In a health care system chiefly directed towards treating disease and surgical intervention, the Surgeon General has pursued a complementary strategy: disease prevention and health promotion. Appointed by the President with the advice and consent of the Senate, the Surgeon General--whose title means chief surgeon--is the federal government's principal spokesperson on matters of public health. The first Surgeon General was appointed in 1871 to head the Marine Hospital Service, itself established in 1798 to minister to sick and injured merchant seamen and reorganized as the U.S. Public Health Service in 1912. In recent decades, the Surgeon General has become the most widely recognized and respected voice on public health issues, preventive medicine, and health promotion through public appearances, speeches, and, most influentially, the reports featured on this Web site. The Surgeon General has often been called upon to deal with difficult and controversial issues, such as smoking and sexual health. In some cases, the public health message has generated controversy, when it ran counter to the political beliefs of the time. But the Surgeon General's public statements often served to generate debate where there had been silence, to the benefit of the nation's health.

The role of the Surgeon General has changed much during the past four decades. As the head of the Public Health Service (PHS), for over half a century the Surgeon General oversaw infectious disease eradication, rural sanitation, medical research, the provision of medical and hospital care to members of the Coast Guard and Merchant Marine, and other public health activities. Until 1968, the Surgeon General's main responsibility was the day-to-day administration of the U.S. Public Health Service and its many programs, including directing the uniformed Commissioned Corps of physicians, dentists, nurses, pharmacists, sanitary engineers, and other health professionals that has been the institutional mainstay of PHS.

In 1968, an organizational reform greatly reduced the Surgeon General's administrative role, abolishing the Office of the Surgeon General (though not the position of Surgeon General itself) and transferring line authority for the administration of PHS to the Assistant Secretary for Health within the Department of Health, Education, and Welfare (since 1980, the Department of Health and Human Services). Since 1968, the Surgeon General has not administered the Public Health Service, and his/her main official duty has been to advise the Secretary of Health and Human Services and the Assistant Secretary of Health on affairs of preventive health, medicine, and health policy. Left with few bureaucratic tasks, the Surgeons General since the 1960s have undertaken a more proactive role in informing the American public on health matters. They have relied on their professional credentials (all Surgeons General have been MDs) and political independence to make themselves into the most visible and, in the public's mind, impartial and therefore trusted government spokespersons on health issues affecting the nation as a whole.