The late Dr. C. Everett Koop was the first Surgeon General to become a household name, while waging battles against smoking and the spread of AIDS. But Koop merely continued a tradition that began in 1870, when the Marine Hospital Fund, established to provide care for disabled seamen, was reorganized as a national Marine Hospital Service, with a Supervising Surgeon, Dr. John Maynard Woolworth.
Dr. Woolworth designed the fouled anchor and caduceus seal still used by the Public Health Service, which became the successor organization in 1912. Woolworth also formally established the Public Health Service Commissioned Corps along military lines, one of the seven uniformed services of the United States Government. The Surgeon General carries the rank of a three star vice-admiral.
The mission of the Public Health Service has expanded from a focus on disabled seamen to "protecting, promoting and advancing the health and safety of the nation." The Public Health Service can be rapidly deployed during public health emergencies, which was done most recently in the response to Hurricane Sandy. Corps officers, including the Surgeon General, wear uniforms modeled on those of the U.S. Navy.
An early activist Surgeon General was Rupert Blue, due to the press of circumstances. He had made his reputation as a member of the Health Service fighting an outbreak of bubonic plague in San Francisco's Chinatown. He became Surgeon General in 1912, at a time when the Health Service was reoriented toward research and oversight of interstate quarantine. Repeated outbreaks of typhoid focused research on the role of contaminated water on the spread of disease. In 1917, the Health Service was charged with the health of newly recruited soldiers as the U.S. entered World War I. These duties were expanded still further with the devastating outbreak of the Spanish Flu, a year later.
Luther Terry, appointed Surgeon General by John F. Kennedy, caused considerable controversy when he established the Surgeon General's Advisory Committee on Smoking and Health. With Terry as chair, the committee issued a report implicating cigarette smoking as a potential causative agent in cancer, emphysema, and cardiovascular disease. The Federal Trade Commission voted to require warnings on cigarette packs in June, 1964.
In 1988, C. Everett Koop increased the pressure on the tobacco firms with his report that nicotine was addicting like other narcotic drugs. This assertion led indirectly to the ludicrous spectacle of tobacco committee CEOs testifying before a 1994 Congressional committee that nicotine was not addictive, contrary to the experience of millions of tobacco smokers.
Koop was surgeon general when the AIDS epidemic made its first rapid expansion in the U.S. Koop took the unprecedented step of mailing accurate information about AIDS transmission to every household in the United States. This infuriated several groups, but for different reasons. Gays felt unfairly signaled out, although homosexual sex was one of the primary routes for infection by HIV early on. Social conservatives were upset over the frank discussion of sex, the recommendation of condom use, and the promotion of sex education in schools. Some health activists were angry that Koop was advocating a public health approach rather than promoting a vaccine or the search for effective drugs.
Though personally opposed to abortion, Koop was credited for resisting the Reagan administration pressure to find that abortion was psychologically traumatic to women or had other negative health effects. Although the so-called "Koop report" was never officially released, it became public after being subpoenaed by a Congressional committee in 1989.
In accepting the nomination as the current Surgeon General in 2009, Regina Benjamin made clear her dissatisfaction with the cost of the current health care system and its uneven accessibility. In 2010, she published The Surgeon General's Vision for a Healthy and Fit Nation, in which she noted the epidemic of overweight and obese Americans and offered some solutions, focused mainly on increased exercise. The report was negatively reviewed by New York Times food columnist Mark Bittman for not taking on the food industry for their role in marketing junk food.