Since the Office of Surgeon General was established in 1871, only 17 individuals have held the office on a permanent (not “acting”) basis. The surgeon general holds the three-star rank of vice admiral, reports to the ASH, and serves a four-year term, which can be renewed for a second term. Since the expiration of Richard Carmona’s four-year term in July 2006, the United States has not had a permanent surgeon general.

The surgeon general also oversees the operation of the 6,000 public health professionals in the Commissioned Corps of the Public Health Service, who serve in full-time capacities in agencies and programs throughout the federal government. Commissioned Corps members are available around the clock to meet public health emergencies anywhere in the United States and, sometimes, the world. Because of the emergency nature of these assignments, the surgeon general must have a smoothly operating management structure and good communication with the ASH, the assistant secretary for preparedness and response, and other HHS agencies involved in emergency response, in order to enable rapid mobilization.1

The President appoints the surgeon general, subject to Senate confirmation, and on occasion these appointments have proved controversial. Surgeon General Joycelyn Elders held an expansive view of sex education, which made her a lightning rod for criticism and led to her exit from office (Elders, 1996). After Surgeon General Richard Carmona left office, he accused the administration of silencing him on embryonic stem cell research, abstinence-only sex education, contraception, climate change, prison health, and mental health, and discouraging him from supporting the Special Olympics (Harris, 2007).

In July 2007 testimony before the House Committee on Oversight and Government Reform, former Surgeon General C. Everett Koop said that, when working on his report on HIV/AIDS and a subsequent mailer, he and the secretary had to maintain strict secrecy throughout the process. If they had “followed protocol and had every word scrutinized by the secretary’s secretariat,” he said, “these reports, because of their nature and plain speaking, would not have seen the light of day” (Koop, 2007). Although the nation’s senior health advocate should speak with discretion, the surgeon general should be free to openly discuss important


In recent years, the surgeon general has deployed these well-trained individuals to respond to the terrorist attacks of 9/11 and to natural disasters, including Hurricanes Katrina and Rita and the Indian Ocean tsunami, where they provided medical and public health services and humanitarian assistance.

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