The Public's Perspective on the United States Public Health System

Public’s perspective about the nation’s public health system at the federal, state, and local levels during the COVID-19 pandemic.

This survey examines trust in key groups in health and health care, 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 departments, and public views on the biggest health problems facing the nation.

The Issue

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 substance abuse.

This survey finds that the public broadly believes that 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 health care professionals than public health institutions and 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

• About seven in ten adults (71%) favor substantially increasing federal spending on improving the nation’s public health programs.
  
• 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 trusts health care workers more than U.S. public health institutions and agencies for recommendations made to improve health. This includes high public trust in nurses (71%), health care workers you know (70%), and doctors (67%) for recommendations they make to improve health.
  
• 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%).
• The public has lower levels of trust in the Centers for Disease Control and Prevention (CDC) (52%), state (41%) and local (41%) health departments, the National Institutes of Health (NIH) (37%), and the Food and Drug Administration (FDA) (37%).

Conclusion

COVID-19 has laid bare the cracks and inequities baked into all of the systems that impact health in the United States, particularly public health institutions. As the country prepares to emerge from the pandemic, substantial public health funding is necessary to ensure we are prepared for the next emergency. In order for leaders to move forward in shaping the future of the U.S. public health system, the public’s lack of trust must be addressed. The field must also use this moment to address the structural discrimination within the system and ensure that all of our communities are protected.