NON-TRIBAL CONTRACT HEALTH SERVICES AS WELL,
22
AS YOU MIGHT EXPECT, THE I.H.S. HAS THE LARGEST NUMBER OF

COMMISSIONED CORPS PHYSICIANS, NURSES, PHARMACISTS, DENTISTS,
SANITARTANS, AND OTHERS ON ACTIVE DUTY.

THE 6TH P.H.S. AGENCY -- AND THE ONE WITH THE LARGEST
APPROPRIATION -- IS THE NATIONAL INSTITUTES OF HEALTH, HEAD-
QUARTERED RIGHT ACROSS THE STREET. WITH LESS THAN A THIRD OF THE
TOTAL P.H.S. WORKFORCE, N.I.H. SPENDS OVER HALF THE P.H.S.,
BUDGET: $6.2 BILLION IN THE CURRENT FISCAL YEAR.
23
NOW BEGINNING ITS SECOND CENTURY OF EXEMPLARY SERVICE TO

SCIENCE, N.I.H. INVESTS MOST OF ITS BUDGET -- ABOUT 60 CENTS OF
EVERY DOLLAR ~- IN MORE THAN 19,000 EXTRA-MURAL, INVESTIGATOR-
INTTIATED RESEARCH PROJECTS. THE ‘89 BUDGET REQUEST WOULD PUSH
THAT TOTAL TO MORE THAN 20,000 SUCH PROJECTS. IT WOULD BE THE
LARGEST NUMBER IN N.I.H. HISTORY,

IT ALSO HAS A ROBUST INTRA-MURAL RESEARCH PROGRAM RUN BY
SOME OF THE INTERNATIONAL SUPERSTARS OF BIOMEDICAL RESEARCH,

ONCE YOU START TALKING ABOUT N.I.H., IT'S DIFFICULT TO STOP
BECAUSE THERE IS SO MUCH TO SAY ABOUT IT.
24
HOWEVER, SINCE N.I.H. IS SO CLOSE BY, I’LL ASSUME YOU KNOW

MANY THINGS ABOUT IT AND, THEREFORE, I’LL MOVE ON TO THE 7TH AND
FINAL ORGANIZATION WITHIN THE U.S. PUBLIC HEALTH SERVICE: THE
OFFICE OF THE ASSISTANT SECRETARY FOR HEALTH, OR “OASH.”

ORDINARILY, THE TOP ADMINISTRATIVE OFFICES IN GOVERNMENT ARE
JUST THAT -- ADMINISTRATIVE, WITH VERY LITTLE PROGRAMMATIC
RESPONSIBILITIES. BUT THE PUBLIC HEALTH SERVICE HAS SEVERAL
PROGRAM ACTIVITIES THAT ARE -- TO USE THE JARGON OF THE DAY --
“CROSS-CUTTING”: THAT IS, THEY ARE ACTIVITIES THAT AFFECT, OR
ARE AFFECTED BY, A NUMBER OF OTHER P.H.S. PROGRAMS.
25
THE MASSIVE BATTLE AGAINST AIDS IS ONE SUCH PROGRAM. IT IS

CENTRALLY COORDINATED WITHIN “OASH.” IN FISCAL 1989, THE FULL
$1.5 BILLION-DOLLAR APPROPRIATION FOR AIDS WILL BE GIVEN TO
“OASH,” TO PARCEL OUT TO THE OTHER P.H.S. AGENCIES FOR ALL THEIR
AIDS-RELATED ACTIVITIES ... CLINICAL RESEARCH, VACCINE
DEVELOPMENT, PUBLIC EDUCATION, AND SO ON.

OTHER, SIMILAR “OASH” PROGRAMS THAT INVOLVE SEVERAL P.H.S.
AGENCIES INCLUDE HEALTH PROMOTION AND DISEASE PREVENTION, FAMILY
PLANNING, ADOLESCENT FAMILY LIFE, MINORITY HEALTH, PHYSICAL
FITNESS, HEALTH SERVICES RESEARCH, AND THE ASSESSMENT OF NEW
HEALTH CARE TECHNOLOGIES,
26
THESE PROGRAMS -- PLUS THE AIDS EFFORT AND THE ROUTINE

P.H.S. OVERHEAD COSTS -- ADD UP TO AN “OASH” BUDGET OF $1.2
BILLION THIS YEAR AND $1.6 BILLION ESTIMATED FOR NEXT YEAR.

THAT IS BASICALLY WHO WE ARE AND WHAT WE ARE. NOW, WHAT ARE
WE TRYING TO BE?

LET ME ANSWER THAT, FIRST, IN BRIEF GENERAL TERMS FOR THE
U.S. PUBLIC HEALTH SERVICE AND, SECOND, IN MORE SPECIFIC TERMS
FOR THE P.H.S COMMISSIONED CORPS ITSELF.
27
AS FAR AS THE P.H.S. IN GENERAL IS CONCERNED, I THINK WE’RE

EVOLVING INTO AN ORGANIZATION WITH THREE MAIN PARTS TO ITS
MISSION:

* FIRST, THE PUBLIC HEALTH SERVICE IS THIS NATION'S
PRIMARY INSTRUMENT FOR CARRYING OUT LONG-TERM,
RESOURCE-INTENSIVE, BIOMEDICAL AND BEHAVIORAL RESEARCH,
THIS HAS BEEN OUR GREATEST STRENGTH SO FAR AND IT HAS
BEEN OUR GREATEST CONTRIBUTION. I AM SURE IT WILL
CONTINUE TO BE JUST THAT.
28
SECOND, THE PUBLIC HEALTH SERVICE HAS BEEN SHIFTING

THE EMPHASIS OF AMERICAN MEDICINE FROM CURATIVE AND
REPARATIVE MEDICINE TO PREVENTIVE AND PROMOTIVE
MEDICINE. IN OTHER WORDS, WE’RE GOING AFTER THE MAJOR
BEHAVIORAL CAUSES OF MORBIDITY AND MORTALITY, SUCH AS
SMOKING, ALCOHOLISM, DIET, AND HIGHWAY TRAUMA,

AND THIRD, THE U.S. PUBLIC HEALTH SERVICE HAS A LONG
AND PROUD TRADITION OF PROVIDING PRIMARY CARE TO
AMERICANS WHO ARE -~ FOR WHATEVER REASON -- OUTSIDE THE
MAINSTREAM OF HEALTH AND MEDICAL CARE: INDIANS AND
ALASKAN NATIVES, MIGRANT WORKERS, THE HOMELESS, AIDS
VICTIMS, FEDERAL PRISONERS, AND SO ON,
29
] BELIEVE THIS IMPORTANT ASPECT OF THE P.H.S. MISSION

WILL NOT ONLY REMAIN BUT MIGHT BE STRENGTHENED IN A
NUMBER OF WAYS,

AND THAT LEADS ME TO MY FINAL REMARKS THIS AFTERNOON. IT
HAS TO DO WITH THE REVITALIZATION OF THE COMMISSIONED CORPS OF
THE U.S. PUBLIC HEALTH SERVICE.
30
SIX YEARS AFTER MY INITIAL APPOINTMENT AS SURGEON GENERAL -~

JUST OVER A YEAR AGO -- I ANNOUNCED A PLAN TO REVITALIZE THE
COMMISSIONED CORPS OF THE UNITED STATES PUBLIC HEALTH SERVICE.

I TOOK THIS STEP, IN CONCERT WITH SECRETARY BOWEN AND
ASSISTANT SECRETARY WINDOM, BECAUSE 1 BELIEVED THAT THE
COMMISSIONED CORPS OF THE PUBLIC HEALTH SERVICE NEEDED SOME
CHANGES TO CONTINUE TO SERVE AS A VITAL FORCE ON BEHALF OF THE
NATION,

AT THAT TIME, I ANNOUNCED SEVERAL CHANGES: IMPROVING
MECHANISMS TO SUPPORT CAREER TRACKS FOR PHS COMMISSIONED PERSON-
NEL, FOSTERING THEIR CAREER DEVELOPMENT AND MOBILITY, AND -- FOR
THE GOOD OF THE OVERALL CORPS AND ITS OFFICERS -- ENHANCING THE
IMAGE OF THE COMMISSIONED CORPS, BOTH IN AND OUT OF OUR UNIFORM,
31
WE SET UP 13 SPECIAL WORK GROUPS TO GIVE A FRESH LOOK TO

MANY ASPECTS OF THE PHS COMMISSIONED CORPS SYSTEM AND ITS
ENVIRONMENT.

THESE GROUPS WERE COMPOSED OF 94 OFFICERS FROM ALL AGENCIES.
OVER 40 PERCENT CAME FROM THE FIELD. THEY CAME FROM ALL RANKS
AND HAD SUBSTANTIAL PARTICIPATION BY WOMEN AND MEMBERS OF
MINORITY GROUPS.

BASED ON THE RECOMMENDATIONS, WE HAVE ALREADY MADE MANY
CHANGES AND WILL BE MAKING OTHERS SOON.
32
HISTORICALLY, OUR PROMOTION BOARDS WERE COMPRISED OF OUR

MOST SENIOR PROFESSIONAL OFFICERS -- OUR 0-6'S -- IN THE REGULAR
CORPS. THIS YEAR’S PROMOTION BOARDS INCLUDE RESERVE CORPS

_ OFFICERS AND SOME OFFICERS BELOW THE 0-6 GRADE; AND THEY ARE
FOLLOWING NEW CRITERIA. THESE WERE BOTH RECOMMENDATIONS OF A WORK
GROUP.

WE HAVE TAKEN SEVERAL STEPS TO CHANGE THE DISTRIBUTION OF
JUNIOR AND SENIOR OFFICERS IN THE PHS CORPS,

WE ARE ALSO TAKING STEPS TO BETTER ANTICIPATE THE NEEDS OF
CAREER OFFICERS FOR A SUCCESSION OF PROGRESSIVELY RESPONSIBLE
POSITIONS -- AND THE NEEDS FOR AGENCIES TO UTILIZE PHS COMMIS-
STONED OFFICERS, TO HAVE A WAY OF CONSIDERING THEM FOR VACANCIES
THEY HAVE OR A PROJECT,
33
THIS IS CRITICAL BECAUSE THE PUBLIC HEALTH SERVICE AND ITS

AGENCIES, FOR A VARIETY OF REASONS, DO NOT DECLARE POSITIONS “UP
FRONT” TO BE FOR COMMISSIONED OFFICERS. (VIRTUALLY ALL PHS
HEALTH PROFESSIONAL POSITIONS MAY BE FILLED BY EITHER COMMIS-
SIONED OFFICERS OR CIVIL SERVANTS.)

UNLIKE SOME OF OUR SISTER SERVICES, FINAL SELECTIONS OF
OFFICERS OR CIVILIANS TO FILL EACH ASSIGNMENT ARE MADE BY THE
AGENCY IN WHICH THE ASSIGNMENT EXISTS,

WE ARE ALSO BETTER DEFINING CAREER TRACKS THAT ARE
APPROPRIATE TO THE VARIOUS PROFESSIONS REPRESENTED BY PHS
OFFICERS. THESE INCLUDE MEDICAL OFFICERS SUCH, AS THOSE
EMBARKING ON THIS PROFESSIONAL TRAINING AT THIS TIMEs THEY ALSO
INCLUDE OTHER HEALTH PROFESSIONALS, SUCH AS DENTISTS, NURSES,
PHARMACISTS, ENGINEERS, SANITARIANS, VETERINARIANS, SCIENTISTS,
THERAPISTS, DIETLTIANS, AND OTHER PUBLIC HEALTH PROFESSIONALS,
34
THE GOAL OF THESE EFFORTS IS TO PROVIDE PHS OFFICERS AND

THE OVERALL PHS CORPS SYSTEM BETTER PROJECTIONS AS WELL AS
CURRENT INFORMATION ABOUT THE RANGE OF ASSIGNMENTS, GEOGRAPHIC
LOCATIONS, AND OTHER ATTRIBUTES AND THUS BE ABLE TO BETTER ASSIST
OUR OFFICERS, THE AGENCIES ALREADY DESCRIBED TO YOU, AND THEIR
OVERALL CAREER SYSTEM.

OUR PROFESSIONAL IMAGE RELIES SUBSTANTIALLY ON THE OVERALL
QUALITY OF THE OFFICERS. THIS BEGINS WITH OUR CRITERIA FOR COM-
MISSIONING, JUST AS IT DOES IN THE OTHER UNIFORMED SERVICES,

YOUR DEGREE WILL BE, AS IS SAID FREQUENTLY ACROSS THE NATION THIS
MONTH, YOUR PROFESSIONAL BEGINNING, WE REQUIRE GRADUATION IN A
HEALTH SPECIALTY FROM AN ACCREDITED PROGRAM,
35
LICENSURE AND PROFESSIONAL CERTIFICATION PROVIDE CRITICAL

EXTERNAL VALIDATION OF QUALITY -- AND COMPLEMENT THE ROLE OF
GRADUATION FROM AN ACCREDITED ACADEMIC PROGRAM. IN AT LEAST THIS
RESPECT, MY EFFORTS TO ENHANCE THE PROFESSIONAL IMAGE AND NATURE
OF PHS COMMISSIONED OFFICERS SOMEWHAT PRECEDED THE FORMAL
REVITALIZATION PROCESS.

WE NOW REQUIRE THAT ALL PHS OFFICERS IN CATEGORIES THAT
PROVIDE CLINICAL CARE BE LICENSED OR HAVE OTHER APPROPRIATE
PROFESSIONAL CERTIFICATION.

OF THE NEARLY 6,000 COMMISSIONED OFFICERS NOW ON ACTIVE
DUTY, THE POLICY APPLIES TO ABOUT 3,900, INCLUDING ALL MEDICAL
OFFICERS.
36
SHORTLY AFTER THE INITIATION OF OUR REVITALIZATION EFFORTS,

I HEARD SEVERAL REACTIONS, ONE WAS GENERAL SUPPORT AND APPRECIA-
TION OF WHAT WE WERE DOING AND AN UNDERSTANDING OF WHY IT WAS
NEEDED. WHILE THIS SUPPORT WAS NOT -- AND IS STILL NOT
UNIVERSAL -- IT WAS BROAD AND DEEP.

AND I BELIEVE THE SUPPORT IS NOW STRONGER THAN EVER.

AS MEMBERS OF A UNIFORMED SERVICE, EACH OFFICER OBLIGATES
HIMSELF OR HERSELF TO A POTENTIAL CAREER THAT SPANS MULTIPLE JOBS
AND PROBABLY MORE THAN ONE LOCATION. WHILE THIS CHARACTERISTIC
WAS, I BELIEVE, GENERALLY WELL UNDERSTOOD BY MOST HEALTH PRO-
FESSIONALS COMMISSIONED IN THE MILITARY SERVICES, THE IDEA WAS
NOT PREVIOUSLY WIDELY APPRECIATED IN THE PUBLIC HEALTH SERVICE,
3/
HOWEVER, UNDER REVITALIZATION OUR OFFICERS NOW ARE QUITE

AWARE OF THE NEED FOR THEIR OWN MOBILITY TO MEET CHANGING OR
IMMEDIATE NEEDS OF THE NATION. IT IS ONE OF THE MAJOR FACTORS
THAT DIFFERENTIATES THEM FROM CIVIL SERVANTS,

WE ARE A UNIFORMED SERVICE AND, AS I AM SURE YOU KNOW BY
NOW, I EXPECT EACH PHS OFFICER TO OWN AND WEAR PROPER UNIFORMS ON
A REGULAR BASIS. AS WITH THE CHARACTERISTIC OF MOBILITY, FOR
SOME PHS OFFICERS OUR UNIFORM WAS UNKNOWN, NOT NOW,

TO ME, AND I HOPE TO YOU, THE UNIFORM SYMBOLIZES A PROUD
TRADITION OF PROFESSIONAL RESPONSIBILITY AND ACCOMPLISHMENT IN
THE FIELD OF HEALTH SERVICE AND SCIENCE.
38
IF COMPARED TO WHERE WE WERE A YEAR AGO, YOU WOULD SEE A

COMMISSIONED CORPS OF GENERALLY SIMILAR SIZE. MORE DETAILED
EXAMINATION WOULD SHOW SOME OVERALL GROWTH, PARTICULARLY IN

JUNIOR-LEVEL OFFICERS, AND A SLIGHTLY GREATER PROPORTION OF

OFFICERS IN THE REGULAR CORPS.

TO ME THE MOST SIGNIFICANT CHANGES DO NOT SHOW UP IN TABLES
BUT ARE BEING EXPRESSED AND FELT. THESE ARE THE INTANGIBLES
RELATING TO OUR IMPROVED IMAGE AND INCREASED VITALITY.

THIS HAS ALSO BEEN A YEAR OF SIGNIFICANT PROGRESS TO THE
OVERALL REVITALIZATION OF THE COMMISSIONED CORPS, ONE THAT HAS
SEEN MANY ACCOMPLISHMENTS, BUT THAT STILL LEAVES PLENTY TO BE
DONE.
39
TO MY EYES, THE HEALTH OF THE COMMISSIONED CORPS [IS NOW

MUCH BETTER THAN IT WAS A YEAR AGO AND IS SHOWING THE CONTINUING
BENEFITS OF ITS OWN FITNESS PROGRAM AS WE APPROACH OUR 100TH
ANNIVERSARY ON JANUARY 4, 1989,

AS ONE WHO HAS BEEN A TEACHER IN SOME CAPACITY FOR ALL HIS
PROFESSIONAL LIFE, IT GIVES ME SINGULAR PLEASURE TO JOIN YOU ON
THIS DAY AS YOU FORMALLY EMBARK ON WHAT I HOPE WILL BE A MOST
PRODUCTIVE AND CARING CAREER AND TO BE AMONG THOSE PRESENT AS YOU
LAUNCH ON A PERIOD OF INTENSE MEDICAL TRAINING AND THEN A CAREER
IN OUR NATION'S UNIFORMED SERVICES,

THANK YOU,
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