Public Release: 

Poll finds US public sees ill health as resulting from a broad range of causes

Many believe their health has been impacted by negative childhood experiences

Harvard T.H. Chan School of Public Health

Boston, MA - A new NPR/Robert Wood Johnson Foundation/Harvard T.H. Chan School of Public Health poll finds that more than six in ten people living in the U.S. (62%) are concerned about their future health. Nearly four in ten (39%) said that they had one or more negative childhood experiences that they believe had a harmful impact on their adult health.

Causes of ill health

"When the public thinks about the causes of ill health, it's not just about germs. They also see access to medical care, personal behavior, stress, and pollution as affecting health," said Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis at Harvard T.H. Chan School of Public Health.

When given a list of 14 factors that might cause ill health, the top five causes cited by the public as extremely important are lack of access to high-quality medical care (42%), personal behavior (40%), viruses or bacteria (40%), high stress (37%), and exposure to air, water, or chemical pollution (35%).

Those rankings diverge, however, among ethnic groups. African Americans are more likely than whites to perceive lack of access to high-quality medical care (56% to 41%), God's will (47% to 29%), having a low income (45% to 23%), and not having enough education (41% to 26%) as extremely important causes of individuals' health problems. Hispanics are more likely than non-Hispanic whites (46% to 31%) to say that bad working conditions are extremely important.

Low-income people (those with household incomes less than $25,000 a year) are more likely than high-income people ($75,000 a year or more) to believe poor neighborhoods and housing conditions (40% to 27%) and bad working conditions (40% to 26%) are extremely important.

"This very important poll illustrates the dire socio-economic factors faced every day by too many people in this country. These factors can have as much, or more, impact on their health as disease - and they know it," said Risa Lavizzo-Mourey, MD, President and CEO of the Robert Wood Johnson Foundation. "Here at the Foundation we have expanded our mission to address these factors, in order to ensure that everyone in America can attain the healthiest life possible."

U.S. Public's Perceptions of the Causes of Individuals' Health Problems
(% saying extremely important)

Lack of access to high-quality medical care 42%
Personal behavior 40%
Viruses or bacteria 40%
High stress 37%
Being exposed to air, water, or chemical pollution 35%
Lack of friends and family members to talk to and rely on 34%
Poor neighborhoods and housing conditions 33%
Being abused as an adult 33%
Bad working conditions 33%
Not having enough education 31%
God's will 29%
Having a low income 27%
Bad genes 19%
Bad luck 9%

Childhood experiences negatively affect later health

When asked specifically about things that happen to a person in childhood that can cause health problems when they are adults, a majority (54%) said that being abused or neglected in childhood was extremely important. In addition, more than four in ten listed the following childhood experiences as extremely important causes of a person's health problems as an adult: living in a polluted area (44%), eating a poor diet (44%), and not getting vaccinations (43%).

African Americans are more likely than whites to believe eating a poor diet in childhood (55% to 42%), not getting vaccinations as a child (54% to 43%), living in poverty in childhood (47% to 31%), not graduating from high school (46% to 26%), and being born premature or underweight (34% to 20%) are extremely important.

Low-income people are more likely than those with high incomes to believe that the following childhood experiences are extremely important causes of future health problems: being abused or neglected in childhood (61% to 51%), living in a polluted environment in childhood (49% to 37%), eating a poor diet in childhood (50% to 36%), living in poverty in childhood (39% to 30%), and being born premature or underweight (30% to 18%).

A substantial number of people report having had negative experiences in childhood that they believe impacted their future health. Nearly four in ten (39%) said that they had one or more negative childhood experiences that they believe had a harmful impact on their adult health. The five childhood experiences people cite most often (from a list of 11) are the death or serious illness of a family member or close friend (18%), a serious physical injury or accident (13%), growing up in a low-income household (11%), parents divorcing or separating (11%), and a parent or other close family member losing a job (10%).

Those with household incomes of less than $25,000 a year (51%) are significantly more likely than those with household incomes of $75,000 a year or more (37%) to report one or more negative experiences in childhood that they believe had a harmful effect on their adult health.

Actions to improve health

Given the wide range of reasons given for why ill health occurs, it is not surprising that people in the U.S. have a very broad view of the actions that could be taken to improve people's health. The top five things (from a list of 16) that the public believes would improve people's health a great deal are: improving access to affordable healthy food (57%), reducing illegal drug use (54%), reducing air, water, or chemical pollution (52%), increasing access to high-quality health care (52%), and improving the economy and the availability of jobs (49%).

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(Note: Watch an NPR/RWJF/HCS webcast March 3, 2015 from 12:30-1:30 PM ET for expert perspectives on the topic. Visit http://theforum.sph.harvard.edu/events/what-shapes-health/ to learn more about the event, watch the live broadcast, and access the on-demand recording once it becomes available. A week-long series will also air on NPR starting March 2, 2015.)

The report/topline and chart will be linked in the press release posted on the Harvard Chan School website.

This poll is part of an ongoing series of surveys developed by researchers at the Harvard Opinion Research Program (HORP) at Harvard T.H. Chan School of Public Health in partnership with the Robert Wood Johnson Foundation and NPR. The research team consists of the following members at each institution.

Harvard T.H. Chan School of Public Health: Robert J. Blendon, Richard L. Menschel Professor of Health Policy and Political Analysis and Executive Director of HORP; John M. Benson, Research Scientist and Managing Director of HORP; Justin M. Sayde, Administrative and Research Manager; and Mary T. Gorski, Research Fellow.

Robert Wood Johnson Foundation: Fred Mann, Vice President, Communications; Carolyn Miller, Senior Program Officer, Research-Evaluation-Learning; and Brooke Van Roekel, Director Audience Engagement and Marketing.

NPR: Anne Gudenkauf, Senior Supervising Editor, Science Desk; and Joe Neel, Deputy Senior Supervising Editor, Science Desk.

Interviews were conducted via telephone (including both landline and cell phone) by SSRS of Media (PA), September 15 - October 15, 2014, among a nationally representative sample of 2,423 adults age 18 and older. The interviews were conducted in English and Spanish. The margin of error for total respondents is +/- 2.4 percentage points at the 95% confidence level.

Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases and for variations in probability of selection within and across households, sample data are weighted by household size, cell phone/landline use, and demographics (sex, age, race/ethnicity, education, marital status, and census region) to reflect the true population. Other techniques, including random-digit dialing, replicate subsamples, and systematic respondent selection within households, are used to ensure that the sample is representative.

Visit the Harvard Chan website for the latest news, press releases, and multimedia offerings.

Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people's lives--not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America's oldest professional training program in public health.

For more than 40 years the Robert Wood Johnson Foundation has worked to improve the health and health care of all Americans. We are striving to build a national culture of health that will enable all Americans to live longer, healthier lives now and for generations to come. Follow the Foundation on Twitter at http://www.rwjf.org/twitter or on Facebook at http://www.rwjf.org/facebook.

NPR is the leading provider of non-commercial news and entertainment programming in the U.S. More than 27 million people listen to NPR programs each week via 800+ radio stations throughout the country. In partnership with Member Stations, NPR strives to create a more informed public - one challenged and invigorated by a deeper understanding and appreciation of events, ideas, and cultures. As a digital innovator, and a leader in the public media community, NPR assures that the unique mission of nonprofit public media is not only preserved, but grows.

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