Americans are worried about the cost of health care and the rising numbers of  people with no health insurance, but those are not the top issues for government action as national elections near, according to the policy journal Health Affairs.

Opinion surveys conducted in 2006 found most Americans don’t think the health care system is in crisis, although there is a lot of dissatisfaction with both health care and the public health system. As a top-level public concern, health has been topped by current issues such as immigration, the war in Iraq, and the price of gasoline, though it remains one of the long-range issues the public is most likely to cite in polls, along with education, terrorism, crime, Social Security, and the environment, especially global warming. "Issues such as health care that are a part of people’s everyday lives remain enduring concerns in poll findings," Health Affairs notes.

To try to present a comprehensive picture of the public’s health priorities in 2006, and the changes that have taken place over time, the paper analyzed polling results from 19 national opinion surveys conducted between 1940 and 2006, with particular attention to trends since the time of the Clinton health reform plan in the early 1990s. Some of the findings:

• In August 2006, respondents asked to say in their own words what they consider to be the top issues for government to address ranked health care fourth, behind  the war, the economy, and energy prices. This second-tier ranking for health care was the lowest since 1993, when it was one of two top issues to a large percentage of the population.
• Asked to say what they think are the two most important health care problems government should address, respondents cited health care costs and lack of insurance most frequently. Medicare and prescription drug benefits, the subjects of considerable recent media attention, ranked well behind the two top issues.
• As of spring 2006, about seven in ten respondents rated the nation’s system of medical care as "fair" or "poor." But in contrast to their views on the health system as a whole, more than 80 percent of persons who had received health care in the past year said the services were "excellent" or "good."
• Cancer and HIV/AIDS were the two most important diseases or health conditions for the government to address, according to the polls, with smaller percentages of respondents identifying avian flu, heart disease, diabetes, and obesity as serious national health concerns. The paper notes that in 1940, syphilis was the public’s top concern, followed by cancer, tuberculosis, and polio.
• Asked whether they consider the public health system adequate to protect against such threats as SARS, anthrax, smallpox, and avian flu, half of respondents rated public health as "poor" and fewer than half found it "good" or "excellent."

Commenting on the poll results this year, Health Affairs said that although most Americans don’t think the health system is in crisis, the public remains dissatisfied with the country’s health care and public health systems. "These attitudes are likely to create a climate supportive of both increased health spending and substantial changes in the years ahead," the paper concluded.

The report "Understanding the American Public’s Health Priorities: A 2006 Perspective," appeared as a Web Exclusive on October 17, 2006, in the online edition of the September-October issue of Health Affairs.