The Reports of the Surgeon General

	Brief History Changing Conceptions of Public Health The 1964 Report on Smoking and Health Secondary Smoking, Individual Rights, and Public Space The AIDS Epidemic Public Health and Disease Prevention Reports of the Surgeon General after 2000
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In a health care system chiefly directed towards treating disease and surgical intervention, the Surgeon General has pursued a complementary strategy: disease prevention and health promotion. Appointed by the President with the advice and consent of the Senate, the Surgeon General--whose title means chief surgeon--is the federal government's principal spokesperson on matters of public health. The first Surgeon General was appointed in 1871 to head the Marine Hospital Service, itself established in 1798 to minister to sick and injured merchant seamen and reorganized as the U.S. Public Health Service in 1912. In recent decades, the Surgeon General has become the most widely recognized and respected voice on public health issues, preventive medicine, and health promotion through public appearances, speeches, and, most influentially, the reports featured on this Web site. The Surgeon General has often been called upon to deal with difficult and controversial issues, such as smoking and sexual health. In some cases, the public health message has generated controversy, when it ran counter to the political beliefs of the time. But the Surgeon General's public statements often served to generate debate where there had been silence, to the benefit of the nation's health.

The role of the Surgeon General has changed much during the past four decades. As the head of the Public Health Service (PHS), for over half a century the Surgeon General oversaw infectious disease eradication, rural sanitation, medical research, the provision of medical and hospital care to members of the Coast Guard and Merchant Marine, and other public health activities. Until 1968, the Surgeon General's main responsibility was the day-to-day administration of the U.S. Public Health Service and its many programs, including directing the uniformed Commissioned Corps of physicians, dentists, nurses, pharmacists, sanitary engineers, and other health professionals that has been the institutional mainstay of PHS.

In 1968, an organizational reform greatly reduced the Surgeon General's administrative role, abolishing the Office of the Surgeon General (though not the position of Surgeon General itself) and transferring line authority for the administration of PHS to the Assistant Secretary for Health within the Department of Health, Education, and Welfare (since 1980, the Department of Health and Human Services). Since 1968, the Surgeon General has not administered the Public Health Service, and his/her main official duty has been to advise the Secretary of Health and Human Services and the Assistant Secretary of Health on affairs of preventive health, medicine, and health policy. Left with few bureaucratic tasks, the Surgeons General since the 1960s have undertaken a more proactive role in informing the American public on health matters. They have relied on their professional credentials (all Surgeons General have been MDs) and political independence to make themselves into the most visible and, in the public's mind, impartial and therefore trusted government spokespersons on health issues affecting the nation as a whole.

Brief Chronology

• 1912 --The Marine Hospital Service is reorganized as the U.S. Public Health Service
• 1913 --R. J. Reynolds launches Camel, the first modern mass-produced cigarette made from blended tobacco
• 1917 --Cigarettes are included in the field rations of American soldiers in World War I
• 1928 --Herbert L. Lombard and Carl R. Doering offer the first detailed statistical data showing a higher proportion of heavy smokers among lung cancer patients than among controls
• 1929 --U.S. Surgeon General Hugh S. Cumming (1920-1936) cautions that smoking causes nervousness and insomnia, particularly among women
• 1938 --Raymond Pearl demonstrates statistically that smoking shortens life expectancy
• 1941-45 --Tobacco is supplied to American servicemen in World War II
• 1942 --In-vitro experiments establish that tars, solid particles of partially burnt tobacco, can act directly on cells to produce neoplasm, or new and abnormal growth
• 1953 --Ernest Wynder, a researcher at Sloan-Kettering Cancer Center, paints smoke condensate on the skin of mice, producing cancerous tumors in 44 percent of the animals
• 1957 --Surgeon General Leroy E. Burney (1956-1961) declares it to be the official position of the U.S. Public Health Service that a causal relationship exists between smoking and lung cancer (June 12)
• 1964 --Surgeon General Luther L. Terry (1961-1965) issues Smoking and Health, the first Surgeon General's report to receive widespread media and public attention (January 11)
• 1965 --Congress mandates health warnings on cigarette packs
• 1957 --Surgeon General Leroy E. Burney (1956-1961) declares it to be the official position of the U.S. Public Health Service that a causal relationship exists between smoking and lung cancer (June 12)
• 1968 --The Office of the Surgeon General is abolished and the position becomes that of an advisor to the Secretary of Health, Education, and Welfare, and to the Assistant Secretary of Health. The Surgeon General no longer directly administers the U.S. Public Health Service
• 1969 --The Public Health Cigarette Smoking Act passes Congress. It imposes a ban on cigarette advertising on television and radio after September 30, 1970, and requires that the Surgeon General produce an annual report on the latest scientific findings on the health effects of smoking
• 1973 --Arizona passes the first state law designating separate smoking areas in public places
• 1979 --Surgeon General Julius B. Richmond issues Healthy People: The Surgeon General's Report on Health Promotion and Disease Prevention, emphasizing the role of nutrition, exercise, environmental factors, and occupational safety in advancing health
• 1980 --With the report Maternal and Infant Health, the Surgeon General takes up a subject that has been a focus of federal social policy since the creation of the Children's Bureau in 1912
• 1981 --Acquired Immune Deficiency Syndrome (AIDS) is first diagnosed
• 1983 --Lung cancer surpasses breast cancer as the leading cause of death from cancer in women
• 1986 --Surgeon General C. Everett Koop (1981-89) releases The Surgeon General's Report on Acquired Immune Deficiency Syndrome, describing AIDS as a preventable, manageable chronic disease
• 1987 --The Office of the Surgeon General is reestablished with the Surgeon General as supervisor of the personnel system of the Commissioned Corps of the U.S. Public Health Service
• 1987 --Congress bans smoking on all domestic flights of two hours or less; two years later smoking is banned on all domestic flights
• 1992 --The Environmental Protection Agency places passive smoke on its list of major carcinogens, making it subject to federal workplace and other regulations
• 1999 --Surgeon General David Satcher publishes Mental Health, marking an expansion of the Surgeon General's concerns beyond a predominant focus on diseases of the body
• 2000 --California becomes the first state to ban smoking in bars and restaurants