MENLO PARK, CA -- Two-thirds of the public supports maintaining (39%) or increasing (26%) U.S. government funding to improve health in developing countries, while fewer than a quarter (23%) say the government is spending too much on global health, according to a Kaiser Family Foundation survey of the American people’s attitudes towards U.S. global health and development assistance.  Levels of support are similar for spending to fight HIV/AIDS in developing countries, although the public’s sense of urgency about the HIV/AIDS epidemic around the world has declined.  However, perhaps not surprisingly given the current recession, the vast majority (71%) of Americans say that given today’s serious economic problems the U.S. can’t afford to spend more on global health right now.

"Support for U.S. aid for global health has shown staying power despite the recession, but it's a critical time to maintain the momentum for development assistance and global health established in recent years," said Kaiser President and CEO Drew Altman.

Global Health As Part Of Development Agenda

The Survey of Americans on the U.S. Role in Global Health found that the public sees health as one of many priorities within a broad development agenda for U.S. aid to poorer nations. Americans place priority on basic investments with long-term payoffs that address a variety of tough challenges.

For instance, 59 percent of Americans say fighting terrorism and promoting peace should be a "top priority" for the president and Congress when it comes to helping developing nations, followed by improving education (55%).  Next in line and clumped together are reducing poverty (41%), improving health (38%), protecting the environment and fighting climate change (37%), and promoting the rights of women (34%). Fewer Americans (25%) see promoting democracy as a top priority.

When it comes to determining how to spend U.S. dollars on improving health in developing countries, Americans say objective criteria of need should carry the most influence. Most people say that whether a problem affects children (69%) and how many people die each year because of it (60%) should be "very important" factors in setting aid priorities. Fewer cite reasons such as whether a country is friendly toward the U.S. (36%) or whether the aid would advance U.S. foreign policy interests (25%), although a strong majority (62%) say that assistance helps improve the U.S.’s image in the countries that receive it.

Along those lines, when asked what should be a "top priority" for U.S. spending on health in developing countries, Americans are most likely to say improving access to clean water (61%), increasing childhood immunizations against diseases like polio (61%), and reducing hunger and malnutrition (60%).

Many See Assistance As "Right Thing To Do," But Are Wary Of Corruption Abroad

When asked what the "most important" reason is for the U.S. to spend money on health in developing countries, nearly half (47%) say because it is "the right thing to do." Far fewer identify national security (11%) or diplomatic interests (8%) as the most important reason.   

The poll also suggests that Americans have mixed views about how far money can go in creating better conditions abroad.  About half the public (51%) says more spending from the U.S. and other countries "won’t make much difference" in improving health for people in developing nations, while 40 percent say it "will lead to meaningful progress."  The public is most likely to cite corruption (80%), widespread poverty (71%) and a lack of political leadership (66%) as barriers to making additional progress abroad.

"There is a glaring need highlighted in these findings to connect aid with results in the public’s mind," said Altman.

Half of Americans say they have personally donated money to an organization that works to improve health for people in developing nations.  And despite their renewed focus on the home front, most Americans (57%) say the U.S. and other industrialized nations are not doing enough to improve health for people in the developing world.

Large majorities say that, over the last five years, U.S. health spending has made at least a small difference in improving the lives of people abroad (83%) and in changing the overall course of disease in developing countries (79%), including some who say it has made a big difference in these areas (38% and 30%, respectively).

Who Is Most/Least Supportive of U.S. Action on Global Health?

Support for increased U.S. action on global health resonates most strongly among young people, members of racial and ethnic minority groups, liberals and Democrats, and those who say they pay "a lot" of attention to global health issues. By contrast, groups less likely to back increased U.S. action include Americans 65 and older, whites, conservatives and Republicans, and those who pay less attention to global health issues.

For example, 44 percent of Americans ages 18-29 say the U.S. spends too little on efforts to improve health in developing countries, compared with just 12 percent of seniors.  Similarly, 40 percent of those who pay a lot of attention to global health issues say that, given the current economic crisis, it is more important than ever for the U.S. to spend on improving health in developing countries. That is twice as many as among those who pay little or no attention to global health issues (18%).

African Americans are particularly supportive of increasing U.S. spending on global HIV/AIDS; 62 percent of them say that the U.S. currently spends too little on HIV/AIDS in developing countries, compared with a third (33%) of whites.

Declines in Visibility Of, Urgency About Global HIV/AIDS

U.S. government funding for global health more than doubled between fiscal year 2004 and fiscal year 2008, in part because of a 5-year, $15 billion effort by the U.S. to fight global HIV/AIDS through the President’s Emergency Plan for AIDS Relief (PEPFAR).

In spite of that effort, or perhaps because of it, the poll also reveals a notable decline in the public’s sense of urgency about and reported visibility of the HIV/AIDS epidemic as a global concern.  

About one in five adults in the U.S. (21%) name HIV/AIDS as the most urgent health problem facing the world, ranking it second behind cancer (31%). That was a marked drop from surveys conducted from 2000 to 2006, in which about a third labeled HIV/AIDS the most urgent problem.

The decline may be partly related to changes in how much people report hearing about the problem of the global HIV/AIDS epidemic. Twenty-six percent of Americans say that they have heard "a lot" about AIDS in Africa in the past year, about half the share who said so in 2004.

Understanding "Foreign Aid"

A majority of Americans believe that the U.S. spends too much on "foreign aid." But perceptions of spending on global health may be shaped in part by what the public believes aid is used for and misperceptions of the size of foreign aid in the context of the overall budget.
 
For instance, public support for more spending increases when foreign aid is described more specifically in terms of health-related goals. Although 52 percent say the U.S. is spending too much on foreign aid in general, this decreases to 23 percent when it comes to spending on "efforts to improve health for people in developing countries."  Support for current levels of aid is even stronger when it comes to spending to fight HIV/AIDS in these countries; just 16 percent say the U.S. is spending too much in this area.  

And much of the public has an inaccurate view of the size of foreign aid in the federal budget. Nearly half of Americans (45%) incorrectly name foreign aid as one of the two largest areas of spending by the government, more than choose Medicare or Social Security (33% each), which together account for about a third of the federal budget.  Foreign aid represents about 1 percent of the federal budget.

Perception matters. Those who believe that the U.S. spends 5 percent of its budget or less on foreign aid -- the more accurate view -- are more likely to say the U.S. is spending "too little" on efforts to improve health for people in developing countries (46%). Far fewer (27%) of those who believe the U.S. spends more than 5 percent of its budget on foreign aid, or who say they don’t know how much the U.S. spends on foreign aid, say the country is spending "too little."

The Foundation conducted the survey to examine the American public’s knowledge, beliefs and opinions about the role of the U.S. in efforts to improve health for people in developing nations. The survey combined new questions about whether, why and how the U.S. should contribute to international health efforts along with trend questions about the U.S. role in global HIV/AIDS that the Foundation has tracked since 2000.

Methodology The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation led by Mollyann Brodie, Ph.D., and including Elizabeth Hamel, Jennifer Kates, Alicia Carbaugh and Sasha Buscho.  It was conducted January 26 through March 8, 2009 (before the international outbreak of the H1N1 influenza A virus), among a nationally representative random sample of 2,554 adults ages 18 and older.  Telephone interviews conducted by landline (N=1,951) and cell phone (N=603, including 214 who had no landline telephone) were carried out in English and Spanish.  The survey includes oversamples of African American and Latino respondents as well as respondents ages 18-29.  Results for all groups have been weighted to reflect their actual distribution in the nation.  The margin of sampling error for the overall survey is plus or minus 3 percentage points.  Most questions reported here were asked of a random half-sample of respondents and have a margin of sampling error of plus or minus 4 percentage points.  For results based on subgroups, the margin of sampling error may be higher. Portions of this survey (questions about the domestic HIV epidemic) have been previously released and can be found at online.

The full question wording, results, charts and a brief on the poll can be viewed online.