A Productive Past for a Future of Service

Good afternoon. Thank you, Admiral Carmona, for that warm introduction. I'd also like to thank Captain Farrell for inviting me to speak to you.

I'm honored to have the opportunity to give this year's C. Everett Koop lecture. For many Americans, Admiral Koop set the tone for the office of the Surgeon General, and I am honored to deliver the fifteenth annual lecture in his honor.

As Deputy Secretary of Health and Human Services, I work with Secretary Leavitt to do all that I can to improve the health and well-being of Americans. At HHS, we work to improve our health care system, to transform lives and offer hope. We do this because we believe, as George Washington wrote in a letter to James Warren, that “Our cause is noble; it is the cause of mankind!”

The past five years have been an historic time for HHS, and thanks to the hard work and dedication of the thousands of employees in our Department, especially the men and women of the Commissioned Corps, we are better prepared than ever to respond to any health emergency, natural disaster, or terrorist attack.

We faced the unprecedented health challenges of September 11, the anthrax attacks, smallpox preparedness, monkeypox, SARS, and hurricanes Katrina, Rita, and Wilma. We have worked to enhance food safety and worked with Congress to pass the historic Bioterrorism Preparedness Act, to protect our nation's food supply. Drug use among schoolchildren is at record lows, and a record number of children are receiving health care. More community health centers are providing more and better care to more needy Americans than ever before. The United States is the unquestioned leader in fighting AIDS around the world.

The next three years promise to be similarly historic for HHS. We are implementing the most historic and substantial changes to Medicare in forty years, to provide critical new benefits and options to our senior citizens and disabled Americans. We're focusing on utilizing health information technology and making electronic health records available to every American in less than ten years. We're spending more on medical research than at any time in history. We're helping Americans who want health insurance obtain it. We're advancing patient safety and quality of care initiatives to reduce medical mistakes. We're fighting avian influenza and preparing against the threat of a pandemic.

As Secretary Leavitt, I, and all of HHS work to implement these and all our other goals, I want to stress to all of you how important the Commissioned Corps is in this.

The Public Health Service has built a remarkable record of keeping America healthy. Many of its successes were led by the elite team of health care professionals of the Commissioned Corps.

The Commissioned Corps has a long and impressive history of service to the American people. From its creation 117 years ago to its deployment in the wake of hurricane Katrina, its officers have risen to the varied, difficult, and often dangerous challenges of public health.

On January 4, 1889, Congress created the Commissioned Corps in response to a shortage of health care in the Marine Hospital Service, which was part of the Treasury Department. In 1939, the Public Health Service (as the Marine Hospital Service had been renamed in 1912) was transferred to the Federal Security Agency, the predecessor to the Department of Health and Human Services.

The 1889 Act of Congress established the creation of a mobile medical corps subject to duty anywhere they were assigned. These first officers served in a variety of different positions, they worked in the Marine Hospital Service's medical facilities, fought epidemics, and responded to emergency situations. In the late nineteenth century, the germ theory of disease had only begun to be accepted, and medical knowledge in general was very limited. As a result, Corps officers relied heavily on tactics such as quarantines to prevent the spread of diseases.

During the late nineteenth and early twentieth centuries, P.H.S. medical officers were held to extremely high standards, especially when compared to their peers in private practice. Essentially, P.H.S. physicians were among the best and most well-trained medical practitioners in the U.S. during this time.

Between about 1889 and 1910, the Commissioned Corps was very small and tight-knit. And through the early twentieth century, the number of officers was so limited that each officer often knew all of his fellow officers, even though they were stationed all over the world, in foreign ports, throughout rural areas in the U.S., and in hospitals in cities across America.

Though the Surgeon General was in constant communication with his field officers, they had a great deal of autonomy, and were able to exercise an incredible amount of independence.

During this time, the Commissioned Corps developed an outstanding reputation, with Corps officers carrying out great advances in medical science, laying the foundation for many of America's first public health initiatives, and determining how public health experts were taught. For example:

• Joseph Goldberger demonstrated that pellagra, a disease that afflicted many Americans, especially Southerners, was not a communicable disease but a nutritional deficiency. As a result of his work, pellagra was virtually eradicated in the South.
• Leslie Lumsdain worked on rural sanitation issues and dramatically improved the health of rural Americans.
• P.H.S. physician and statistician Wade Frost was one of the earliest faculty members of the first school of public health, at Johns Hopkins University.

The Corps also stopped several epidemics that threatened major American cities, such as:

• The plague in San Francisco in 1900.
• The last outbreak of yellow fever in the U.S., in New Orleans in 1905.
• And Public Health Service officers were at the forefront of our fight against the Spanish Flu in 1918. In fact, many officers fell ill with influenza while serving, though none died, that we know of. Dr. Wade Frost with a team of inspectors conducted door-to-door surveys in ten cities and towns across America, and discovered that the virus causing the Spanish Flu tended to strike people ages twenty to forty, a key characteristic of that pandemic that still puzzles researchers today.

Also between 1880 and 1924, Corps officers examined all 23 million immigrants who entered the U.S. And because over 40% of Americans can trace their ancestry to this period of immigration, more than 119 million Americans have an ancestor who was most likely examined by a commissioned officer of the Public Health Service. In fact, I am one of them. Both my grandparents on one side of my family, and two of my great-grandparents on the other side were examined by P.H.S. officers.

During the period between World War I and World War II, major advances in health sciences created a growing need for collaboration with other types of scientists and health practitioners. So in 1930, an Act of Congress admitted dentists, sanitary engineers, and pharmacists into the Corps, when before the Corps had been composed largely of physicians. And in 1944, the Corps was expanded to included scientists, nurses, dieticians, physical therapists, veterinarians, and sanitarians.

As early as 1902, Congress had authorized the President, in times of war or emergency, to use the Public Health Service in the interests of the American people. In World Wars I and II, the Army and the Navy drew on the services of Corps officers, who saw action at key events:

P.H.S. Commissioned officers had long provided health care for the Coast Guard. And during World War II, 663 PHS medical, dental, nurse, and engineer officers were assigned to duty with the Coast Guard. Three of them were killed in action.

A P.H.S. team provided the medical staff for the U.S.S. Bayfield during the D-Day invasion. The ship anchored off the coast for 20 days, and served as a hospital ship for casualties brought from the beach and from sunken ships.

In total, five P.H.S. personnel assigned to the Coast Guard during World War II won purple hearts and three of them won bronze stars.

Commissioned Corps officers served in many areas other than the Coast Guard during World War II. Between 1941 and 1943, P.H.S. officers were placed in charge of public health for workers building a railroad from China to Burma. P.H.S. officers were assigned responsibility for public health in liberated areas of Europe and Northern Africa as the war progressed. The P.H.S. provided large numbers of clinicians and public health administrators to the medical care programs in refugee camps in Europe and the Middle East. And P.H.S. officers also served in civilian defense and other vital programs on the home front in America.

A dramatic example of the Public Health Service in action is the story of the surgeon Floyd A. Hawk. Dr. Hawk had been put in charge of the quarantine station in the Philippines. When the Japanese invaded in December of 1941, Dr. Hawk offered his services to the American forces stationed on the island of Cebu, the most densely populated island in the Philippines. As the Japanese invasion progressed throughout the islands, the American forces on Cebu realized that capture was inevitable. Many thought it would be better to vanish into the woods and join guerilla forces rather than surrender, and they tried to talk Dr. Hawk into joining him. Instead, he decided to stay behind and care for his 100 critically ill patients. As a result of his bravery and commitment to his patients, he was captured by the Japanese, and in 1945 died of exposure and malnutrition in a prisoner of war camp.

On June 21, 1945, President Truman issued Executive order number 9575 that declared: “the commissioned corps of the Public Health Service to be a military service and a branch of the land and naval forces of the United States during the period of the present war.” The Corps remained militarized until 1952.

Corps officers have also served with distinction in the Korean War, the Vietnam War, the first Gulf War, and are currently saving lives in Afghanistan and Iraq during the current war on global terrorism.

As you all know, though, Corps officers serve in all sorts of dangerous places, not just wars:

In 1930, Congress made the medical care of federal prisoners the responsibility of the P.H.S. This has put officers at risk during riots, such as the 1987 riot at the Federal Penitentiary in Atlanta.

Starting in the 1920s, at the leprosarium in Carville, LA, P.H.S. officers cared for people suffering from leprosy when the disease was still greatly feared and little understood.

P.H.S. officers assisted at the Three Mile Island nuclear reactor accident in 1979.

Under Surgeon General C. Everett Koop, for whom this lecture is named, the Public Health Service was on the forefront of the fight against AIDS.

Officers provided emergency services at the Oklahoma City bombing in 1995 and at the World Trade Centers in 2001.

The Corps also provided life saving pharmaco prophylaxis to mail workers and hill staff after the anthrax attacks on Capitol Hill in 2001.

Most recently, the Public Health Service has had officers on the ground in Asia, monitoring the strains of avian influenza and helping us prepare against the threat of a pandemic. And in response to hurricanes Katrina, Rita, and Wilma members of the Corps, in its largest deployment ever, showed the American people that the Public Health Service could be depended on in times of need. As Secretary Leavitt said, the Corps was the “tip of the public health spear.”

Under the direction of the Surgeon General and Admiral Vanderwagen, we sent clinical teams to support special needs shelters, hospital staffing, primary care outreach, and the mass immunization of evacuees. We deployed engineers, environmental health officers, veterinarians, epidemiologists, pathologists, pharmacists, mental health professionals, and even food inspectors to affected areas.

Our officers coordinated HHS resources across the Gulf region and in major cities like Houston, New Orleans, San Antonio, Dallas, and Baton Rouge, and managed state and federal emergency operations centers.

The past year has shown us just how vulnerable we can be against the capriciousness of the natural world. I was proud to personally witness the excellent response of the Corps to the hurricanes and to see how you stepped up and demonstrated that the professionalism and competency that were hallmarks of its beginnings are just as strong among the officers who serve today.

Whether saving lives in war-torn countries, conducting critical disease research in remote locations, or innovating ways to improve the health of Americans, the Commissioned Corps has accomplished so much for so many. And I believe that this active, front-line component is the specific characteristic of the Commissioned Corps that makes it such a valuable asset to the American people. I know that Secretary Leavitt is looking forward to working with you in the coming weeks to enhance this aspect of the Public Health Service. At the outset of our response to hurricane Katrina, Secretary Leavitt issued this order to the Surgeon General: “I want the Corps to function as if transformation has occurred already.” And the Corps responded to that order, in spades. What does transformation mean? Specifically, Secretary Leavitt wants to transform the Commissioned Corps to ensure that:

• The Commissioned Corps is able to respond rapidly with appropriate types of health professionals;
• The size of the active-duty Commissioned Corps is based not upon historical levels but on the needs of current and future challenges;
• Recruitment of new officers is a priority of all agencies;
• Personal incentive systems are strengthened so that isolated, hardship, and hazardous positions are filled; and
• The total functional capacity of the Commissioned Corps should include active-duty, reserve, and auxiliary personnel.

Secretary Leavitt and I believe that such a transformation will enable the Commissioned Corps to build upon its productive and successful past in order to lay the foundation for a great future of service. Thank you all for the work you have done in making the Corps the bedrock of America's public health system and for all that you will do to help us in our mission to transform the Corps so that it will continue to be the “tip of the public health spear.”