COMPARISON OF ROLES OF ASSISTANT SECRETARY FOR HEALTH AND SURGEON

GENERAL

 

Prior to 1968

SG

o Line responsibilities over
all PHS agencies. Control
of all personnel and
budget.

o Statutory responsibilities
of the SG, e.g., transport
of hazardous substances;
joint travel regulations.

 

 

SG was the professional
spokesman on health matters.
The best minds in the PHS
provided the scientific and
background information to
the SG who had the respect
of Congress, Government

and public.

* Two Individuals
** One Individual

 

 

1968 = 1971
Assistant Secretary for Health and Scientific Affairs and SG*

ASH

o Special Assistant to, the,
Secretary (Health and’...

Medical Affairs) appointed _

by President. Review the
health and medical programs
of the Department and
advise the Secretary.
and pay comparable to
Assistant Secretary.

Rank

o Line responsibility over
egencies.

 

 

7

SGs position began to erode
when Dr. Egeberg was ASH
and Dr. Steinfeld the SG.

 

SG

Retained some statutory
responsibilities, e.g.,,
transport of hazardous
substances; joint travel
regulations.

High level policy advisor
to ASH on health policy,
program, legislative,
planning and evaluation
proposals and professional
personnel issues. :

Represents ASH at Depart-
mental, interdepartmental,
national and international
meetings.

Designates PHS professionals
to serve as PHS representa-~
tives, e.g., Association of
Military Surgeons of the
U.S. (AMSUS); American

Board of Cardiology.

1976
Acting SG Appointed. Office of

SG Informally Recreated.

o Stronger input into policy
and management issues.

o Responsible for review of
health professional
personnel issues.

 

 

 

Office of SG was not,
established since ASW-SG
were the same person and SC
statutory authorities were
delegated to the Deputy SG
within the Office of the
Deputy SG. ,

Dr. Ted Cooper, ASH

began to use Dr. Ehrlich

as Acting SG. He thought
that the ASH should make
political decisions but

the health. spokesman should
be the SG. For example, in
the swine flu episode there
was no one spokesman who
had legitimacy in the eyes
of the health professions
or the public.

197
ASH ~ SG**

Delegations to Deputy SG

o Ex officio member Board of
Regents Uniformed Services
University of the Health
Sciences (USUHS) Le

o Principal liaison for
operations with USUHS
Medical School.

o Ex officio member Board of
Regents Armed Forces
Institute of Pathology
and National Library of
Medicine.

© Delegate to AMA House of
Delegates,

~

 

o PHS representative AMA
Section, Council on Federal
and Military Medicine.

o PHS member Executive Board
Association of Military
Surgeons of the U.S.(AMSUS).

o Oversight of the Public
Health Employee Assistance
Program (PHEAP).

o Professional focus for
Chief Professional Officers
(11 category disciplines).

o Chief Advisor to ASH-SG
health professional person~
nel issues and personnel
policy actions. |

© Responsibility for
Commissioned Corps Awards
recommended by Boards.

o Delegation of Commissioned
Corps medical standards and
determine final action
regarding medically related
personnel actions.

o Oversight of bilateral
agreement with 20 countries.

1982
ASH

o Line authority over PHS
agencies:

~ Control of PHS budget

~- Supervises PHS Agency
Heads

o Directs OASH Operating
Division Heads in their
myriad responsibilities
and appoints task forces
to advise ASH in action .
leading to policy.

o Directs activities of all
Deputy Assistant Secretaries
of Health to assure uniform
interpretation and imple-~
mentation of policies.

 

 

 

 

 

Dr. Richmond began to use the
SG title more and more as time
went on as he recognized its
credibility with the health
professions and the public.

 

The Deputy Assistant Secretary
for Health-SG has uncertain
and indefinite assignments.
1982

The Public Health Service needs (and has not had in the minds of many
health professionals) a spokesman on health matters who has the con-
fidence of. the profession and the public. That spokesman should be the
Surgeon General.

Particularly at this time of uncertainty with the budget constraints, the
professional societies' perception of the administration has slipped con-
siderably since inauguration. The Surgeon General should strengthen the
dialogue between Federal and State governments and between the Federal
government and professional societies and the private sector. (Where I
have done this I think I have succeeded because I ama clinician from

the market place with academic credentials.)

The RIF has done to the PHS what budget constraints have done to the

public, - generated uncertainty, shifted personnel into positions where

the mission of the PHS is not. fully understood and has left some bitterness.
The SG could attempt to pull the PHS together ‘inside. . I think that I could
succeed to some extent because I am perceived as a White House appointee
(with more clout than I have) and the degrading publicity I received from
the media while awaiting confirmation is perceived by those workers as
something we have in common as kindred spirits.