The surgeon general reports to the assistant secretary for health, who may be a four-star admiral in the commissioned corps, and who serves as the principal advisor to the secretary of health and human services on public health and scientific issues. The surgeon general is the overall head of the Commissioned Corps, a 6,500-member cadre of uniformed health professionals who are on call24 hours a day and can be dispatched by the secretary of HHS or the assistant secretary for Health in the event of a public health emergency. The surgeon general is also the ultimate award authority for several public health awards and decorations, the highest of which that can be directly awarded is the Surgeon General's Medallion. The surgeon general also has many informal duties, such as educating the American public about health issues and advocating healthy lifestyle choices. The office also periodically issues health warnings. Perhaps the best known example of this is the surgeon general's warning label that has been present on all packages of American tobacco cigarettes since 1966. A similar health warning has appeared on alcoholic beverages labels since 1988.
History
In 1798, Congress established the Marine Hospital Fund, a network of hospitals that cared for sick and disabled seamen. The Marine Hospital Fund was reorganized along military lines in 1870 and became the Marine Hospital Service—predecessor to today’s United States Public Health Service. The service became a separate bureau of the Treasury Department with its own staff, administration, headquarters in Washington, D.C, and the position of supervising surgeon. After 141 years under the Treasury Department, the Service came under the Federal Security Agency in 1939, then the Department of Health, Education, and Welfare in 1953, and finally the United States Department of Health and Human Services. Some surgeons general are notable for being outspoken and/or advocating controversial proposals on how to reform the U.S. health system. The office is not a particularly powerful one, and has little direct statutory impact on policy-making, but Surgeons General are often vocal advocates of precedent-setting, far-sighted, unconventional, or even unpopular health policies.
On January 11, 1964, Rear Admiral Luther Terry, M.D., published a landmark saying that smoking may be hazardous to health, sparking nationwide anti-smoking efforts. Terry and his committee defined cigarette smoking of nicotine as not an addiction. The committee itself consisted largely of physicians who themselves smoked. This report went uncorrected for 24 years.
In 1986, Vice Admiral Dr. C. Everett Koop's report on AIDS called for some form of AIDS education in the early grades of elementary school, and gave full support for using condoms for disease prevention. He also resisted pressure from the Reagan administration to report that abortion was psychologically harmful to women, stating he believed it was a moral issue rather than one concerning the public health.
In 1994, Vice Admiral Dr. Joycelyn Elders spoke at a United Nations conference on AIDS. She was asked whether it would be appropriate to promote masturbation as a means of preventing young people from engaging in riskier forms of sexual activity. She replied, "I think that it is part of human sexuality, and perhaps it should be taught." Elders also spoke in favor of studying drug legalization. In a reference to the national abortion issue, she said, "We really need to get over this love affair with the fetus and start worrying about children." She was fired by President Bill Clinton in December 1994.
The U.S. Army, Navy, and Air Force also have officers overseeing medical matters in their respective services who hold the title Surgeon General, of their respective services, while the surgeon general of the United States is surgeon general of the entire country as a whole. The insignia of the surgeon general, and the USPHS, use the caduceus as opposed to the Rod of Asclepius.
Service rank
The surgeon general is a commissioned officer in the U.S. Public Health Service Commissioned Corps, one of the eight uniformed services of the United States, and by law holds the rank of vice admiral. Officers of the Public Health Service Commissioned Corps are classified as non-combatants, but can be subjected to the Uniform Code of Military Justice and the Geneva Conventions when designated by the commander-in-chief as a military force or if they are detailed or assigned to work with the armed forces. Officer members of these services wear uniforms that are similar to those worn by the United States Navy, except that the commissioning devices, buttons, and insignia are unique. Officers in the U.S. Public Health Service wear unique devices that are similar to U.S. Navy staff corps officers. The only surgeon general to actually hold the rank of a four-star admiral was David Satcher. This was because he served simultaneously in the positions of surgeon general and assistant secretary for health. John Maynard Woodworth, the first holder of the office as "Supervising Surgeon", is the only surgeon general to not hold a rank.
