This category includes government establishments primarily engaged in planning, administration, and coordination of public health programs and services, including environmental health activities, mental health, categorical health programs (e.g., cancer control, communicable disease control, maternity, child health), health statistics, and immunization services.
Administration of Public Health Programs
The U.S. public health system consists of programs administered by federal, state, and local government agencies; voluntary health care and research associations, such as the American Red Cross and the American Cancer Society; and professional associations, such as the American Medical Association and American Dental Association. Although several agencies of the federal government had responsibility for aspects of public health, the U.S. Department of Health and Human Services (DHHS) is the principal federal health agency.
The Department of Health and Human Services (DHHS) oversees most of the U.S. government's health programs. It is headed by the secretary of health and human services, a cabinet-level position appointed by the president and confirmed by the Senate. The surgeon general, the chief medical officer, and various agency heads report to the secretary. In 2003 the department employed 65,500 people and had a budget of $502 billion. These numbers both increased from 1999, when the department employed 59,800 workers and had a budget of $387 billion. DHHS' operations are divided between Public Health Operating Divisions, which include much of what was formerly the Public Health Service, and Human Services Operating Divisions, which include Medicare, Medicaid, and the Administration for Children and Families. The human services divisions are discussed in greater detail under SIC 9441: Administration of Social, Human Resource, and Income Maintenance Programs.
Major divisions of the DHHS include the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control, the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, the Agency for Toxic Substances and Disease Registry, the Indian Health Service, and the Agency for Healthcare Research and Quality.
This top-level agency includes National Cancer Institute; the National Eye Institute; the National Heart, Lung, and Blood Institute; the National Human Genome Research Institute; the National Institute on Aging; the National Institute on Alcohol Abuse and Alcoholism; the National Institute of Allergy and Infectious Diseases; the National Institute of Arthritis and Musculoskeletal and Skin Diseases; the National Institute of Biomedical Imaging and Bioengineering; the National Institute of Child Health and Human Development; the National Institute on Deafness and Other Communication Disorders; the National Institute of Dental and Craniofacial Research; the National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute on Drug Abuse; the National Institute of Environmental Health Sciences; the National Institute of General Medical Sciences; the National Institute of Mental Health; and a number of others. Almost all of the NIH institutes and research centers are located in Bethesda, Maryland. In 2003, the NIH had 17,693 employees, including roughly 4,500 scientists and medical personnel, and a budget of $27.2 billion.
The FDA is responsible for enforcing the Food, Drug, and Cosmetic Act of 1938 and the Drug Amendments Act of 1962, which were designed to ensure the purity of food products and the safety and effectiveness of drugs, cosmetics, and therapeutic devices. The FDA inspects all food and drug manufacturing facilities, enforces sanitary standards at restaurants and other public eating places, establishes labeling requirements for food and drugs, and reviews test results on all drugs before they are approved for use in the United States. The FDA had more than 10,479 employees in 2003, including roughly 2,000 scientists and 1,000 inspectors and investigators. The FDA's 2003 budget totaled $1.7 billion.
The CDC, located in Atlanta, Georgia, maintains records on the incidence of disease and provides information to health agencies worldwide. The agency also investigates the causes and works with state health care agencies to control the outbreak of diseases and administers the U.S. quarantine program at ports of entry. The CDC includes the Center for Chronic Disease Prevention and Health Promotion; the Center for Environmental Health and Injury Control; the Center for Infectious Diseases; the Center for Prevention Services; the National Center for Health Statistics; and the National Institute for Occupational Safety and Health. The CDC also administers the Agency for Toxic Substances and Disease Registry, which was established in 1980 by the Comprehensive Environmental Response, Compensation, and Liability Act to clean up hazardous waste sites. The Public Health Service is responsible for identifying the health risks involved with toxic wastes and developing ways to lessen the danger of working with hazardous substances. In 2003 the CDC employed a workforce of 8,668 people and had a budget of $6.8 billion.
Created in 1992, the Substance Abuse and Mental Health Services Administration is responsible for developing substance abuse treatment and prevention programs in conjunction with state and local agencies, as well as programs to promote mental health. The division also supports efforts to develop local mental health facilities by providing leadership and federal grants. Approximately 588 persons staffed the agency in 2003 with a budget of $3.2 billion.
The HRSA is charged with improving health care services in areas without adequate resources. The agency is responsible for the National Health Service Corps, which recruits and assigns physicians, dentists, and nurses to areas with a shortage of health care professionals. The agency also provides grants for health care education and administers well-child programs through the Bureau of Maternal and Child Health and Resources Development. In 2003 this agency's $7.1 billion budget was implemented by a workforce of 1,937 people.
With 14,961 employees, including roughly 1,270 physicians and dentists and 2,700 nurses, the IHS is responsible for providing health care to more than 1.5 million Native Americans. The IHS has 63 health centers, 44 health stations, 36 hospitals, and 5 residential treatment centers under federal management. In addition, it has 445 health care facilities under the direction of Indian tribes or Alaska Native corporations, including 13 hospitals and 170 Alaskan village clinics. The Bureau of Indian Affairs transferred responsibility for Native American health care to the Public Health Service in 1955. The Indian Health Service was elevated to agency status in 1988. Its 2003 expenditures were budgeted for $3.5 billion.
Established in 1989, the Agency for Healthcare Research and Quality focuses on improving the quality of patient care. It also assesses new health care technologies, promotes health care services in rural areas, and investigates questions of medical malpractice and liability. This agency employed 294 persons and had a $309 million budget in 2003.
Several public health programs are conducted by the Office of the Assistant Secretary for Health. These include population research and family planning by the Office of Population Affairs, the promotion of healthy lifestyles by the Office of Disease Prevention and Health Promotion, the President's Council on Physical Fitness and Sports, special health initiatives for minorities, and the National AIDS Program.
Early efforts to provide for the public health in the United States were concerned with quarantine and sanitation. As early as 1795, the governor of New York appealed to the state medical society for help in controlling epidemics. The medical society recommended improving drainage in low-lying areas, collecting refuse from along river banks, controlling the air pollution from slaughter houses and soap factories, and generally cleaning up "the accumulation of filth in the street."
The U.S. Public Health Service traced its beginnings to 1798, when Congress authorized the Marine Hospital Fund for the "care and relief of sick and disabled seamen." The fund was financed by a 20-cents-per-month tax on merchant seamen and administered by the Treasury Department. The first Marine Hospital was established on Castle Island in Boston Harbor in 1799. Other hospitals, often small facilities located in boarding houses, were eventually established in port cities from Newport, Rhode...