THE PUBLIC’S PERSPECTIVE ON THE UNITED STATES PUBLIC HEALTH SYSTEM

[Pages:51]THE PUBLIC'S PERSPECTIVE ON THE UNITED STATES PUBLIC HEALTH SYSTEM

May 2021

REPORT SUMMARY

Survey Background

Public health is a broad field, encompassing the protection and promotion of the public's health domestically and globally. In the United States, over the past several decades, the field of public health has moved away from focusing on infectious disease control and now encompasses a much wider range of issues such as the environment and climate change, injury prevention, racism, healthy housing, and reducing drug and alcohol abuse. However, the emergence of the Covid-19 pandemic in 2020 has once again brought infectious diseases back into the forefront of the American consciousness. The Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health conducted this poll in February and March of 2021 to inform leaders about public views on the public health system in the United States during the Covid-19 era. This survey focuses on public views about the nation's public health system at the federal, state, and local levels. It examines trust in key groups in health and healthcare, ratings of the job performance of public health agencies, trust in information from public health departments, understanding of different health and social issues that fall within the purview of public health, and public views on the biggest health problems facing the nation. This report uses data from an original survey conducted February 11 ? March 15, 2021, among a nationally representative, probability-based sample of 1,305 adults ages 18 or older. It also includes summaries of related polling data from other organizations, where comparisons and trends are relevant.

1

Report Highlights

As the U.S. government has led a large-scale response to the Covid-19 pandemic, it has brought infectious disease control back to the forefront of the American consciousness. Most Americans are now familiar with the term public health and assign public health agencies broad responsibility over many issues, including chronic and infectious disease prevention, mental health, health care, and drug abuse.

This survey finds that the public broadly believes the activities of public health agencies are important to the health of the United States and supports substantial increases in spending on public health programs, but has serious concerns about how the system functions now. The public lacks the high level of trust in key public health institutions necessary to address today's and future challenges.

Despite a broad awareness and recognition for the important role public health agencies play in protecting and promoting the health of the general public and vulnerable groups, this survey also shows the American public has higher trust in healthcare professionals than public health institutions and agencies, people give mixed ratings on the job performance of public health agencies, and a substantial minority of the public does not trust health information shared by their state and local public health departments.

These findings raise notable concerns for leaders working to shape the future of the United States public health system in the post-Covid-19 era of the 21st century. If this important field is to move ahead, it has to address the concerns of lack of trust and inadequate performance ratings for major public health institutions and agencies.

Key Findings

? There is broad public support for substantially increasing federal spending on public health. About seven in ten adults (71%) favor substantially increasing federal spending on improving the nation's public health programs, while 27% are opposed.

? A large majority of the public (72%) believes the activities of public health agencies are extremely or very important to the health of the nation.

? The public's rating of the nation's public health system and medical system have changed over time, with positive ratings of the public health system declining from 43% to 34% from 2009 to 2021, and positive ratings of the medical system increasing from 36% to 51% from 2009 to 2020.

? In terms of overall trust in the recommendations made to improve health, in the middle of the Covid-19 pandemic, the public currently trusts nurses, healthcare workers, and doctors more than public health institutions and agencies.

? In both 2009 and 2021, the public rated the job performance of the Centers for Disease Control and Prevention (CDC) higher than the nation's public health system overall. In 2021, 54% of the public gave the CDC positive job performance ratings (excellent or good), while 59% did in 2009.

2

Additional Findings

? When it comes to rating the job performance of public health agencies in the federal government, the public is divided over positive ratings of the CDC (54%), the Food and Drug Administration (FDA) (48%), and the National Institutes of Health (NIH) (47%).

? When rating the job performance of their own state and local health departments, the public is also divided, where a slight majority of adults (53%) rate their local health department as doing an excellent or good job and about half of adults (49%) rate their state health department as doing an excellent or good job at protecting the public from health threats and preventing illness, including responding to the Covid-19 outbreak.

? When it comes to the reliability of information at the state level, about two-thirds of adults (65%) say that on balance, they think the information provided by their state health department about the health of people in their state is reliable, leaving about onethird of adults (32%) who say they think the information is unreliable.

? When it comes to the reliability of information at the local level, about three-quarters of adults (74%) say that on balance, they think the information provided by their local health department about the health of people in their local community is reliable, leaving more than one in five adults (23%) who say they think the information is unreliable.

? When asked an open-ended question about the top two biggest health problems facing the nation, the most-cited health problems are Covid-19 (59%), cancer (19%), obesity (19%), health care access (15%), and mental illness (10%). In addition, heart disease (9%), diabetes (8%), health care costs (7%), and drug addiction/abuse (7%) are mentioned among the biggest health problems facing the nation.

? In addition, public views of the issues that fall under the responsibility of public health agencies are more limited than views of public health experts. Importantly, unlike public health experts, a majority of the public does not currently identify three major problems facing society -- climate change, gun violence, and racism -- as main responsibilities for public health agencies to handle.

3

INTRODUCTION

This report, The Public's Perspective on the United States Public Health System, summarizes the results of a 2021 poll conducted for the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health. It examines ratings of the job performance of public health agencies, familiarity with the public health system, trust in public health leadership groups and information from public health departments, understanding of different health and social issues that fall within the purview of public health, and views on the biggest health problems facing the nation.

Table of Contents

SECTION I. TRUST AND PERFORMANCE I. Trust in Key Groups................................................................................. 5 II. Views on the U.S. Public Health System .................................................. 6 III. Familiarity and Reliability of Public Health Information .......................... 9

SECTION II. WHAT IS PUBLIC HEALTH? IV. Understanding of Public Health Issues .................................................. 11 V. Views on the Biggest Local and National Health Problems .................... 14

SECTION III. SUBGROUP FINDINGS VI. Differences by Race/Ethnicity................................................................ 15 VII. Differences by Geographic Location ...................................................... 17 VIII. Differences by Political Party Affiliation................................................ 18

SECTION IV. METHODS IX. Methodology.......................................................................................... 20

This report uses data from an original survey conducted February 11 ? March 15, 2021, among a nationally representative, probability-based sample of 1,305 adults ages 18 or older living in the U.S. Race/ethnicity is categorized as non-Hispanic white, nonHispanic Black, and Hispanic/Latino (self-reported). The margin of error at the 95% confidence interval is ? 3.6 percentage points. This report also includes summaries of related polling data from other organizations, where comparisons and trends are relevant. Other polling data includes Harris 1996 (n=1004), HSPH/RWJF 2009 (n=1109), Gallup 2009 (n=1011), Gallup 2019 (n=1015), HSPH/RWJF/NPR 2020 (n=1885), and Gallup 2020 (n=1226).

4

I. Trust in Key Groups

Nurses, healthcare workers, and doctors are the most-trusted groups for recommendations made to improve health

When it comes to public trust in the recommendations made by different groups to improve health, in the middle of the Covid-19 pandemic, the public currently trusts nurses, healthcare workers, and doctors more than the nation's public health institutions and agencies (see Table 1). At least two-thirds of the public report trusting nurses (71%), healthcare workers they know (70%), and doctors (67%) a great deal or quite a lot when it comes to recommendations made to improve health.

Table 1. Public Trust in Key Groups in Health and Healthcare (in Percent)

Q5. In terms of recommendations made to improve health, how much do you trust the recommendations of each of the following groups? Do you trust them a great deal, quite a lot, somewhat, not very much, or not at all for recommendations they make to improve health?

Great deal/Quite a lot Somewhat Not very much/Not at all DK/Ref

Nurses

71

22

5

2

Healthcare workers you know

70

24

5

1

Doctors

67

24

7

2

The American Cancer Society

56

31

11

2

The CDC

52

25

20

3

The American Red Cross

48

30

16

6

Your local health department

44

36

18

2

Your state health department

41

36

21

2

The Surgeon General

40

37

19

4

Your friends or family

40

37

20

3

The NIH

37

29

19

15

The FDA

37

38

24

1

The National Academy of Medicine

34

35

16

15

The federal Department of Health and Human Services

33

37

28

2

Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health, The Public's Perspective on the United States Public Health System, 2/11/21 ? 3/15/21. Q5. Questions asked of randomized half-samples of adults ages 18+ (n=655 and n=650). DK/Ref = don't know or refused response. CDC = Centers for Disease Control and Prevention. NIH = National Institutes of Health; FDA = Food and Drug Administration.

A slight majority of the public also reports having a great deal or quite a lot of trust in the American Cancer Society (56%) and the Centers for Disease Control and Prevention (CDC) (52%). At least four in ten adults report having high trust in the American Red Cross (48%), their local health department (44%), their state health department (41%), the Surgeon General (40%), and their friends or family (40%).

Notably, less than half the public has high trust ("a great deal" or "quite a lot") in the nation's public health institutions and agencies, with the exception of the CDC. Fewer than four in ten adults report having a great deal or quite a lot of trust in the National Institutes of Health (37%), the Food and Drug Administration (37%), the National Academy of Medicine (34%), and the federal Department of Health and Human Services (33%), when it comes to recommendations made to improve health.

5

II. Views on the U.S. Public Health System

Majority of adults favor substantially increasing federal spending to improve the nation's public health programs

There is broad public support for increasing federal spending on public health in the U.S. (see Figure 1). About seven in ten adults (71%) favor substantially increasing federal spending on improving the nation's public health programs, while 27% are opposed.

Figure 1. Public Support for Substantially Increasing Federal Spending on Improving U.S. Public Health Programs (in Percent)

Q11. Do you favor or oppose substantially increasing federal spending on improving the nation's public health programs?

Favor

71

Oppose

27

Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health, The Public's Perspective on the United States Public Health System, 2/11/21 ? 3/15/21. Q11. Asked of a randomized half-sample of n=650 adults ages 18+. 2% of adults provided don't know responses or refused to answer the question.

Majority of adults believe the activities of public health agencies are extremely or very important to the health of the nation

In addition, when it comes to rating the importance of public health agencies, a large majority of the public (72%) believes the activities of public health agencies in the United States are extremely or very important to the health of the United States (40% "extremely," 32% "very"). One in five adults (20%) say the activities of public health agencies are somewhat important to the health of the United States, while 4% say they are not too important, and an additional 4% say they are not important at all.

6

During the Covid-19 pandemic, the public rates the nation's medical system higher than the public health system

Despite the recognized importance of public health agencies and broad public support for increased funding, a larger share of the public gives positive ratings to the nation's medical system (51% express a great deal or quite a lot of confidence) than it does to the nation's public health system (34% give excellent or good ratings) during the Covid-19 pandemic (see Table 2). Public confidence in the nation's medical system has increased during the Covid-19 pandemic (see Gallup 2020), with about half of adults (51%) giving it a positive rating in 2020 compared with pre-pandemic measures in both 2009 (36%) and 2019 (36%).1

By contrast, only about one-third of adults (34%) adults give positive ratings to the nation's system for protecting the public from health threats and preventing illness, with nearly two-thirds of adults (65%) rating the nation's public health system as fair or poor. These ratings are lower than roughly a decade ago, when this question was previously asked in 2009 and 43% of the public rated the nation's public health system as excellent or good.

Table 2. Public Ratings of the Nation's Public Health vs. Medical Systems, 2009 and 2020/2021

Nation's medical system a

Positive Rating (%)

2009

2020-2021

36

51*

Nation's public health system b

43

34*

a Gallup 6/14-6/17/09 (n=1011) and Gallup 6/8-7/24/20 (n=1226), Q: Please tell me how much confidence you, yourself, have in each one ? a great deal, quite a lot, some or very little? The medical system. A great deal/quite a lot reported as positive ratings. b 2009 data from the HSPH/RWJF Health Priorities Survey, 6/24-6/28/09 (n=556 adults). Q: How would you rate the nation's system for protecting the public from health threats and preventing illness? Excellent/good reported as positive ratings. 2021 data from HSPH/RWJF, The Public's Perspective on the United States Public Health System, 2/11/21 ? 3/15/21 (n=1,305 adults ages 18+). *Statistically significant difference from 2009 to 2020/2021 at p ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download