ORIGINAL

3

REMARKS
RESERVED OFFICERS ASSOCIATION

BY
C, EVERETT KOOP. M.D.
SURGEON GENERAL
U.S, PUBLIC HEALTH SERVICE

WASHINGTON, D.C,

JANUARY 23, 1985
GOOD MORNING,

I WANT TO THANK MAJOR GENERAL HULTMAN AND THE RESERVE
OFFICERS ASSOCIATION FOR THE INVITATION TO JOIN YOU THIS MORNING
TO HELP YOU GET THIS MID-WINTER CONFERENCE UNDERWAY,

THIS IS A VERY HEADY TIME FOR THIS CITY AND. INDEED FOR THE
COUNTRY. THE NATION HAS JUST OBSERVED THE BICENTENNIAL
INAUGURATION OF THE NEW PRESIDENT AND VICE PRESIDENT, AND WE ALL
TAKE PRIDE IN AMERICA AS WE SHARE IN THIS GREAT CELEBRATION,

WITH ONLY HALF AS MUCH EXPERIENCE THE COMMISSIONED CORPS OF
THE UNITED STATES PUBLIC HEALTH SERVICE HAS JUST CELEBRATED ThE
CENTENNIAL OF ITS FORMATION AND WE THANK THE RESERVE OFFICERS
ASSOCIATION FOR JOINING US IN THIS CELEBRATION,
AS THE PHS COMMISSIONED CORPS MOVES TO REJOIN OUR SISTER
UNIFORMED SERVICES AS A FULL PARTICIPATING MEMBER, WE SALUTE THE
RESERVE OFFICERS ASSOCIATION FOR THE VITAL AND CONTINUING SUPPORT
OF OUR ACTIVITIES. IN OUR JOINT EFFORT OF MAINTAINING STRONG
NATIONAL SECURITY, WE STAND READY TO DO OUR PART, TO PRESERVE THE
HEALTH OF THIS NATION UNDER ALL CIRCUMSTANCES,

THIS MONTH WE MARKED THE DATE, JANUARY 4TH, A 100 YEARS AGO,
WHEN PRESIDENT GROVER CLEVELAND SIGNED INTO LAW SOMETHING CALLED
"AN ACT TO ESTABLISH THE COMMISSIONED CORPS OF THE MARINE
HOSPITAL SERVICE.”

THAT NEW LAW PLACED THE MARINE HOSPITAL SERVICE ON A FORMAL
CAREER FOOTING WITH THE ARMY AND THE NAVY,
FROM THAT POINT FORWARD, 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 THE SERVICE COULD BE USED.

IN 1889, THE MARINE HOSPITAL SERVICE -- THE PREDECESSOR OF
TODAY’S U.S, PUBLIC HEALTH SERVICE, -- ALREADY 91 YEARS OLD, 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,
BUT THE SERVICE WAS POISED TO ASSUME A GREATER LEADERSHIP
ROLE IN PUBLIC HEALTH. AND THERE WAS MUCH TO DO.

o STATE AND LOCAL HEALTH DEPARTMENTS WERE STILL A RARITY,

o THE WORLD WAS ONLY ON THE BRINK OF THE BACTERIOLOGICAL
REVOLUTION. THAT FULL ADVENTURE WAS STILL TO COME.

o AND THE CONCEPTS OF DISEASE CONTROL AND PREVENTION WERE
JUST EVOLVING, THANKS TO ROBERT KOCH AND LOUIS PASTEUR,
WITH THE HELP OF THIS NEW LEGISLATION, THE SERVICE ENTERED
THE 20TH CENTURY AS A LEADING FORCE FOR HEALTH, THE SCIENTISTS
OF THE NEWLY STRENGTHENED UNIFORMED HEALTH SERVICE COULD BE
QUICKLY ASSIGNED TO WRESTLE WITH PUBLIC HEALTH PROBLEMS WHERE
EVER THEY EXISTED.

o THE SERVICE HAS MET MANY CHALLENGES IN IMMIGRATION AND
QUARANTINE . . .

o IN RESEARCH, ESPECIALLY BASIC BIOMEDICAL AND BIOBEHAVIORAL
RESEARCH . .

oO IN DISEASE SURVEILLANCE...
oO AND IN THE GROWING AREA OF HEALTH SERVICES TO AMERICAN
SAILORS, THE COAST GUARD, FEDERAL PRISONERS, ALASKAN °
NATIVES AND NATIVE AMERICANS, AND ALL THE NATION'S
UNDERSERVED POPULATIONS . . . ITS URBAN AND RURAL POOR,

ITS AGED, ITS DISADVANTAGED MINORITIES, ITS HANDICAPPED,
AND ITS CHILDREN,

WE RECEIVED THOSE CHALLENGES, ALONG WITH THE NEW LAW, BACK

IN 1889, AND WE HAVE RETAINED THE SPIRIT AND THE ADVENTURE OF
BOTH,

ANOTHER LANDMARK YEAR FOR THE CORPS WAS THE YEAR 1987,
IT WAS IN APRIL OF 1987 WHEN HEALTH AND HUMAN SERVICES
SECRETARY, DR, OTIS R, BOWEN, REDELEGATED THE PERSONNEL
AUTHORITIES FOR THE COMMISSIONED CORPS TO THE SURGEON GENERAL.
AT THE SAME TIME, SECRETARY BOWEN ASKED ME TO UNDERTAKE A
REVITALIZATION OF THE COMMISSIONED CORPS,

] WAS STILL FAIRLY NEW TO THE CORPS -- 6 YEARS, THAT’S ALL
-- BUT I WAS ALREADY QUITE FAMILIAR WITH ITS RECENT TROUBLED
HISTORY,

THERE HAD BEEN SEVERAL ATTEMPTS TO CHANGE OR TO ABOLISH THE
CORPS,
AT THE SAME TIME, IN THE 1960’S AND THE 1970°S, OTHER
ACTIVITY WAS TAKING PLACE WHICH WOULD AFFECT THE CORPS. THERE
WAS A GREAT DEAL OF REORGANIZATION IN THE EXECUTIVE BRANCH,
INCLUDING THE TRANSFER OF MUCH OF OUR ENVIRONMENTAL HEALTH
EXPERTISE TO THE DEPARTMENT OF THE INTERIOR AND TO THE NEW
ENVIRONMENTAL PROTECTION AGENCY,

SHORTLY AFTER I ARRIVED IN WASHINGTON, IN MARCH 1981, I
WITNESSED THE DISMANTLING OF THE PHS HOSPITAL SYSTEM AND THE
CONCURRENT REDUCTION IN THE STRENGTH OF THE PHS OFFICER CORPS,

IT WAS A PERIOD OF SOME TURMOIL. IT WAS A TIME WHEN THE
CORPS CAME UNDER VERY CLOSE SCRUTINY, BOTH BY ITS HARSHEST
CRITICS AND ITS STRONGEST DEFENDERS,
BUT I WOULD ALSO HAVE TO SAY, ON REFLECTION AND ON BALANCE,
THAT THAT DIFFICULT PERIOD WAS A NECESSARY AND VERY HELPFUL
PERIOD FOR US AS WELL.

WE LEARNED THAT WE HAD TO FACE UP TO A FEW THINGS AND SET
SOME OTHER THINGS STRAIGHT.

WE LEARNED, FOR EXAMPLE, THAT WE HAD BETTER FACE THE FACT
THAT OUR RECRUITMENT EFFORTS WERE NOT BRINGING INTO THE
COMMISSIONED CORPS THE MINORITIES AND THE WOMEN WE NEEDED. AND
WE VERY MUCH NEEDED THEM, IF WE WANTED A COMMISSIONED CORPS THAT
WOULD BE TRULY SENSITIVE TO THE HEALTH CHALLENGES OF THE REST OF
THIS CENTURY -- AND THOSE OF THE NEXT.
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THE CORPS WAS PREDOMINANTLY - EVEN OVERWHELMINGLY -- WHITE
AND MALE, AND THAT WASN’T GOOD ENOUGH ANYMORE.

NEXT, WE WERE IN REAL DANGER OF LOSING SIGHT OF THE IDEA OF
THE CORPS ITSELF, MANY MEMBERS OF THE CORPS WERE STRONG,
IMPORTANT MEMBERS OF PHS AGENCIES AND CONSIDERED THEMSELVES TO BE
-- FIRST AND FOREMOST -- EMPLOYEES OF THOSE AGENCIES. THAT'S
WHERE THEIR LOYALTIES WERE.

THAT WAS UNDERSTANDABLE, CONSIDERING THE GROWTH OF THE
PUBLIC HEALTH MISSION IN THE DECADES FOLLOWING THE SECOND WORLD
WAR. IT WAS UNDERSTANDABLE . . . BUT IT WAS NOT ACCEPTABLE.
ll

THE UNITED STATES NEEDED A MOBILE, ALERT ORGANIZATION
DEDICATED TO SAFEGUARDING THE HEALTH OF THE AMERICAN PEOPLE, THE
COMMISSIONED CORPS OF THE U.S, PUBLIC HEALTH SERVICE IS SUPPOScD
TO BE THAT KIND OF ORGANIZATION,

THEREFORE, WE EITHER HAD TO RECLAIM THE CORPS WE ALREADY HAD
» » OR WE HAD TO INVENT A NEW ONE. WE WISELY DECIDED 10
RECLAIM THE ONE WE HAD. AND I’M GLAD WE DID.

BUT THE RECLAMATION PROCESS WAS NOT EASY TO BRING ABOUT. WE
HAD TO DEAL WITH A VARIETY OF MANAGEMENT PROBLEMS . . . WE NEEDED
TO CONFRONT THE ISSUE OF CAREER DEVELOPMENT FOR OFFICERS...
ND WE NEEDED TO REESTABLISH AND REDEFINE THE CONCEPT OF THE
EMERGENCY MOBILIZATION AND DEPLOYMENT OF CORPS PERSONNEL,
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THESE THINGS HAVE NOW BEEN DONE.

FOR EXAMPLE, THE MANAGEMENT OF THE CORPS HAS BEEN IMPROVED
. «+ THE CAREER SYSTEM HAS BEEN STRENGTHENED, WITH NEW CAREER
TRACKS FOR OFFICERS . . . WE HAVE BETTER RELATIONS BETWEEN THE
CORPS AND THE INDIVIDUAL AGENCIES OF THE U.S. PUBLIC HEALTH
SERVICE, AND THE AGENCIES WERE VERY HELPFUL DURING OUR REVIEW AND
REVISION OF THE BILLET SYSTEM. . . AND WE HAVE A NUMBER OF
ENLARGED AND ENHANCED INITIATIVES FOR YOUNG OFFICERS FIRST
JOINING US AS STUDENTS.

THE STATISTICS OF THE PAST YEAR ARE ALSO GENERALLY
ENCOURAGING BUT ALSO EXTRAORDINARY.
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ALTHOUGH I HATE TO BURDEN YOU WITH STATISTICS, THERE ARE A
COUPLE THAT ARE NEVERTHELESS WORTH MENTIONING AT THIS PARTICULAR
OCCASION,

FOR EXAMPLE, WE HAVE INCREASED THE STRENGTH OF THE
COMMISSIONED CORPS BY 1,5 PERCENT,

WE HAVE INCREASED MINORITY AND FEMALE COMMISSIONS BY 15 AND
8 PERCENT RESPECTIVELY.

WE HAVE INCREASED THE MOBILITY OF OFFICERS WITHIN POSITIONS
BY 21 PERCENT AND GEOGRAPHIC MOBILITY IS UP BY 13 PERCENT.

AND WE’VE INCREASED THE PUBLIC VISIBILITY OF THE CORPS AND
ITS ESPRIT,
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THROUGH THESE AND FOR MANY OTHER ACCOMPLISHMENTS, WE HAVE
SURPRISED AND PLEASED OUR CRITICS,

FOR EXAMPLE, I NEVER IMAGINED THAT I WOULD EVER READ A
PARAGRAPH, SUCH AS THE ONE I AM ABOUT TO READ NOW, 1’M SURE THAT
MANY PHS OFFICERS FEEL THE SAME WAY , . . THAT THESE SENTIMENTS
ARE NOTHING SHORT OF EXTRAORDINARY.

THE WORDS ARE FROM NOTES TAKEN BY DEPARTMENT REPRESENTATIVES
DURING A RECENT MEETING WITH PERSONNEL FROM THE OFFICE OF
MANAGEMENT AND BUDGET. THE OCCASION WAS AN OMB PASS-BACK IN THE
COURSE OF THE 1991 BUDGET DEVELOPMENT PROCESS. THE NOTES
SAY . as
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QUOTE -- 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,

OMB EXPRESSED ITS CONTINUING SUPPORT FOR THE INITIATIVE AND
URGED US TO CONTINUE TOWARDS FULL IMPLEMENTATION OF
REVITALIZATION. CLOSE QUOTE,

SO WE PLEASED OMB -- NO SMALL FEAT IN ITSELF. BUT WE ALSO
PLEASED SEVERAL OF OUR GREATEST CRITICS OVER THE YEARS, THAT IS,
OUR SISTER UNIFORMED SERVICES,
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OF PARTICULAR INTEREST TO YOU TODAY IS OUR ACTIVITY TO
ENHANCE OUR ABILITY TO ACTIVELY SUPPORT MOBILIZATION OF OUR ARMED
FORCES. THE PUBLIC HEALTH SERVICE HAS A CORPS OFFICER ASSIGNED
TO WORK WITH THE JOINT CHIEFS OF STAFF TO FACILITATE ThE JOINT
MEDICAL MOBILIZATION EFFORT,

RECENTLY, THE ASSISTANT SECRETARY FOR HEALTH OF DHHS JOINED
ME, THE SURGEONS GENERAL OF THE ARMY. NAVY AND AIR FORCE, AND
ASSISTANT SECRETARY FOR HEALTH AFFAIRS, DOD. IN SIGNING A
MEMORANDUM OF UNDERSTANDING FORMALIZING THE PROCEDURE FOR THE
COMMISSIONED CORPS OF THE USPHS TO PROVIDE VITAL MEDICAL SUPPORT
TO THE ARMED FORCES IN TIME OF EMERGENCY MOBILIZATION. OUR 5,500
OFFICERS STAND READY TO MEET THIS NEED, IF THE SITUATION ARISES,
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ADDITIONALLY, PHS OFFICERS WORK ON A DAILY BASIS IN MANY OF
THE DOD HEALTH CARE FACILITIES TO INSURE CONTINUING MUTUAL
COOPERATION IN THE PROVISION OF QUALITY HEALTH CARc. WE
CURRENTLY ARE UPGRADING OUR CAPABILITY TO RESPOND TO MAJOR
NATURAL CATASTROPHIES, WHERE LARGE NUMBERS OF VICTIMS. WHETHER
MILITARY OR CIVILIAN, MAY BE INVOLVED,

AS WE LOOK TO THE FUTURE AND MOVE FORWARD AS A UNIFORMED
SERVICE, WE ARE SEEKING TO TAKE THE NEXT LOGICAL STEP IN ASSURING
GREATER DEPTH OF OUR MANPOWER CAPACITY. THIS STEP INVOLVES OUR
REQUEST, WITH THE BLESSINGS OF THE OFFICE OF MANAGEMENT AND
BUDGET, AND THE SUPPORT OF THE RESERVE OFFICERS ASSOCIATION, TO
FORM A FULLY FUNCTIONING ACTIVE RESERVE COMPONENT, THE RESERVE
COMPONENT WILL PROVIDE SHORT TOURS OF DUTY AND PERIODIC DRILLS
COMPARABLE TO THE OTHER UNIFORMED SERVICES,
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ALTHOUGH WE ARE SIMILAR TO YOU IN MANY WAYS, THE PUBLIC
HEALTH SERVICE IS ALSO UNIQUE IN THAT WE ARE CHARGED WITH
MAINTAINING AND IMPROVING THE PUBLIC HEALTH, 1 WOULD BE REMISS
TODAY IF I DID NOT AT LEAST TOUCH ON SOME OF THE CRITICAL ISSUES
FACING US ALL TODAY,

ALL THAT WE WILL DO IN PUBLIC HEALTH WILL BE DONE AGAINST A
BACKGROUND WHERE OUR ASPIRATIONS FOR HEALTH CARE EXCEED OUR
RESOURCES,

FOR STARTERS, OUR HEALTH CARE DELIVERY SYSTEM IS IN CHAOS;
IT WILL NOT FIX ITSELF,
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AIDS, IS OF COURSE CONSTANTLY IN THE PUBLIC’S ATTENTION
TODAY, THE PHS CONTINUES ITS EFFORT TO PROVIDE LEADERSHIP IN THE
PREVENTION OF THIS DREADED DISEASE THROUGH EDUCATION, ALTHOUGH
THERE 1S NO CURE ON THE HORIZON, THE PHS IS DIRECTING APPROPRIATE
RESOURCES INTO RESEARCH ON TREATMENT AND THE DEVELOPMENT OF A
VACCINE,

AS BAD AS THE MORTALITY FIGURES ARE FOR AIDS, AS MANY PEOPLE
DIE EVERY 40 DAYS IN THE UNITED STATES FROM SMOKING AS HAVE DIED
FROM AIDS SINCE ITS BEGINNING IN 1981,

THIS ONE ADDICTION IS THE SINGLE MOST PREVENTABLE CAUSE OF
PREMATURE DEATH WE FACE TODAY. AND THE PHS CONTINUES ITS EFFORTS
TO PROVIDE A "SMOKE FREE SOCIETY BY THE YEAR 2000,”
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ALCOHOL AND OTHER SUBSTANCE ABUSE CONTINUE TO GET GREAT
ATTENTION FROM THE PUBLIC AND THE PHS CONTINUES ITS WORK IN THE
PREVENTION AND TREATMENT OF THESE PROBLEMS,

GREAT NUMBERS OF THE POPULATION REMAIN WITHOUT ADEQUATE
INSURANCE COVERAGE AND ACCESS TO HEALTH CARE.

OTHER FIELDS OF ENDEAVOR COVER THE WHOLE GAMUT OF PUBLIC
HEALTH CONCERNS -- FROM CHILD ABUSE TO THE SPECIAL NEEDS OF THE
ELDERLY. FROM THE CARE OF THE HANDICAPPED TO THE REDUCTION OF
INTERPERSONAL VIOLENCE,
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WE IN THE PUBLIC HEALTH SERVICE ARE PROUD OF OUR 191 YEARS
OF SERVICE RELATED TO THE HEALTH OF THIS COUNTRY. WE ARE ALSO
PROUD TO BE ONE OF THE UNIFORMED SERVICES PROVIDING SECURITY FOR
THIS GREAT COUNTRY. WE LOOK FORWARD TO WORKING WITH YOU TO
INSURE THAT OUR SHARED VALUES REMAIN A STRONG COMPONENT OF OUR
FUTURE AND THAT OUR SHARED CONCERNS FIND HONORABLE SOLUTIONS,

BEST WISHES FOR THE REMAINDER OF THIS MEETING,