Public Opinion About Public Health -- California and the United States, 1996

Despite widespread belief that public support is critical to the success of public health programs and agencies, systematic efforts to measure public opinion about public health have been limited. This report summarizes surveys conducted by two organizations -- one a public policy center in California, the other a national opinion polling firm -- to measure support for public health activities. The findings indicate widespread support for community-oriented disease-prevention and health-promotion activities. California Survey

From September 30 through November 5, 1996, the Field Institute of San Francisco (with consultation by Louis Harris and Associates, Inc.) conducted a random-digit-dialed telephone survey of California residents aged greater than or equal to 18 years; the survey was commissioned by the nonprofit California Center for Health Improvement and was funded by The California Wellness Foundation (1). A representative sample of 4803 persons was interviewed. The standard error associated with the results of this survey was plus or minus 2% at the 95% confidence level.

The percentage of respondents who reported that selected public health services were "top priority" ranged from 29% (for collecting community health data) to 84% (for ensuring safe drinking water). The percentage who reported delivery of these services as "very effective" ranged from 18% (for providing community education and counseling services about improving health) to 37% (for minimizing the spread of disease carried by insects or animals) (Table_1). Selected local and state fees or tax increases were supported by substantial proportions of respondents if funds were needed to pay for what the survey instrument termed as "adequate programs" (Table_2). Most respondents preferred that funds for public health services be raised at the state level instead of at the local level (Table_2). The sources of revenue for those services that were most supported by respondents were increases in state taxes on alcoholic beverages and tobacco. Most respondents opposed state surtaxes on health insurance premiums (72%), local residential property taxes (64%), and local sales taxes (57%). Respondents supported the existing state requirements that nonprofit health-care providers fund community health programs (84%) and that nonprofit health-care providers that convert to for-profit status be required to dedicate funds to promote health (82%). In addition, most respondents indicated support for a statewide initiative for a 63[ per pack increase in cigarette tax (i.e., 72% strongly or somewhat favored the increase). National Survey

During December 12-16, 1996, Louis Harris and Associates, Inc., conducted a national random-digit-dialed telephone survey of 1004 U.S. residents aged greater than or equal to 18 years (2 ). This survey was conducted for the Harris Poll column, which is syndicated to the media but is not commissioned by any one client. The standard error associated with the survey was plus or minus 3% at the 95% confidence level. The response rate was 62%.

Respondents were asked to rank the importance of eight services "to improve the health of the public" on a five-point scale (i.e., very important, somewhat important, not very important, not at all important, or did not know). The percentage of respondents who rated specific public health services as very important ranged from 56% (for helping persons cope with stress) to 93% (for preventing the spread of infectious diseases) (Table_3).

Respondents also were asked "Who do you think should be mainly responsible for the performance of prevention rather than the treatment of disease." Most (57%) respondents indicated that government should be responsible for this service; and 40%, that "someone else" should be responsible. Of those persons who responded that government should provide this service, 53% stated that the federal government should do so; 32%, the state government; and 13%, city and local governments.

When asked the open-ended question, "What do the words `public health' mean to you?," less than 4% of respondents gave answers corresponding to what the Harris Poll considered "generally...regarded as referring to public health" (i.e., health education/healthier lifestyles, prevention of infectious diseases, immunization, and medical research) (2). Eighty-three percent of respondents identified one or more of the following: general physical health, mental health, and well-being of the public; the health-care system; welfare programs; universal health care; health assurance; health insurance; and Medicaid and Medicare.

Reported by: K Bodenhorn, MPH, California Center for Health Improvement, Woodland Hills, California. H Taylor, Louis Harris and Associates, Inc., New York. Office of the Director, Public Health Practice Program Office, CDC.

Editorial Note

Editorial Note: Opinion polling is used extensively as an adjunct to or in assessing contemporary public policy. Polling can help to clarify the perceived importance of issues and the impact of advocacy campaigns and other factors on public support for, or opposition to, policies. The survey conducted in California identified 1) substantial support for public health services and 2) substantial support for taxes, if necessary, to achieve more effective public health programs and services. Although findings from the national survey were consistent with findings from the California survey about support for public health services, the national survey did not address financial concerns.

The findings in this report are subject to several limitations. First, the results of the two surveys were not directly comparable because the samples were drawn from different populations, the questions differed, and the results were reported in different formats. Second, each survey gauged public opinion at a specific point in time; therefore, the reported opinions could not be linked to contextual, secular events. Other limitations associated with survey methodology (e.g., refusals to be interviewed, wording and order of questions, and interviewer bias) also apply to the results of these two surveys.

Interest in marketing public health has been stimulated by perceived low public support for public health activities, limited financial resources, and the impact of extensive restructuring in the health-care sector. The findings in this report indicate substantial public support for public health services and suggest the need to determine the extent to which this support is consistent across jurisdictions and whether it can be translated into policy. Finally, these findings suggest the need for strengthened methods to improve the polling of opinion about public health, including clarifications of the distinction between clinical care and community- or population-oriented disease and injury prevention, and the practical meanings of "public health," "community health," and other key terms.

References

1. California Center for Health Improvement. Spending for health: Californians speak out about priorities for health spending. Sacramento: California Center for Health Improvement, 1997.

2. Louis Harris and Associates, Inc. `Public health': two words few people understand even though almost everyone thinks public health functions are very important. New York: Louis Harris and Associates, Inc., 1997.

TABLE 1. Percentage of survey respondents who reported that selected public health
services were "top priority," and percentage who reported delivery of these
services as "very effective" -- California, 1996 *
=====================================================================================

                                                       % Respondents
                                                ---------------------------------
Public health service                               Top        Very  effective
                                                  priority
-------------------------------------------------------------------------------------
Ensuring safe drinking water                         84              34

Ensuring that foods are free from                    77              33
contamination (e.g.,through restaurant and
produce inspections)

Protecting the public from exposure to toxic         75              29
chemicals and other hazardous materials
(e.g.,monitoring the disposal of industrial
and medical wastes and after oil spills)

Protecting the public from the spread of             74              22
communicable diseases
(e.g.,AIDS,hepatitis,and tuberculosis)

Helping treat disease and injury after               65              30
natural disasters
(e.g.,earthquakes,wildfires,and floods)

Providing community education and counseling         53              18
services about improving health (e.g.,through
nutrition education programs,alcohol- and
drug-abuse programs,and tobacco prevention
programs)

Minimizing the spread of disease carried by          49              37
insects or animals (e.g.,rabies)

Collecting community health data                     29              19
(e.g.,registering births,determining causes
of deaths,and monitoring health trends)
-------------------------------------------------------------------------------------
* Results of a random-digit-dialed telephone survey of California residents aged
  >=18 years (n=4803 respondents) (1). The survey was conducted by the Field
  Institute of San Francisco, with consultation by Louis Harris and
  Associates Inc.; the survey was commissioned by the nonprofit California
  Center for Health Improvement and was funded by the California Wellness
  Foundation. The standard error was +/-2% at the 95% confidence level.

=====================================================================================

TABLE 2. Preferred sources of revenue for improving community health promotion and disease
and injury prevention programs and environmental health services, by percentage of
survey respondents -- California, 1996 *
===============================================================================================

                                                              % Respondents
                                                  --------------------------------------
Source of revenue                                    Favor       Oppose   Did not know
-----------------------------------------------------------------------------------------------
Increasing state taxes on tobacco products             81          18           1

Increasing state taxes on beer, wine, and other        78          21           1
alcoholic beverages

Expanding tax deductions for contributions to          72          24           4
charities and other nonprofit organizations

Increasing state income taxes for persons              68          29           2
earning $200,000 per year

Increasing city developer fees on builders of          59          38           3
new homes

Increasing local taxes on business property            53          43           4

Increasing local sales taxes                           41          57           2

Increasing local taxes on residential property         33          64           3

Charging a surtax on health insurance premiums         24          72           4
paid by businesses and persons
-----------------------------------------------------------------------------------------------
* Results of a random-digit-dialed telephone survey of California residents aged 318 years
  (n=4803 respondents) ( 1 ). The survey was conducted by the Field Institute of San Francisco,
  with consultation by Louis Harris and Associates, Inc.; the survey was commissioned by the
  nonprofit California Center for Health Improvement and was funded by The California Wellness
  Foundation. The standard error was  2% at the 95% confidence level.
===============================================================================================

TABLE 3. Percentage of survey respondents who reported that selected public health services were
"very important" or "somewhat important" -- United States, 1996 *
==================================================================================================
                                                             % Respondents
                                                    --------------------------------------
Public health service                                 Very important   Somewhat important
--------------------------------------------------------------------------------------------------
Preventing the spread of infectious diseases                 93                  7
(e.g.,tuberculosis,measles,influenza,and AIDS)

Vaccinating to prevent diseases                              90                  9

Delivering medical care to ill patients by doctors           85                 13
and hospitals

Improving the quality of education and employment            83                 14

Ensuring persons are not exposed to unsafe water             82                 15
supply,dangerous air pollution,or toxic waste

Conducting medical research on the causes and                82                 15
prevention of disease

Encouraging persons to live healthier lifestyles             72                 24
(e.g.,eat well,exercise,and not to smoke)

Helping persons cope with stress from the problems of        56                 34
daily living and work
--------------------------------------------------------------------------------------------------
* Results of a random-digit-dialed telephone survey of U.S. residents aged 318 years (n=1004
  respondents) ( 2 ) conducted by Louis Harris and Associates, Inc., for the Harris Poll column,
  which is syndicated to the media but is not commissioned by any one client. The standard error
  was +/-3% at the 95% confidence level.
==================================================================================================

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