COMPARISON OF ROLES OF ASSISTANT SECRETARY FOR HEALTH AND SURGEON GENERAL Prior to 1968 SC o Line responsibilities over all PBS agencies. Control of all personnel and budget. o Statutory responsibilities of the SG, e.g., transport of hazardoue 8UbStance8; joint travel regulations. SG was the professional spokesman on health matters. Ihe best minds in the PHS provided the scientific and background information to the SG who had the respect of Congress, Government and public. * `Iv10 Individual8 ** One IndivFdual 1968 - 1971 I a Assistant Secretary for Healtt Ind Scientific Affairs and SG* ASH - o Special Assistant to: the,,: Secretary (Health end *. Medical Affairs) appointed .. by President. Review the health and medical program8 of the Department and advise the Secretary. Rank and pay comparable to Assistant Secretary. o Retained some statutory reSpon8ibilitie8, e.g.,, transport of hazardous substances; joint travel regulations. o Line responsibility over agenciee. o High level policy'advisor to ASH on health policy, program, legislative, planning and evaluation proposal8 and professional personnel issues. SG8 position began to erode when Dr. Egeberg was ASH and Dr. Steinfeld the SG. o Represent8 ASH at Depart- mental, interdepartmental, national and international meeting8. o Designate8 PHS professionals to serve a8 PHS representa- tives, e.g., Association of Military Surgeon8 of the U.S. (AMSUS); American Board of Cardiology. Acting SG Appointed. Office of SG Informally Recreated. 0 Stronger input into policy and management Issues. o Responsible for review of health professional personnel i88Ue8. Office of SG was not, established since ASP-SC were the same person and SG Statutory authorities were delegated to the Deputy SG within the Off ice of the Deputy, SC, 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 na one kpokesman who had legitimacy in the eye8 of the health profession8 or the public. 1977 ASH - SC** Delegations to Deputy SG o Rx officio member Board of Regents Uniformed Service8 UniGersity of the Health Science8 (USUHS) --. 0 Principal liaison for operations with USUHS Medical School. o Rx officio member Board of Regent8 Armed Force8 Institute of Pathology and National Library of Medicine. o 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 lbnployee Assistance Program (PHEAP) . 0 Professional focus for Chief Professional Officers (11 category dieciplines). o Chief Advisor to ASH-SC health professional person- nel i88ueS and personnel policy actions. . o Responsibility for Commi88ioned Corps Awards recommended by Boards. o Delegation of Commissioned Corps medical standard8 and determine final action regarding medically related personnel actions. o Oversight of bilateral agreement with 20 countries. Dr. Richmond began to use the SG title more and more a8 time went on as he recognized it8 credibility with the health professions and the public. 1982 ASH* - o Line authority over PHS agencies : - Control of PHS budget - Supervises PHS Agency Head8 o Direct8 OASH Operating Division Head8 In their myriad reSpon8ibilitie8 and appoints task forces to advise ASH in action leading to policy. 0 Direct8 activities of all Deputy Assistant Secretaries of Health to a88ure uniform interpretation and imple- mentation of policies. The Deputy Assistant Secretary for Health-SC ha8 uncertain and indefinlte 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 admin+stration 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.thlrik-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.