March 30, 2000 (Atlanta) -- A new survey finds that while most Americans might not be able to define the term "public health," they are very concerned about issues related to it.
A study commissioned by The Pew Charitable Trusts and released by the CDC asked more than 1,200 registered voters a list of questions last year about public health, the public health system, and the environment's relationship to that system. The study's goal was to help characterize attitudes about public health.
The public health system essentially strives to assure conditions in which people can be healthy. Public health differs from health care in that it focuses on entire populations rather than individuals.
Respondents to the survey were given four descriptions of public health, then asked what they thought of when they heard the term. Just over half could not define public health either as protecting the population from disease or as policies and programs that promote healthy living conditions for everyone, the researchers say.
"It's not a surprise; people don't have a clue what public health means," study author Shelley Hearne, DrPH, tells WebMD. But when they understand that public health is about large-scale ways to prevent disease and how much the environment affects that, "the support for public health is extraordinary."
When the survey participants were given accurate descriptions of public health, a little more than half weighed in with negative evaluations of the existing public health system. Almost two-thirds said they thought government needed to do more to protect the public from health crises.
Only education beat out public health as a greater priority for additional government resources. About three-quarters of the group thought that public health deserved more economic support than that given to build roads or maintain missile defense. Nearly two-thirds said even tax cuts were a lower priority.
"It's the actual numbers that are the most telling part, because when you asked voters how they want their tax dollars [allotted], how they want the government to spend the money, ? public health came out significantly stronger in every instance," says Hearne, who is with the Johns Hopkins School of Public Health.
When asked whether such environmental factors as pollution can lead to disease and health problems, the answer was a resounding yes, with 85% of the respondents voicing concerns. More than a third considered the environment very important in health concerns.
A little more than half felt that sinus problems, allergies, and childhood asthma were influenced by the environment. About a third thought the environment played a "very important" role in colds and influenza and in birth defects. Thirty-nine percent felt the same about childhood cancer. Interestingly, the numbers dropped considerably for breast cancer, to 28%, and for prostate cancer and infertility, to 20%. "I was surprised by that, too," Hearne says.
Contaminated drinking water was seen as the worst threat to public health. Fifty-eight percent said it had a "great deal" to do with the level of impact that the environment has on a person's health. Just below that was toxic waste, and 53% thought air pollution and contaminated food were large threats. Oddly enough, about one in five people said air pollution was no threat at all. About one-quarter of the respondents blamed some illnesses on "sick buildings" (indoor air pollution).
According to the researchers' report, financial support for the public-health infrastructure has decreased since 1981. Yet, Hearne says, public health accounts for 25 out of the 30 years of increased longevity for Americans since the beginning of the last century.
"It's not actually medical interventions that have gotten us there; it's been very basic public health activities," Hearne tells WebMD. She mentions clean drinking water, sanitation, and food-inspection systems. "Those kinds of basic, very prevention-based approaches have led to 25 years added on to our life expectancy. People don't get that, though; they keep thinking it's the silver bullet that comes ? from treatment."
Hearne says one reason for that misperception is that public health is a "quiet" system, which does its work unobtrusively. In addition, people in the system are not used to clamoring for money, even as new and unforeseen challenges continue to arise. "Some of the issues facing the country, with the health challenges, we're not really prepared to deal with," she says.
"I guess the eye-opening part of [the study] was, even though the people don't know the phrase 'public health,' they sure care about the concepts of public health, and they're willing to see their tax dollars go into it," Hearne says.
Unfortunately, public lack of concern about public safety is "the reward for a job well done," she tells WebMD.