Americans have conflicting views about spending on public health system, poll analysis finds

The analysis, by Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health, and three co-authors, appears in the November issue of Health Affairs. The article, which draws on results from 12 national opinion polls, provides an in-depth examination of Americans' views about the nation's public health system.

"In order to sustain public support for increased spending, it will be critically important to give specific examples of cost savings from public health programs and to highlight how specific public health programs have reduced mortality from major chronic diseases, such as cancer, heart disease, and HIV/AIDS," said Blendon.

With growing concern about the federal budget deficit, there is likely to be a debate about whether the public health funds in the health care reform law passed earlier this year should be fully funded.

Polls show that three-fourths of Americans believe the U.S. is spending too little on improving and protecting the nation's health. A majority also sees long-term savings from spending on measures to improve health and prevention.

However, Americans do not believe the nation's public health system as a whole is working very well: 56% rate its performance as fair or poor, while 42% rate it as excellent or good. Just slightly more than half (52%) have a positive view of their state health department, but a larger majority (62%) approves of the job being done by the Centers for Disease Control and Prevention (CDC).

Most Americans do not see the health of their state's residents as having improved over the past five years. In addition, a majority does not see their state public health department as having been effective in preventing chronic illnesses, such as heart disease, cancer, and arthritis.

This area of weakness is important because preventing chronic illnesses is one of the highest priorities for the public. State public health agencies are seen as more effective in combating outbreaks of infectious disease. However, with the exception of major epidemics such as H1N1, these diseases are lower on the public's list of health threats.

The polls suggest that Americans may support increased spending in the abstract but may find the expansion of specific health programs less salient. If Americans generally do not see prior health programs as having improved health in their state, they may not feel strongly about increased spending on new public health initiatives when there is increased public concern about the federal budget deficit and states are facing severe financial shortfalls because of the reduction in tax revenues as a result of the economic downturn and the slow recovery of the economy.

In addition to the possible threat from fiscal restraints, the poll results suggest a partisan divide. Republicans are generally opposed to the health reform law and much less supportive of additional spending on public health programs than Democrats are.

This work was supported by a grant from the Robert Wood Johnson Foundation.