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 (a forerunner of the present-day
Coast Guard) 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. 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 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. 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 () 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 (it eventually became the
National Institute of Mental Health). 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.
Mid-20th century in
Bethesda, Maryland in 1949 ' Robert A. Taft Sanitary Engineering Center in
Cincinnati in 1957By 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. 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. In 1943, PHS's divisions were collected into three operating agencies by law (). and in 1954 they moved across town from the former Cincinnati Marine Hospital to the newly constructed Robert A. Taft Sanitary Engineering Center. However, the period was one of decline for the marine hospital system. In 1943, the hospital system had reached its peak of 30 hospitals. 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. However, PHS funded construction of hospitals by the states through the 1946
Hill–Burton Act. In 1953 the Federal Security Agency was abolished and most of its functions, including the PHS, were transferred to the newly formed
Department of Health, Education and Welfare. In 1955 the
Division of Indian Health was established upon transfer of these functions from the
Bureau of Indian Affairs in the
Department of the Interior.
Reorganization era Between 1966 and 1973, a series of reorganizations and realignments led to the end of the bureau structure. 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 as the top leader of the Public Health Service, although the Surgeon General was retained in a subordinate role. Also in 1968, the
Food and Drug Administration, which traced its origins to 1862, became part of the PHS. 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
Lexington and
Fort Worth were transferred to other agencies, and the
Galveston hospital was replaced with one acquired by PHS in nearby
Nassau Bay. This left eight general hospitals plus the
National Leprosarium in the system. 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
Environmental Protection Agency. 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 of 1970. 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 • Merging of the Health Resources Administration and Health Services Administration into the
Health Resources and Services Administration (HRSA) in 1982 • The
Agency for Health Care Policy and Research being split from the
Office of the Assistant Secretary for Health in 1989 • 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 The PHS hospital system had been the target of efforts to close the entire system since the mid-1970s. As the result of pressure from the
Reagan administration, In 1995, supervision of the agencies within PHS was shifted from the Assistant Secretary for Health to report directly to the
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. 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==