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Survey Shows Voters Rank Public Health Over New Roads, Missile Defense System, or Tax Cuts


According to a 1999 survey commissioned by the Pew Charitable Trusts, a Philadelphia-based philanthropy, a majority of American voters believe the nation's public health system has been neglected and is more deserving of additional funding than are highways, a missile defense system, or tax cuts. Only education was viewed by a majority of the voters surveyed as more deserving of additional resources. The results of the poll appeared in the March 31, 2000 issue of the Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report (MMWR).

Shelley Hearne, DrPH, executive director of the Pew Environmental Health Commission and a visiting scholar in Health Policy and Management at the Johns Hopkins School of Public Health, said that this strong show of support for public health has important implications for medical and government policy makers. "We stacked public health up against some very tough political issues," she said, "and yet 80 percent of the voters we polled chose public health over more highways; 73 percent chose public health over a missile defense system; and 63 percent chose public health over cutting taxes." A significant percentage -- 42 percent -- even placed public health spending above additional funds for fighting crime.

In their analysis of the poll's results, the authors noted that, whereas financial support for the nation's public health infrastructure has decreased over the past 20 years, during that same period expenditures for medical services and interventions have climbed steadily in the United States.

Because of their potential influence on government priority setting, registered voters, age 18 and older, were the subject of the telephone survey conducted between March 24 and 31, 1999. Initially, when the 1,234 respondents were read the question, When you hear the term "public health," what do you think of?, 47 percent responded incorrectly, with most answering that "public health" meant health care for the poor, or a government-provided system of health care for everyone. However, after being informed that "public health" actually concerns policies and programs that protect the entire population from disease and promote healthy living conditions for everyone, over 50 percent of the respondents ranked the United States' public health system as being only fair or poor, and 65 percent said more should be done to improve it.

The voters who were polled strongly supported efforts to protect the environment, with 85 percent saying they believed environmental factors were important causes of disease and health problems (38 percent of this majority said environmental factors were very important causes). A majority of respondents also believed an unhealthy environment contributes heavily to many diseases -- sinus and allergy problems, childhood asthma and cancer, colds and influenza, and birth defects all were seen as most likely resulting from environmental factors. Air pollution, bacteria-contaminated food, contaminated drinking water, toxic waste, and pesticides were thought to have the greatest impact on the population's health.

"The environment is the light bulb for the public," said Dr. Hearne, "It illuminates why we need a stronger public health system."

"Many of those polled believed passionately that the health of the environment is linked closely with the health of the population," said Paul Locke, DrPH, MPH, visiting scholar, Health Policy and Management, the Johns Hopkins School of Public Health. "Safe food and water, clean air, concerns for asthma -- over and over, the voters we spoke with made some of their strongest connections between the health of the environment and the public's health. Moreover, this issue was not politically divisive: Environmental health was popular across the entire political spectrum."

To see the full Pew Environmental Health Survey, visit

Support for this study was provided by The Pew Charitable Trusts.

Public Affairs Media Contacts for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons or Kenna Brigham @ 410-955-6878 or