In 1887, the federal government opened a one-room research laboratory within the Marine Hospital Service. This small Staten Island laboratory was the modest forerunner of the National Institutes of Health. The 1906 Pure Food and Drugs Act added regulatory authority to a small chemistry department—then in the Department of Agriculture—that we now know as the Food and Drug Administration. The Social Security program, enacted in 1935, was placed in the department, and in 1946, the Communicable Disease Center—parent of today’s Centers for Disease Control and Prevention—was born, when a highly successful Public Health Service (PHS) program on malaria control was expanded to include other communicable diseases.
Congress created the cabinet-level Department of Health, Education, and Welfare (HEW) in 1953. Twelve years later, the department acquired two new programs—Medicare and Medicaid, which in the past 40 years have completely reshaped the U.S. health care system. Despite its growing size and multiplicity of responsibilities, the department’s three-part mission remained intact until a separate Department of Education was created in 1979. Loss of the “E” in HEW prompted a name change, and the department became HHS the following year. In 1995 it lost much of the “W,” when the Social Security Administration became an independent agency.
Today, the department has 11 operating divisions, has 15 staff divisions, and implements more than 300 programs (HHS, 2008). Figure 1-2 shows how total department spending for FY 2007 was distributed across agencies and programs, and Figure 1-3 shows the trend in financial resources of the PHS agencies, with the National Institutes of Health (NIH) accounting for the largest share.