Lecture January 4, 1989
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Remarks by C. Everett Koop, MD, ScD
Surgeon General of the U.S. Public Health Service
U.S. Department of Health and Human Services
Presented at the 100th Anniversary of the P.H.S. Commissioned Corps
Washington, DC
January 4, 1989
During all of 1989 there was a celebration here and a celebration there stretching all the way from Florida to Hawaii, all in honor of the 100th Anniversary of the Commissioned Corps. This particular occasion was the beginning of those celebrations and was the premier celebration. No one in the Commissioned Corps failed to understand my sincere affection for them all and my confidence that it was one of the gems of the United States government. I did remind them though that we were big enough to feel and to show compassion for the people we serve. And I declared the Public Health Service Commissioned Corps to be one uniformed service that does not do it job "by the numbers". I reminded the group that 100 years ago President Grover Cleveland signed into law something called "An act to establish the Commissioned Corps of the Marine Hospital Service." That law placed the Marine Hospital Service on a formal career footing with the Army and the Navy.
Thereafter, the President of the United States had the authority to make appointments to the "Marine Hospital Service", entrance to the service and promotion within the service were to be by merit examination, and the Surgeon General could say how the unique uniform of service could be used. In those days in 1889, the Marine Hospital Service, the predecessor of today's US Public Health Service, was devoted almost exclusively to providing health and medical care to the ocean-going Merchant Marine and to those who sailed the inland rivers and canals of the growing United States.
But other things were not happening the same way. The state and local health
departments were still a rarity, the world was only on the brink of bacteriological revolution and the concepts of disease control and prevention were just evolving, thanks to Robert Koch and Louis Pasteur. I reminded those present that the Service had met many challenges in immigration and quarantine, in research, in biobehavioral research, in disease surveillance, and in the growing area of health services to American sailors, the Coast Guard, federal prisoners, American Indians and Native Americans, and all the nation's underserved populations including its urban and rural poor, its aged, its disadvantaged minorities, its handicapped, and its children. A very tall order.
I jumped then a great many years to 1987. When in April, Dr. Otis R. Bowen, re-delegated the personnel authorities of the Commissioned Corps to the Surgeon general. At that time, Secretary Bowen asked me to undertake a revitalization of the Commissioned Corps.
Our audience was all too familiar with the fact that there had been several attempts to change or abolish the Corps. And everyone remembered that in the 60s and 70s there was a great deal of reorganization in the Executive Branch which included the transfer of much of our environmental health expertise to the Department of the Interior and to the new Environmental Protection Agency. Then there was that quasi disaster in March of 1981, when I myself, witnessed the dismantling the PHS hospital system and the concurrent reduction in the strength of the PHS Officer Corps.
I wouldn't go so far to say it was a blessing in disguise but it did make us face up to a few things and set some other things straight. We learned that we had better face the fact that our recruitment efforts were not bringing into the Commissioned Corps the minorities and women we needed. And we were also in real danger of losing sight of the idea of the Corps itself. Many members for the Corps were strong, important members of the various PHS agencies and considered themselves to be -- first and foremost -- employees of those agencies. That's were their loyalties were. It was understandable but not acceptable. We ether had to reclaim the Corps we already had or invent a new one. We decided on the former.
It wasn't easy but a lot has been accomplished. I then ticked off a tremendous list of things that had happened and gave statistics to back them up which I thought were extraordinary and encouraging. The numbers and the changes that went with them are worth reading.
One very important thing happened that perhaps gave me as much pleasure as anything that came my way in Washington. I had not been in office for more than a few weeks when one of the oldest member of the Corps told me that, to his knowledge, for 80 years somebody had been trying to get rid of the Corps and then in the last 10 years, OMB took the lead in that effort. I can personally attest to the fact that everything I did and that the Corps did came under their scrutiny and adverse criticism. But in the course of preparing the 1991 budget there was an OMB pass back and the notes say: "OMB congratulated the Public Health Service Commissioned Corps and the Office of the Surgeon General for the progress made thus far in implementing the Surgeon General's revitalization initiative." I never thought anything like that would happen during my tenure or anyone else's. I went on to say, " OMB expressed its continuing support for the initiative and urged us to continue towards full implementation of revitalization. OMB specifically pointed out the quality of the Commissioned Corps newsletter, how it has enhanced their understanding of the many changes occurring in the Corps, and their appreciation for regularly receiving the newsletter.
OMB was pleased but so were our sister Uniformed Services.
I then looked to the future with one disclaimer, and reminded the audience that this little bit of crystal ball gazing is done within the context of a society whose aspirations are beginning to run well ahead of its resources. I then talked about health promotion and disease prevention, international health, money, and demography. These were comments not greatly different than I had made on other occasions but they were made to the family that had to see that they were carried out.
I then looked to the future with one disclaimer, and reminded the audience that this little bit of crystal ball gazing is done within the context of a society whose aspirations are beginning to run well ahead of its resources. I then talked about health promotion and disease prevention, international health, money, and demography. These were comments not greatly different than I had made on other occasions but they were made to the family that had to see that they were carried out.
I closed with reminding them of the challenges we faced in the development of a stronger data base for health promotion and disease prevention, the potential for a heightened intergenerational competition for resources in public health, and the need to understand in greater depth how the public health is being care for, under the new partnership of federal, state, and local health authorities.
That evening will always be indelibly imprinted in my memory. But the evening was topped off as far as I was concerned, by having the privilege of leading the Coast Guard Band from New London, Connecticut, where the office of the Coast Guard Academy is stationed. The piece we played was, of course, my favorite march: "The Stars and Stripe Forever." (Although I haven't got a musical gene in my DNA, I've had the privilege of leading the Marine Corps Band and the United States Army Band in the occupied city of Berlin.)