Public Health Service Operating Agencies

Public Health Service Operating Agencies

Order Code RL31940
CRS Report for Congress
Received through the CRS Web
Public Health Service Operating Agencies
Updated May 24, 2006
Janet Kinzer
Information Research Specialist
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress

Public Health Service Operating Agencies
Summary
The Public Health Service (PHS) originated in an act of July 16, 1798, that
authorized marine hospitals for the care of American merchant seamen. Over the
years, the scope and responsibilities of the act and the service have broadened. The
Public Health Service Act of July 1, 1944, revised and consolidated into one law all
legislation existing at that time relating to programs and activities of the PHS. The
act, codified at 42 U.S.C. § 201 et seq., has been amended and extended nearly every
year since 1944 and currently includes 28 titles. The most recent title was added
under P.L. 107-188, the Public Health Security and Bioterrorism Preparedness and
Response Act, to respond to the September 11, 2001, terrorist attacks and the
deliberate release of anthrax spores.
The PHS Act is administered by the Department of Health and Human Services
through operating agencies. Those agencies are the Agency for Healthcare Research
and Quality, the Agency for Toxic Substances and Disease Registry, the Centers for
Disease Control and Prevention (CDC), the Food and Drug Administration (FDA),
the Health Resources and Services Administration, the Indian Health Service (IHS),
the National Institutes of Health (NIH), and the Substance Abuse and Mental Health
Services Administration. These agencies administer more than 300 programs that
cover a wide spectrum of health-related activities. Total appropriations to these
agencies for FY2006 totaled more than $53 billion.
This report provides a short description of the PHS operating agencies. It will
be updated as needed.

Contents
Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Operating Agencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Agency for Healthcare Research and Quality (AHRQ) . . . . . . . . . . . . . . . . . 3
Agency for Toxic Substances and Disease Registry (ATSDR) . . . . . . . . . . . 3
Centers for Disease Control and Prevention (CDC) . . . . . . . . . . . . . . . . . . . 4
Food and Drug Administration (FDA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Health Resources and Services Administration (HRSA) . . . . . . . . . . . . . . . . 5
Indian Health Service (IHS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
National Institutes of Health (NIH) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Substance Abuse and Mental Health Services Administration
(SAMHSA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Agency Appropriations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
CRS Reports on Agency Appropriations . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
List of Tables
Table 1. Table of Contents of the Public Health Service Act . . . . . . . . . . . . . . . . 2
Table 2. PHS Agency Appropriations History FY2001-FY2006 . . . . . . . . . . . . . 7

Public Health Service Operating Agencies
Background
The Public Health Service Act (PHS Act) authorizes programs for the
promotion and coordination of research, investigations, experiments, demonstrations,
and studies relating to the causes, diagnosis, treatment, control, and prevention of
physical and mental diseases and impairments of man, including water purification,
sewage treatment, and pollution of lakes and streams.1 The Department of Health
and Human Services (HHS) is the executive branch department responsible for
carrying out the provisions of the act.
The Public Health Service originated in an act of July 16, 1798. That act
authorized marine hospitals to care for American merchant seamen. Over the years,
the scope and responsibilities of the PHS Act and the service have broadened. The
Public Health Service Act of July 1, 1944, revised and consolidated into one law all
legislation existing at that time relating to programs and activities of the PHS. The
act has been amended and extended nearly every year since 1944 and currently
includes 28 titles. A table of contents of the act is provided in Table 1.
Reorganization Plan No. 3 of 1966 transferred all statutory power and functions
of the Surgeon General and other officers and agencies of the PHS to the Secretary
of Health, Education, and Welfare (HEW).2 In 1979, the Department of Education
Organization Act, P.L. 96-88, provided for a separate Department of Education, and
the Department of Health, Education, and Welfare was redesignated as HHS,
officially on May 4, 1980. HHS has designated these eight agencies as public health
service operating divisions: the Agency for Healthcare Research and Quality, the
Agency for Toxic Substances and Disease Registry, the Centers for Disease Control
and Prevention, the Food and Drug Administration, the Health Resources and
Services Administration, the Indian Health Service, the National Institutes of Health,
and the Substance Abuse and Mental Health Services Administration.
In addition, HHS has been designated by presidential directive as the lead
federal agency in preparing to combat bioterrorism. HHS is to prevent, identify, and
respond to incidents of bioterrorism through the following PHS operating agencies:
Centers for Disease Control and Prevention, the Food and Drug Administration, the
Health Resources and Services Administration, and the National Institutes of Health.
1 Section 301 of the PHSA, codified at 42 U.S.C. § 241(a).
2 The House and Senate held hearings on President Johnson’s reorganization plan, but no
further legislative action was taken. The plan became effective June 25, 1966, 80 Stat. 1610.

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Table 1. Table of Contents of the Public Health Service Act
Title I
Short Title and Definitions
Title II
Administration and Miscellaneous Provisions
Title III
General Powers and Duties of Public Health Service
Title IV
National Research Institutes
Title V
Substance Abuse and Mental Health Services Administration
Title VI
Assistance for Construction and Modernization of Hospitals and Other
Medical Facilities
Title VII
Health Professions Education
Title VIII
Nursing Workforce Development
Title IX
Agency for Healthcare Research and Quality
Title X
Population Research and Voluntary Family Planning Programs
Genetic Diseases, Hemophilia Programs, and Sudden Infant Death
Title XI
Syndrome
Title XII
Trauma Care
Title XIII
Health Maintenance Organizations
Title XIV
Safety of Public Water Systems
Title XV
Preventive Health Measures with Respect to Breast and Cervical Cancers
Title XVI
Health Resources Development
Title XVII
Health Information and Health Promotion
Title XVIII
President’s Commission for the Study of Ethical Problems in Medicine
and Biomedical and Behavioral Research
Title XIX
Block Grants
Title XX
Adolescent Family Life Demonstration Projects
Title XXI
Vaccines
Title XXII
Requirements for Certain Group Health Plans for Certain State and Local
Employees
Title XXIII
Research with Respect to Acquired Immune Deficiency Syndrome
Title XXV
Prevention of Acquired Immune Deficiency Syndrome
Title XXIV
Health Services with Respect to Acquired Immune Deficiency Syndrome
Title XXVI
HIV Health Care Services Program
Title XXVII
Assuring Portability, Availability, and Renewability of Health Insurance
Coverage
National Preparedness for Bioterrorism and Other Public Health
Title XXVIII
Emergencies
Source: Compiled by CRS from U.S. House of Representatives, Committee on Energy and Commerce,
Compilation of Selected Acts Within the Jurisdiction of the Committee on Energy and Commerce, July 2001, and
P.L. 107-188, Public Health Security and Bioterrorism Preparedness and Response Act.

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Operating Agencies
Agency for Healthcare Research and Quality (AHRQ)
[http://www.ahrq.gov]
Title IX of the act establishes the Agency for Healthcare Research and Quality
(AHRQ) to enhance the quality, appropriateness, and effectiveness of health services,
and access to such services, through the establishment of a broad base of scientific
research and through the promotion of improvements in clinical and health system
practices, including the prevention of diseases and other health conditions.3 The
agency is required to (1) conduct research that develops and presents scientific
evidence regarding all aspects of health care; (2) synthesize and disseminate
scientific evidence for patients, consumers, practitioners, providers, purchasers,
policy makers, and educators; and (3) conduct initiatives to advance private and
public efforts to improve health care quality. The agency was created in 1989 as the
Agency for Health Care Policy and Research (Omnibus Budget Reconciliation Act,
P.L. 101-239). In 1999, it was redesignated as AHRQ and reauthorized until the end
of FY2005 (Healthcare Research and Quality Act, P.L.106-129). AHRQ had a
workforce of 295 full-time equivalents (FTE) and a program level budget of $319
million for FY2006.4 AHRQ receives its funding under the Department of Labor,
Health and Human Services, and Education, and Related Agencies Appropriations
Act (L-HHS-ED).
Agency for Toxic Substances and Disease Registry (ATSDR)
[http://www.atsdr.cdc.gov]
The Comprehensive Environmental Response, Compensation, and Liability Act
of 1980, P.L. 96-510, CERCLA, commonly known as the “Superfund” Act, created
ATSDR and provided the congressional mandate to remove or clean up abandoned
and inactive hazardous waste sites and to provide federal assistance in toxic
emergencies. ATSDR carries out the health-related responsibilities of CERCLA.
Further amendments to the Superfund laws authorized ATSDR to provide public
health assessments of waste sites, health consultations concerning specific hazardous
substances, health surveillance and registries, applied research in support of public
health assessments, information development and dissemination, and education and
training concerning hazardous substances. The Director of the Centers for Disease
Control and Prevention serves as the Administrator of ATSDR. The Superfund
Account provides funding for ATSDR activities. ATSDR receives its appropriations
under bills that provide funding for the Interior, Environment, and Related Agencies.
For FY2006, the agency had a workforce of 429 FTEs and had appropriations of $75
million.
3 Section 901 of the PHSA, codified at 42 U.S.C. § 299.
4 These figures and all other FY2006 figures referenced in this report come from
Department of Health and Human Services Budget In Brief, Fiscal Year 2007, available at
[http://www.hhs.gov/budget/07budget/2007BudgetInBrief.pdf].

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Centers for Disease Control and Prevention (CDC)
[http://www.cdc.gov]
CDC was established in 1946 as the Communicable Disease Center. Though
not established under the PHS Act, CDC is considered an agency of the PHS. The
Preventive Health Amendments of 1992, P.L. 102-531, amended several acts,
including the PHS Act, to rename the center. It is the agency responsible for the
prevention and control of diseases and other preventable conditions and for
responding to public health emergencies. CDC provides a system of health
surveillance to monitor and prevent disease outbreaks, implements disease prevention
strategies, maintains national health statistics, provides immunization services, and
monitors workplace safety. Its mission is to promote health and quality of life by
preventing and controlling disease, injury, and disability. For FY2006, CDC had a
workforce of 8,992 FTEs, and an appropriation of $5.9 billion under L-HHS-ED.
CDC is also the lead DHHS agency responsible for public health emergency
preparedness and response. Additional L-HHS-ED funds are earmarked for CDC to
fund the vaccines for children program, the Public Health and Social Service
Emergency Fund, and for PHS Evaluation transfers, making its total funding level
$8.4 billion for FY2006. CDC is composed of these organizational components:
! National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
! National Center for Chronic Disease Prevention and Health
Promotion (NCCDPHP)
! National Center for Environmental Health (NCEH)
! The National Center for Health Statistics (NCHS)
! National Center for HIV, STD, and TB Prevention (NCHSTP)
! National Center for Infectious Diseases (NCID)
! National Center for Injury Prevention and Control (NCIPC)
! National Immunization Program (NIP)
! National Institute for Occupational Safety and Health (NIOSH)
! Epidemiology Program Office (EPO)
! Public Health Practice Program Office (PHPPO)
! Office of the Director (CDC/OD)
Food and Drug Administration (FDA)
[http://www.fda.gov]
The origins of the FDA go back to the early 1800s when a group of physicians
met to establish the U.S. Pharmacopeia, the first drug compendium of standard drugs
for the United States. The Agency was officially established in 1906 under the Food
and Drugs Act, 34 Stat. 768, and enforced the food and drug laws under the
Department of Agriculture. President Johnson’s reorganization plan of 1966 (Plan
No. 3) placed the FDA in the Public Health Service, under the Secretary of Health,
Education and Welfare. The FDA assures the safety of foods and cosmetics, and the
safety and efficacy of pharmaceuticals, biological products and medical devices. It
is authorized to set and enforce standards for safety of all domestic and imported

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foods, except for meat, poultry, and certain egg products.5 FDA is funded through
user fee programs and receives appropriations under the Agriculture, Rural
Development, Food and Drug Administration, and Related Agencies Appropriations
Act. For FY2006, FDA had 10,176 FTEs, and a budget of $1.9 billion. FDA
operates through eight centers/offices:
! Center for Biologics Evaluation and Research (CBER)
! Center for Devices and Radiological Health (CDRH)
! Center for Drug Evaluation and Research (CDER)
! Center for Food Safety and Applied Nutrition (CFSAN)
! Center for Veterinary Medicine (CVM)
! National Center for Toxicological Research (NCTR)
! Office of the Commissioner (OC)
! Office of Regulatory Affairs (ORA)
Health Resources and Services Administration (HRSA)
[http://www.hrsa.gov]
HRSA was established on September 1, 1982, with the merger of the Health
Resources Administration and the Health Services Administration, two free-standing
agencies within the PHS. The decision, made within HHS, to combine the two
agencies was in response to budgetary reductions made over several years. HRSA’s
mission is to improve and expand access to quality health care for all. HRSA
provides access to essential health services for low-income, uninsured, isolated,
vulnerable and special needs populations and to meet their unique health care needs.
Among the programs administered by HRSA are the health centers program, the
maternal and child health block grant, the health professions program, the Ryan
White CARE Act, and rural health policy programs. HRSA received an increase in
funding for bioterrorism efforts and with this funding has instituted a Bioterrorism
Hospital Preparedness program. HRSA receives its appropriations from L-HHS-ED.
For FY2006, HRSA had 1,894 FTEs and a total budget of $6.6 billion. HRSA
operates through four bureaus:
! Bureau of Primary Health Care (BPHC)
! Bureau of Health Professions (BHPr)
! Maternal and Child Health Bureau (MCHB)
! HIV/AIDS Bureau (HAB)
Indian Health Service (IHS)
[http://www.ihs.gov]
The principal legislation authorizing federal funds for Indian health services is
the Snyder Act of 1921 (42 Stat. 208). The IHS was transferred from the Department
of the Interior to the former Department of HEW in 1955, P.L. 83-568. IHS provides
health services to members of federally-recognized tribes of American Indians and
Alaska Natives. Its mission is to raise the physical, mental, social, and spiritual
5 CRS Report 98-91, Food Safety Agencies and Authorities: A Primer, by Jean Rawson,
Alejandro Segarra, and Donna Vogt.

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health of American Indians and Alaska Natives to the highest level. IHS receives its
funding under appropriations for the Department of the Interior. IHS employed
15,549 FTEs in FY2006 and had a budget of $3.8 billion.
National Institutes of Health (NIH)
[http://www.nih.gov]
Title IV of the act authorizes National Research Institutes.6 NIH is the principal
biomedical research agency of the federal government. Founded in 1887 as the
Hygienic Laboratory, NIH now is composed of 27 centers and institutes, and an
Office of the Director. NIH supports more than 35,000 research projects in diseases
like cancer, Alzheimer’s, diabetes, arthritis, heart ailments, infant mortality, and
AIDS. Besides research efforts, NIH provides information through fact sheets,
hotlines, Medline, and clinical trials. NIH is principally funded under L-HHS-ED
and receives a small amount from VA/HUD for the National Institute of
Environmental Health Sciences. In FY2006, NIH had 17,336 FTEs, and a budget of
$28.6 billion. NIH operates through the following institutes or centers:
! National Cancer Institute (NCI)
! National Eye Institute (NEI)
! National Heart, Lung, and Blood Institute (NHLBI)
! National Human Genome Research Institute (NHGRI)
! National Institute on Aging (NIA)
! National Institute on Alcohol Abuse and Alcoholism (NIAAA)
! National Institute of Allergy and Infectious Diseases (NIAID)
! National Institute of Arthritis and Musculoskeletal and Skin
Diseases (NIAMS)
! National Institute of Biomedical Imaging and Bioengineering
(NIBIB)
! National Institute of Child Health and Human Development
(NICHD)
! National Institute on Deafness and Other Communication Disorders
(NIDCD)
! National Institute of Dental and Craniofacial Research (NIDCR)
! National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK)
! National Institute on Drug Abuse (NIDA)
! National Institute of Environmental Health Sciences (NIEHS)
! National Institute of General Medical Sciences (NIGMS)
! National Institute of Mental Health (NIMH)
! National Institute of Neurological Disorders and Stroke (NINDS)
! National Institute of Nursing Research (NINR)
! National Library of Medicine (NLM)
! Center for Information Technology (CIT formerly DCRT, OIRM,
TCB)
! Center for Scientific Review (CSR, formerly DRG)
! John E. Fogarty International Center (FIC)
6 Section 401 of the PHSA, 42 U.S.C. § 281.

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! National Center for Complementary and Alternative Medicine
(NCCAM)
! National Center on Minority Health and Health Disparities
(NCMHD)
! National Center for Research Resources (NCRR)
! Warren Grant Magnuson Clinical Center (CC)
Substance Abuse and Mental Health Services
Administration (SAMHSA)
[http://www.samhsa.gov]
SAMHSA was established under the Alcohol, Drug Abuse and Mental Health
Administration (ADAMHA) Reorganization Act, P.L. 102-321, on October 1, 1992,
and placed under Title V of the PHS Act.7 (Its predecessor agency, ADAMHA, was
established in 1974.) SAMHSA is the federal agency charged with improving the
quality and availability of prevention, treatment, and rehabilitative services to reduce
illness, death, disability, and cost to society resulting from substance abuse and
mental illnesses. SAMHSA administers categorical, formula, and block grant
programs to local communities and states and private entities to address the needs of
substance abuse and mental illness. In FY2005, SAMHSA employed 558 FTEs and
had a budget of $3.3 billion. SAMSHA is funded under L-HHS-ED and its centers
of operation are as follows:
! Center for Mental Health Services (CMHS)
! Center for Substance Abuse Prevention (CSAP)
! Center for Substance Abuse Treatment (CSAT)
Agency Appropriations
Appropriations are part of a complex federal budget process that includes budget
resolutions, appropriations bills, rescissions, and budget reconciliation. Table 2
below provides appropriations history for these PHS operating agencies.
Table 2. PHS Agency Appropriations History FY2001-FY2006
($ in billions)
Agency
FY2002 FY2003 FY2004 FY2005 FY2006
Agency for Healthcare Research and
Quality
$ .298
$ .303
$ .304
$ .319
$ .319
Agency for Toxic Substances and
Disease Registry
.081
.082
.073
.076
.075
Centers for Disease Control and
Prevention
6.5
6.8
6.9
7.9
8.4
Food and Drug Administration
1.6
1.7
1.7
1.8
1.9
7 Section 501 of the PHSA, 42 U.S.C. § 290aa.

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Agency
FY2002 FY2003 FY2004 FY2005 FY2006
Health Resources and Services
Administration
6.4
6.9
7.2
7.3
6.6
Indian Health Service
2.9
3.5
3.7
3.7
3.9
National Institutes of Health
23.5
27.3
28.0
28.6
28.6
Substance Abuse and Mental Health
Services Administration
3.1
3.2
3.4
3.4
3.3
Totals
44.379
49.785
51.277
53.095
53.094
Source: Department of Health and Human Services Budget In Brief, Fiscal Year 2007, available at
[http://www.hhs.gov/budget/07budget/2007BudgetInBrief.pdf].
CRS Reports on Agency Appropriations
CRS Report RL32952. Labor, Health and Human Services, and Education: FY2006
Appropriations, by Paul M. Irwin.
CRS Report RL32904. Agriculture and Related Agencies: Appropriations for
FY2006, by Jim Monke, Coordinator.
CRS Report RL32893. Interior, Environment and Related Agencies: Appropriations
for FY2006, by Carol Hardy Vincent and Susan Boren, Coordinators.