Surgeon General: No Longer Relevant?
Written by Editor   
Wednesday, July 02, 2014 08:08 AM

Once "the kings of U.S. public health," surgeons general have seen their powers gutted to the extent that the post should be done away with, according to one expert.  "It's probably time to get rid of the surgeon general." The position is at a nadir and unlikely to rise again in the perennially risk-averse political climate, one author concluded after seven years of research and interviews.  Yet there's evidence suggesting the public health message is just not getting through.

"Federal reorganizations in the 1960s stripped away most of the job's responsibilities and gave them to people appointed by whoever was in the White House at the time. ... The surgeon general, meanwhile, became a bench-riding bureaucrat and glorified health educator." [1]

Physicians are really in kind of a tough spot. Public health issues are touchy topics and the doctor is trying to get through so many issues and tasks with each patient. When we had a strong surgeon general talking about smoking or talking about HIV, it has been a big help to many physicians in broaching the topic or even getting some patients on the same page as physicians even before they walk in the door. It's a tall order to ask each physician in the country to do the surgeon general's work, to do all the public health communications, to sell them on vaccinations, to sell them on taking it easy on sun tanning, to sell them on taking it easy on the weight. There are a lot of things that an effective and aggressive surgeon general could help the public and the physicians communicate with." [1]

As the Nation’s Doctor, the Surgeon General provides Americans with the best scientific information available on how to improve their health and reduce the risk of illness and injury.  In 2010, the Affordable Care Act designated the Surgeon General as the Chair of the newly formed National Prevention Council, which provides coordination and leadership among 20 executive departments with respect to prevention, wellness, and health promotion activities.  The Surgeon General is nominated by the President of the United States with advice and consent of the United States Senate for a four-year term of office. [2]

The Surgeon General oversees the U.S. Public Health Service Commissioned Corps (USPHS), an elite group of more than 6,800 uniformed officer public health professionals working throughout the Federal government whose mission is to protect, promote, and advance the health of our Nation.  Additionally, the Office of the Surgeon General is the headquarters for the Civilian Volunteer Medical Reserve Corps, a national network of more than 200,000 volunteers committed to improving the public health, emergency response, and resiliency of their communities. [2]

In 1798, Congress established the U. S. Marine Hospital Service—predecessor of today's U.S. Public Health Service—to provide health care to sick and injured merchant seamen. In 1870, the Marine Hospital Service was reorganized as a national hospital system with centralized administration under a medical officer, the Supervising Surgeon, who was later given the title of Surgeon General. On January 4, 1889, the Congress recognized this new personnel system by formally authorizing the Commissioned Corps. The Corps was established along military lines to be a mobile force of professionals subject to reassignment to meet the needs of the Service. Originally, the Corps was composed only of physicians. However, over the years, as the functional responsibilities of the Public Health Service (PHS) and the Corps have broadened, a commensurate broad range of health professionals has been included. [3]

Prior to 1968, the Surgeon General was the head of the PHS, and all program, administrative, and financial management authorities flowed through the Surgeon General, who reported directly to the Secretary of Health, Education, and Welfare. In 1968, pursuant to a reorganization plan issued by President Lyndon B. Johnson, the Secretary delegated line responsibility for the PHS to the Assistant Secretary for Health. The Office of the Surgeon General was abolished and the position of Surgeon General became that of a principal deputy to the Assistant Secretary for Health with responsibility for advising and assisting on professional medical matters. In addition, a primary role developed in which the Surgeon General became the PHS spokesperson on certain health issues. [3]

In 1987, the Office of the Surgeon General (OSG) was reestablished as a staff office within the Office of the Assistant Secretary for Health. There currently are more than 6,700 officers on active duty. Officers are assigned to all of the PHS Agencies and to a number of agencies outside of PHS, including the Bureau of Prisons, U. S. Coast Guard, Environmental Protection Agency, Health Care Financing Administration, and the Commission on Mental Health of the District of Columbia. [3]

The politicalization of surgeon general selection should be eliminated, rather than scrapping "the nation's doctor," a former holder of that post argued.   The 17th Surgeon General, Richard Carmona, MD, MPH, commented "It is an extremely important role and one that the public recognizes as important because of the credibility of the surgeon general. I would argue very strongly that more than ever we need the office of surgeon general today, as we do the U.S. Public Health Service." [4]

Says Carmona, "The challenge has been more a political one than any issue of relevance to the office of surgeon general. If you go back to the late '60s and early '70s the surgeon generals were always promoted from within the ranks in a merit system and this is the same system that the other services follow. The Army, Navy, and Air Force have surgeons general too. Their secretary offers a name to the White House, the president nominates, the same process takes place and ultimately the Senate confirms that person. The departure started few decades ago when both parties started to politicize the office and go outside of the system and pretty much ignore the career officers in the uniformed system in hopes of probably finding someone that may be more aligned to the political party in power at that time. I think it's wrong for a lot of reasons. First and foremost, it's devaluing the service of career officers. In the Army, Navy, and Air Force you never see those challenges. It becomes an embattled position because of the politics."  [4]

"The surgeon general really is not the doctor of the Democratic or Republican party; you are the nation's doctor. I look at the surgeon general's office much like we look at the Federal Reserve or even a Supreme Court Justice. You are supposed to rise above the political bias and rule on the best finance information, the best law information, and, the surgeon general, opining on the best scientific information."  [4]

"I think we should revert back to promotions to U.S. Surgeon General based on merit from the career public service officers who merit consideration because they have dedicated their lives to the health, safety, and security of the nation. Number two, would be to reaffirm that the surgeon general is the commander of the U.S. Public Health Service and that the surgeon general should be involved interpreting and understanding complex science and translating it to the American public, translating it to Congress, translating it to the secretaries in other departments. Last, my recommendation to Congress and the president would be that we should not ask, but demand, that that the surgeon general prepare a State of the Nation's Health every year and that would include an assessment of global health because we are inextricably tied to the rest of the world. And it should include what are the challenges that we're facing now, whether they be infectious diseases, whether they be chronic diseases, whether they be the long-term effects on our veterans in the war effort -- there are so many issues that our government are involved in where there's an intersection of health, or safety, or security. The surgeon general is the interface there as well."  [4]

"The fact is this is a very valued position both to the American public and to America in general. I strongly believe a strong surgeon general and a strong Public Health Service is in best interest of the United States and, in some cases, the rest of the world."  [4]

Sources: [1]