The surgeon general of the United States is the leading spokesperson on public health issues for the federal government. Nominated by the president and confirmed by the U.S. Senate, the surgeon general is also the head of the Public Health Service Commissioned Corps (PHSCC).
The PHSCC is one of seven uniformed services of the federal government. This group includes the U.S. Army, the U.S. Navy and other military services. As a result, the Office of the Surgeon General (OSG) and the PHSCC are organized in a military fashion — its members wear uniforms almost identical to U.S. Navy uniforms and hold military-style ranks even though they serve in noncombatant roles.
In 2013, President Barack Obama nominated Dr. Vivek Murthy of Harvard Medical School and Brigham and Women's Hospital in Boston as surgeon general. Until Murthy is confirmed by the Senate, Acting Surgeon General Boris D. Lushniak remains head of the OSG and the PHSCC. [7 Declassified Military & CIA Secrets]
Despite the position's military overtones, the surgeon general reports to the assistant secretary for health, a position within the U.S. Department of Health and Human Services. Each surgeon general — sometimes called "the nation's doctor" — serves a four-year term, which may be extended by the president.
The surgeon general may be called upon to address health emergencies, such as epidemics, environmental crises or other medical situations. The surgeon general is also one of the leading advocates for public health, though some surgeon generals have used the office's "bully pulpit" more assertively than others.
In 1964, for example, Surgeon General Luther L. Terry released the report of the Surgeon General's Advisory Committee on Smoking and Health. That report, which sent shock waves throughout the medical field — and the tobacco industry — concluded that smoking is a direct cause of lung cancer and chronic bronchitis, and is linked to several other diseases and conditions.
C. Everett Koop, appointed surgeon general by President Ronald Reagan in 1981, was expected to espouse conservative positions against abortion and other practices. Instead, he created widespread controversy by claiming that abortion was an individual moral issue, not a psychological health issue.
Koop also recommended sex education for grade-school students, the use of condoms to prevent the spread of AIDS and regulations to create smoke-free environments due to concerns about second-hand smoke — positions that infuriated Reagan's right-wing colleagues.
Fifty years after the first surgeon general's report on smoking, Lushniak issued a report that blamed smoking for type 2 diabetes, age-related macular degeneration, erectile dysfunction, rheumatoid arthritis and a host of other conditions.
As a result of these and other efforts, smoking rates have decreased substantially: In 1965, 42 percent of U.S. adults were regular smokers, but only 18 percent regularly smoked in 2012 — proof that the surgeon general can be an influential advocate for public health in the United States.