Exhibit 4-1: U.S. Public Health Service Agencies

Health Resources and Services Administration (HRSA)

HRSA helps provide health resources for medically underserved populations. The main operating units of HRSA are the Bureau of Primary Care, Bureau of Health Professions, Maternal and Child Bureau, and the HIV/AIDS Bureau. A nationwide network of 643 community and migrant health centers, plus 144 primary care programs for the homeless and residents of public housing, serve 8.1 million Americans each year. HRSA also works to build the health care workforce and maintains the National Health Service Corps. The agency provides services to people with AIDS through the Ryan White Care Act programs. It oversees the organ transplantation system and works to decrease infant mortality and improve maternal and child health. HRSA was established in 1982 by brining together several existing programs. HRSA has 2,100 employees and is headquartered in Rockville, MD.

The Indian Health Service (IHS)

The IHS operates 37 hospitals, 60 health centers, 3 school health centers, and 46 health stations. It assists 34 urban Indian health centers. Services are provided for nearly 1.5 million American Indians and Alaska Natives of 557 federally recognized tribes through a workforce of approximately 14,500 employees and an additional tribal and urban Indian health workforce of approximately 10,000. Annually there are about 90,000 hospital admissions and 7 million outpatient visits, 4 million community health representative client contacts, and 2.4 million dental services. HIS was established in 1924; its mission was transferred from the Interior Department in 1955. Agency headquarters are in Rockville, MD.

Centers for Disease Control and Prevention (CDC)

Working with states and other partners, CDC provides a system of health surveillance to monitor and prevent disease outbreaks, and maintains national health statistics. CDC also provides for immunization services, supports research into disease and injury prevention, and guards against international disease transmission, with personnel stationed in more than 25 foreign countries. CDC was established in 1946 (see Exhibit 4-1); its headquarters are in Atlanta, GA. CDC has 7,100 employees.

National Institutes of Health (NIH)

NIH is the world’s premier medical research organization, supporting some 35,000 research projects nationwide in diseases like cancer, Alzheimer’s, diabetes, arthritis, heart ailments and AIDS. Though the majority of NIH resources sponsor external research, there is also a large in-house research program. NIH includes 17 separate health institutes, the National Center for Complementary and Alternative Medicine, the National Library of Medicine and the National Center for Human Genome Research. NIH was established in 1887 as the Hygienic Laboratory; its headquarters are in Bethesda, MD. NIH has about 16,000 employees.

Food and Drug Administration (FDA)

FDA assures the safety of foods and cosmetics, and the safety and efficacy of pharmaceuticals, biological products and medical devices—products that represent 25 cents out of every dollar in U.S. consumer spending. FDA, established in 1906, has its headquarters in Rockville, MD. The agency has 9,500 employees.

Substance Abuse and Mental Health Services Administration (SAMHSA)

SAMHSA works to improve the quality and availability of substance abuse prevention, addition treatment, and mental health services. The agency functions through 3 centers: the Center for Mental Health Services, the Center for Substance Abuse Prevention, and the Center for Substance Abuse Treatment. SAMHSA provides funding through block grants to states for direct substance abuse and mental health services, including treatment for over 340,000 Americans with serious substance abuse problems. It helps improve substance abuse treatment through its Knowledge Development and Applications grant program, and monitors the prevalence and incidence of substance abuse and mental illness. SAMHSA was established in 1992; its predecessor agency, the Alcohol, Drug Abuse and Mental Health Administration, was established in 1974. SAMHSA headquarters are in Rockville, MD; the agency has bout 700 employees.

Agency for Toxic Substances and Disease

Registry (ATSDR)

Working with states and other federal agencies, ATSDR seeks to prevent exposure to hazardous substances from waste sites. The agency conducts public health assessments, health studies, surveillance activities, and health education training in communities around waste sites on the U.S. Environmental Protection Agency’s National Priorities List. ASTDR also has developed toxicological profiles of hazardous chemicals found at these sites. The agency is closely associated administratively with CDC; its headquarters are also in Atlanta, GA. ASTDR has 400 employees.

Agency for Health Care Research and Quality (AHRQ)

AHRQ supports cross-cutting research on health care systems, health care quality and cost issues, and effectiveness of medial treatments. The agency has about 300 employees: its headquarters are in Rockville, MD. Formerly know as the Agency for Health Care Policy and Research, AHRQ was established in 1989, assuming broadened responsibilities of its predecessor agency, the National Center for Health Services Research and Health Care Technology Assessment.