2015 marks the fourth year that the Kaiser Family Foundation has been analyzing donor government funding for family planning, tracking progress against commitments made at the 2012 London Summit on Family Planning.¹  After steady increases since the Summit, funding for bilateral family planning activities remained essentially flat in 2015 in real terms (after adjusting for the effects of exchange rate fluctuations and inflation). However, in current U.S. dollars, 2015 funding (US$1.3 billion) was 6% below the 2014 level.  The decrease in current U.S. dollars was largely due to a complex set of factors, primarily the appreciation of the U.S. dollar, but also to real declines by several donors.  In addition to bilateral funding, donor governments also contributed US$392.6 million in core contributions to the United Nations Population Fund (UNFPA) in 2015, a decrease of US$78.9 million (-17%) below 2014 levels, similarly due to the appreciation of the U.S. dollar. Among the donor governments profiled, eight made specific commitments as part of the London Summit, seven of which are on track to meet these commitments.

Key findings include:

• In 2015, donor governments provided US$1.3 billion for bilateral family planning programs, essentially matching the 2014 level (US$1.4 billion) when measured in real terms (after adjusting for the effects of exchange rate fluctuations and inflation). In current dollars, 2015 funding was 6% below (-US$88.6 million) 2014, and essentially a return to 2013 levels, though still above the 2012 baseline (see Table 1 and Appendix 1).
• The decline, when measured in current U.S. dollars, is due to a complex set of factors, primarily the significant appreciation of the U.S. dollar, resulting in the depreciation of most other donor currencies, but also to real declines by several donors. In their currency of origin, five donors (Denmark, France, Germany, the Netherlands, and Sweden) increased, while funding from three donors (Australia, Norway, and the U.K.) declined. Funding from the U.S. and Canada remained flat. Despite the real declines by several donors, when the effects of the exchange rate fluctuations are removed, 2015 funding essentially matches 2014 levels.
• The U.S. was the largest bilateral donor to family planning in 2015, providing US$638.0 million or almost half (47%) of total bilateral funding. The U.K. (US$269.9 million, 20%) was the second largest donor, followed by the Netherlands (US$165.8 million, 12%), France (US$68.6 million, 5%), and Sweden (US$66.0 million, 5%). Funding trends for family planning have been primarily driven by the two largest donors, the U.S. and U.K., which have accounted for approximately two-thirds of total funding between 2012 and 2015.
• Among the 10 donors profiled, 8 made commitments during the 2012 London Summit on Family Planning: Australia, Denmark, France, Germany, the Netherlands, Norway, Sweden, and the U.K., of which all but one are on track towards fulfilling these commitments. Australia had made progress in prior years, but due to recent declines would need to significantly increase funding in order to fulfill its commitment (see Appendix 2).
• In addition to donor contributions to UNFPA that are earmarked for family planning, and are therefore counted as bilateral funding above, the donors examined also provided US$392.6 million in core contributions to UNFPA. This too was a decline – US$78.9 million below the 2014 level (US$471.5 million). Similar to bilateral funding, much of this decline can be attributed to the appreciation of the U.S. dollar. In fact, when measured in the currency of origin, all of the donors profiled essentially maintained their contribution to UNFPA’s core resources at the prior year level, with the exception of Denmark, which increased funding. Among the donor governments profiled, Sweden provided the largest core contribution to UNFPA in 2015 (US$57.4 million), followed by Norway (US$55.6 million), the Netherlands (US$39.7 million), and Denmark (US$35.7).² 

Introduction

At the London Summit on Family Planning (FP2020), the global community made commitments totaling US$2.6 billion in additional funding for family planning by 2020 (see Box 1). With the commitment period of several donors coming to an end in 2015 and with 2016 marking the halfway point towards fulfillment of the FP2020 goals, it is important to assess the progress made as well as plans moving forward. The status of global funding for family planning takes on added relevance as donors navigate additional budgetary and other pressures, including the ongoing refugee crisis and other competing demands, as well as the effects of Brexit.

While funding from all sources – domestic public and private spending, donor government bilateral assistance, multilateral organizations, and private philanthropy (see Box 2) – is needed to help fulfill international family planning goals and commitments, donor governments provide a significant share of the total.³  Following the London Summit, the Kaiser Family Foundation conducted an analysis of donor government funding for family planning activities in 2012 to establish a FP funding baseline that could be used to track funding levels over time as well as specific donor government progress in meeting the Summit’s commitments.

This report provides an analysis of donor government bilateral funding for family planning activities in 2015 compared to prior year levels. It includes data from the 29 governments who were members of the Organisation for Economic Co-operation and Development (OECD), Development Assistance Committee (DAC) in 2015.⁷  Data were collected directly from ten donors, who represent approximately 99% of bilateral family planning funding, and are profiled in this report: Australia, Canada, Denmark, France, Germany, the Netherlands, Norway, Sweden, the U.K., and the U.S. Data for the remaining DAC members was obtained from the OECD Credit Reporting System (CRS). For purposes of this analysis, family planning services were defined to include the following activities as specified in the CRS: “counseling; information, education and communication (IEC) activities; delivery of contraceptives; capacity building and training.”⁸  Bilateral totals include actual funding amounts provided (e.g., cash transfers) as well as other types of transactions and activities (e.g., technical assistance), products (e.g., commodities), and donor government earmarked contributions to multilateral organizations (e.g. contributions to the Global Programme to Enhance Reproductive Health Commodity Security at UNFPA).

Where bilateral family planning funding was included as part of broader reproductive and maternal health activities or other non-health-sector activities, we worked directly with donor governments to identify family planning specific amounts to the extent possible (see Methodology for more information). Where it was not possible to disaggregate FP funding from broader reproductive and maternal health activities, the estimated level of family planning funding may be an overestimate. At the same time, some family planning funding provided under non-health-sectors remains largely unidentified, likely resulting in an underestimate of total family planning funding.

Findings

Bilateral Assistance

In 2015, donor governments disbursed⁹  US$1,344.0 million in bilateral funding for family planning activities (see Table 1, Figure 1 & Appendix 1), essentially flat compared to 2014 when measured in real terms (adjusting for the effects of exchange rate fluctuations and inflation). However, when measured in current U.S. dollars, 2015 was a decrease of US$88.6 million (-6%) below 2014 levels (US$1,432.7 million) and essentially a return to 2013 levels (US$1,325.0 million). The decline, when measured in current U.S. dollars, is due to a complex set of factors, primarily the significant appreciation of the U.S. dollar in 2015, which resulted in the depreciation of most other donor currencies, but also to real declines (in currency of origin) by several donors. Among the donors profiled, five (Denmark, France, Germany, the Netherlands, and Sweden) actually increased FP funding in 2015 – when measured in their currencies of origin, while funding from three donors (Australia, Norway, and the U.K.) declined. Funding from two donors (Canada and the U.S.) remained flat. Despite the decline in 2015 compared to 2014, donor government bilateral assistance for family planning is still approximately US$250 million above the 2012 baseline (US$1,093.6 million).

The United States (US$638.0 million) was the largest bilateral donor in 2015 accounting for almost half (47%) of total bilateral assistance (see Figure 2). The U.K. (US$269.9 million, 20%) was the second largest bilateral donor, followed by the Netherlands (US$165.8 million, 12%), France (US$68.6 million, 5%), and Sweden (US$66.0 million, 5%).

While the majority of donor governments increased family planning funding between 2012 and 2015, recent trends have been largely driven by the two largest donors, the U.S. and U.K., which have accounted for approximately two-thirds of total funding over the period.

Progress Towards FP2020 Commitments

Eight of the donor governments profiled in this analysis made multi-year commitments at the FP2020 Summit in 2012: Australia, Denmark, France, Germany, the Netherlands, Norway, Sweden, and the U.K. (see Appendix 2). Data collected for 2012-2015 indicate that seven of the eight donors have either fulfilled or are on track to fulfill their FP2020 commitment including: Denmark, France, Germany, the Netherlands, Norway, Sweden, and the U.K. Australia, whose commitment period ends in 2016, had made progress, but due to recent declines, would need to significantly increase family planning funding in 2016 in order to fulfill its commitment.

Donor Contributions to UNFPA

While the majority of donor government assistance for family planning is provided bilaterally, donors also provide support for family planning activities through contributions to the United Nations Population Fund (UNFPA) (see Box 3).¹⁰  Most of UNFPA’s funding is from donor governments, which provide funding in two ways: 1) donor directed or earmarked contributions for specific activities (e.g. donor contributions to the Global Programme to Enhance Reproductive Health Commodity Security at UNFPA), which are included as part of bilateral funding; and 2) general contributions to “core” activities that are untied and meant to be used for both programmatic activities (family planning, population and development, HIV-AIDS, gender, and sexual and reproductive health and rights) and operational support as determined by UNFPA.

In 2015, donor governments provided US$392.6 million in core contributions to UNFPA, a decrease of US$78.9 million (-17%) below 2014 levels (US$471.5 million). Similar to bilateral funding, much of this decline can be attributed to the appreciation of the U.S. dollar. In fact, when measured in the currency of origin, all of the donors profiled essentially maintained their contribution to UNFPA’s core resources at the prior year level, with the exception of Denmark, which increased funding. Sweden provided the largest core contribution to UNFPA in 2015 (US$57.4 million), followed by Norway (US$55.6 million), the Netherlands (US$39.7 million), and Denmark (US$35.7) (see Figure 3 and Table 2).¹³  Among the ten donors profiled, two provided a larger contribution to UNFPA’s core resources than their total bilateral disbursement for family planning: Denmark and Norway.

Conclusion

After several years of funding increases since the 2012 London Summit on Family Planning, donor government funding for family planning was essentially flat in 2015 in real terms, and fell when measured in current U.S. dollars.  While the decline was primarily driven by the appreciation of the U.S. dollar, some donors did reduce funding, as measured in their currencies of origin.  At the same time, seven of the eight profiled who made commitments at the London Summit, have either fulfilled or are on track towards fulfilling their commitments. Still, as donor commitment periods come to an end and given the uncertainty associated with the value of the U.S. dollar, it is unclear what the scope of support for family planning will be going forward.

Methodology

Bilateral and multilateral data on donor government assistance for family planning (FP) in low- and middle-income countries were collected from multiple sources. The research team collected the latest bilateral assistance data directly for 10 governments: Australia, Canada, Denmark, Germany, France, the Netherlands, Norway, Sweden, the United Kingdom, and the United States during the first half of 2016. Data represent the fiscal year 2015 period for all governments. Direct data collection from these donors was desirable because they represent the preponderance of donor government assistance for family planning and the latest official statistics – from the Organisation for Economic Co-operation and Development (OECD) Creditor Reporting System (CRS) (see: http://www.oecd.org/dac/stats/data) – which are from 2014 and do not include all forms of international assistance (e.g., funding to countries such as Russia and the Baltic States that are no longer included in the CRS database).  In addition, the CRS data may not include certain funding streams provided by donors, such as FP components of mixed-purpose grants to non-governmental organizations. Data for all other OECD DAC member governments – Austria, Belgium, the European Commission, Finland, Greece, Ireland, Italy, Japan, Korea, Luxembourg, New Zealand, Portugal, Spain, and Switzerland – who collectively accounted for less than 2 percent of bilateral family planning disbursements, were obtained from the OECD CRS and are from calendar year 2014.

For purposes of this analysis, funding was counted as family planning if it met the OECD CRS purpose code definition: “Family planning services including counselling; information, education and communication (IEC) activities; delivery of contraceptives; capacity building and training.” Where it was possible to identify funding amounts, family-planning-related activities funded in the context of other official development assistance sectors (e.g. education, civil society) are included in this analysis. Project-level data were reviewed for Canada, Denmark, France, Germany, the Netherlands, Norway, and Sweden to determine whether all or a portion of the funding could be counted as family planning. Family-planning-specific funding totals for the United States were obtained through direct data downloads and communications with government representatives. Funding attributed to Australia and the United Kingdom is based on a revised Muskoka methodology as agreed upon by donors at the London Summit on Family Planning in 2012. Funding totals presented in this analysis should be considered preliminary estimates based on data provided by representatives of the donor governments who were contacted directly.

It was difficult in some cases to disaggregate bilateral family planning funding from broader reproductive and maternal health totals, as the two are sometimes represented as integrated totals. In addition, family-planning-related activities funded in the context of other official development assistance sectors (e.g. education, civil society) have in the past remained largely unidentified.  For purposes of this analysis, we worked closely with the largest donors to family planning to identify such family-planning-specific funding where possible. In some cases (e.g. Canada), specific FP percentages were recorded for mixed-purpose projects.  In other cases, it was possible to identify FP-specific activities by project titles in languages of origin, notwithstanding less-specific financial coding. In still other cases, detailed project descriptions were analyzed. (see Appendix 1 for detailed data table).

Bilateral funding is defined as any earmarked (FP-designated) amount and includes family planning-specific contributions to multilateral organizations (e.g. non-core contributions to the Global Programme to Enhance Reproductive Health Commodity Security at UNFPA). U.S. bilateral data correspond to amounts disbursed for the 2015 fiscal year. UNFPA contributions from all governments correspond to amounts received during the 2014 calendar year, regardless of which contributor’s fiscal year such disbursements pertain to.

With some exceptions, bilateral assistance data were collected for disbursements. A disbursement is the actual release of funds to, or the purchase of goods or services for, a recipient.  Disbursements in any given year may include disbursements of funds committed in prior years and in some cases, not all funds committed during a government fiscal year are disbursed in that year. In addition, a disbursement by a government does not necessarily mean that the funds were provided to a country or other intended end-user. Enacted amounts represent budgetary decisions that funding will be provided, regardless of the time at which actual outlays, or disbursements, occur. In recent years, most governments have converted to cash accounting frameworks, and present budgets for legislative approval accordingly; in such cases, disbursements were used as a proxy for enacted amounts.

UNFPA core contributions were obtained from United Nations Executive Board documents. UNFPA estimates of total family planning funding provided from both core and non-core resources were obtained through direct communications with UNFPA representatives. Other than core contributions provided by governments to UNFPA, un-earmarked core contributions to United Nations entities, most of which are membership contributions set by treaty or other formal agreement (e.g., United Nations country membership assessments), are not identified as part of a donor government’s FP assistance even if the multilateral organization in turn directs some of these funds to FP.  Rather, these would be considered as FP funding provided by the multilateral organization, and are not considered for purposes of this report.

The fiscal year period varies by country.  The U.S. fiscal year runs from October 1-September 30. The Australian fiscal year runs from July 1-June 30.  The fiscal years for Canada and the U.K. are April 1-March 31.  Denmark, France, Germany, the Netherlands, Norway, and Sweden use the calendar year.  The OECD uses the calendar year, so data collected from the CRS for other donor governments reflect January 1-December 31. Most UN agencies use the calendar year and their budgets are biennial.

All data are expressed in US dollars (USD).  Where data were provided by governments in their currencies, they were adjusted by average daily exchange rates to obtain a USD equivalent, based on foreign exchange rate historical data available from the U.S. Federal Reserve (see: http://www.federalreserve.gov/) or in some cases from the OECD.  Data obtained from UNFPA were already adjusted by UNFPA to represent a USD equivalent based on date of receipts.

1. The Kaiser Family Foundation initiated a family planning resource tracking project in 2013, adapting the methodology it has long used to track donor government spending on HIV. Since 2002, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Kaiser Family Foundation have been tracking donor government assistance for HIV in low- and middle-income countries by the donor government members of the Organization for Economic Co-operation and Development’s (OECD) Development Assistance Committee (DAC). For the methodological approach used to monitor donor government spending on HIV see: https://modern.kff.org/global-health-policy/report/financing-the-response-to-aids-in-low/. ↩︎
2. In 2014, Finland provided the third largest core contribution (US$60.4 million) to UNFPA, followed by the Netherlands. ↩︎
3. UNFPA, Financial Resource Flows for Population Activities Report 2011, 2013. ↩︎
4. UNFPA, Direct communication, September, 2016. UNFPA methodological note: “When accounting for Family Planning expenses, it is crucial to take into account the cross-cutting nature of this area of work. Family Planning is strictly inter-linked with other areas in which UNFPA operates such as integrated services on sexual and reproductive health, HIV/AIDS, gender equality and reproductive rights, adolescents and youth, data and analysis.  For example, family planning is an integral part of the activities to provide or support integrated SRH services, such as post-partum family planning, post-abortion family planning, family planning services for HIV positive individuals, etc. UNFPA’s focus on adolescents and youth includes access to contraceptives information and services for adolescents through advocacy, comprehensive sexuality education or youth-friendly services. When UNFPA supports countries in advocating for gender equality and promoting reproductive rights, especially for marginalized women and girls, family planning services are the top priority on the agenda. Family planning is closely linked with population policies and strategies, and UNFPA assists governments to link family planning with population dynamics, while developing national strategies and build reliable population data and analysis. In light of these inter-linkages, the family planning expense hereby reported also takes into account the family planning component of expense that, while predominantly conducted under some other areas of UNFPA mandate, still contribute to the achievement of family-planning related results.” ↩︎
5. World Bank, Direct communication, August, 2014. ↩︎
6. Bill & Melinda Gates Foundation, Direct communication, September, 2016. ↩︎
7. Includes funding from 28 DAC member countries and the European Commission (EC). ↩︎
8. OECD, The List of CRS Purpose Codes, 2013. ↩︎
9. A disbursement is the actual release of funds to, or the purchase of goods or services for, a recipient. An enactment represents a budgetary decision that funding will be provided, regardless of the time at which an actual outlays, or disbursement, occurs. Therefore, disbursements in any given year may include funds committed (enacted) in prior years and in some cases, not all funds committed (enacted) during a government fiscal year are disbursed in that year. While most donor governments examined disburse enacted amounts within the same year, the U.S. government does not and may disburse enactments over multiple years. For instance, in FY 2013, U.S. bilateral enacted funding for family planning activities totaled $615.1 million, while disbursements totaled $585 million. ↩︎
10. UNFPA, “Frequently Asked Questions” (http://www.unfpa.org/frequently-asked-questions), accessed October, 2016. ↩︎
11. UNFPA, “Frequently Asked Questions” (http://www.unfpa.org/frequently-asked-questions), accessed October, 2016. ↩︎
12. UNFPA, “Frequently Asked Questions” (http://www.unfpa.org/frequently-asked-questions), accessed October, 2016. ↩︎
13. In 2015, Finland, which was not directly profiled in this analysis, provided the fifth largest core contribution ($38.0 million) to UNFPA, followed by the U.S. ↩︎

KEY FINDINGS:

• As the presidential election continues to dominate the attention of most Americans, the candidates themselves, the economy and jobs, and foreign policy rank as top factors in voters’ decisions, with health care following far below. However, the vast majority of voters say there are differences between the two presidential candidates’ views on health care, although more feel they have a good understanding of what Democratic presidential nominee Hillary Clinton is proposing in the health care arena than Republican presidential nominee Donald Trump.
• When thinking about health care priorities for the next president and Congress to address, dealing with the high price of prescription drugs tops the public’s list while issues specific to the Affordable Care Act (ACA), such as repealing provisions of the law or repealing the law entirely, are viewed as top priorities by fewer Americans.
• The public remains divided on what’s next for the ACA with about equal shares saying the law should be repealed as saying it should be expanded. As discussions about the challenges facing the ACA marketplaces continue, about two-thirds of Americans say they favor creating a public health insurance option to compete with private health insurance plans in the ACA marketplaces, but support for this is relatively malleable, with attitudes shifting after hearing counterarguments.
• With the ACA’s fourth open enrollment period beginning on November 1^st, the corresponding Data Note examines the public’s view on the future of the 2010 health care law, which groups they think are better off as a result of this legislation, and what sources they go to for information about the law.

The 2016 Presidential Election

With less than two weeks until Election Day, the October Kaiser Health Tracking Poll finds that when asked in their own words the single most important issue in their vote for president, voters offer the candidates themselves, the economy and jobs, and foreign policy rank as top factors in their decisions. On the other hand,  a much smaller number of voters – regardless of party – volunteer health care as the most important issue. The poll finds that about one-third of Democratic voters (36 percent) say the candidates themselves are the most important issue in their vote. For Republican voters, the economy and jobs (34 percent) and foreign policy (34 percent) are volunteered most often. Similar shares of independent voters mention the presidential candidates (27 percent) and the economy and jobs (29 percent).

While health care is playing a limited role in voters’ decisions, the majority of voters say the two presidential candidates have different views on what should be done on health care. Nearly nine in ten voters say the candidates’ views on what should be done on health care are either “very different” (74 percent) or “somewhat different” (14 percent), with fewer than one in ten saying they are either “very” or “somewhat” similar (2 percent and 5 percent, respectively).

Although discussion of health care policies on the campaign trail has been somewhat limited, seven in ten (71 percent) voters say they understand (either “very well” or “somewhat well”) what Hillary Clinton is proposing to do on health care if she wins the election while fewer (51 percent of voters) say the same of Donald Trump.

Health Care Priorities for the Next President and Congress

This month’s Kaiser Health Tracking Poll also examines the public’s attitudes on which health care issues should be a priority for the next president and Congress. Making sure high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable to those who need them is viewed as a “top priority” by 74 percent of the public and majorities of individuals across party lines. In addition, the majority of the public say government action to lower prescription drug prices is a top priority (however, larger shares of Democrats and independents than Republicans view this as a top priority). Issues specific to the ACA, such as repealing provisions of the law or repealing the law entirely, are viewed as top priorities by fewer Americans. However, repealing the ACA is seen as a top priority by six in ten Republicans – ranking second in top priorities among this group.

Next Steps for the Health Care Law

When it comes to the future of the Affordable Care Act, the public is divided on what they want to see the next president and Congress do. About one-third (32 percent) of the public want to see the next president and Congress repeal the entire law which is similar to the share (31 percent) who want to see the next administration expand what the health care law does. One in five (18 percent) say they want to see the next president and Congress move forward with implementing the law as it is while 9 percent want to see the next administration scale back what the law does.

Voters who currently support Democratic presidential candidate Hillary Clinton are also more likely to say they want to see the next president and Congress expand the law (48 percent) or move forward with implementing the law as it is (29 percent) than voters who currently support Republican presidential candidate Donald Trump (7 percent and 3 percent, respectively). Three-fourths (73 percent) of Trump supporters say they want to see the next president and Congress repeal the entire law. These differences mirror overall partisan differences with larger shares of Democrats (48 percent) wanting to see the law expanded than independents (31 percent) and Republicans (9 percent).

Public Health Insurance Option

Decisions by insurers to no longer sell coverage through some ACA marketplaces have spurred renewed discussions of establishing a public health insurance option in an effort to address potential gaps in access to health insurance plans through the marketplace. Overall, about two-thirds (62 percent) of Americans favor a public health insurance option to compete with private health insurance plans in the ACA marketplaces; however, how the proposal is described and labeled affects the level of support.

When half of the sample are asked whether they favor or oppose creating a public health insurance option, 70 percent express a favorable view while one-fourth (24 percent) oppose. When the other half of the sample are asked whether they favor or oppose creating a government-administered public health insurance option, about half (53 percent) say they favor such a plan while 41 percent oppose.

Across all partisan groups, the inclusion of the detail of “government-administered” in the question wording decreases favorability – yet, to varying degrees. Majorities of Democrats, Clinton supporters, and individuals with a favorable view of the ACA say they favor both a government-administered public health insurance option and a public health insurance option. Among independents, a majority (70 percent) favor a public health insurance option but fewer (52 percent) favor creating a government-administered public health insurance option. Smaller shares of Republicans, Trump supporters, and individuals who have an unfavorable view of the ACA favor either proposal. However, the share who favor a government-administered public health insurance option is significantly smaller than those who favor a public health insurance option.

How Flexible Are Americans’ Opinions of a Public Option?

Until recently, there had been little public discussion or details of a public health insurance plan. Therefore, it is unsurprising that for some, attitudes on this issue can be swayed when they hear messages being made from the alternative viewpoint. For instance, 21 percent overall shift their opinion from favor to oppose after hearing the argument often made by opponents of the proposal that doctors and hospitals would be paid less under a public health insurance plan, and one-fourth (27 percent) of the public shifts their opinion to oppose when hearing that the government would have an unfair advantage over private insurance companies. On the other side of the debate, some of those who originally say they oppose a public health insurance option are also persuaded by hearing arguments often made by supporters of the proposal. About one in ten change their stance from oppose to favor after hearing that the public health insurance option could help drive down costs because private insurers would be competing with the public plan (13 percent), provide more choice to people getting insurance through the ACA marketplaces (11 percent), or be the only health insurance option for people living in areas where private health insurance companies may not be offering coverage through the ACA marketplaces (11 percent).

Kaiser Health Policy News Index: October 2016

The October Kaiser Health Tracking Poll finds the 2016 presidential campaign and Hurricane Matthew dominating the public’s attention during the past month. Nearly three-fourths of Americans say they were closely following news stories about Hillary Clinton’s presidential campaign (73 percent), the damage caused by Hurricane Matthew in the Atlantic Ocean (72 percent), and Donald Trump’s presidential campaign (70 percent). Fewer Americans report closely following the top health stories during the month, with two-thirds closely following news about the Zika virus outbreak, 61 percent following news about the increase in cost for an EpiPen, and 59 percent following news about the ongoing opioid epidemic. Smaller shares report closely following news about the conflict in Aleppo, Syria (51 percent) or former President Bill Clinton’s remarks about the Affordable Care Act (33 percent).

This Kaiser Health Tracking Poll was designed and analyzed by public opinion researchers at the Kaiser Family Foundation (KFF). The survey was conducted October 12-18, 2016, among a nationally representative random digit dial telephone sample of 1,205 adults ages 18 and older, living in the United States, including Alaska and Hawaii (note: persons without a telephone could not be included in the random selection process). Computer-assisted telephone interviews conducted by landline (424) and cell phone (781, including 476 who had no landline telephone) were carried out in English and Spanish by Princeton Data Source under the direction of Princeton Survey Research Associates International (PSRAI). Both the random digit dial landline and cell phone samples were provided by Survey Sampling International, LLC. For the landline sample, respondents were selected by asking for the youngest adult male or female currently at home based on a random rotation. If no one of that gender was available, interviewers asked to speak with the youngest adult of the opposite gender. For the cell phone sample, interviews were conducted with the adult who answered the phone. KFF paid for all costs associated with the survey.

The combined landline and cell phone sample was weighted to balance the sample demographics to match estimates for the national population using data from the Census Bureau’s 2014 American Community Survey (ACS) on sex, age, education, race, Hispanic origin, and region along with data from the 2010 Census on population density. The sample was also weighted to match current patterns of telephone use using data from the July-December 2015 National Health Interview Survey. The weight takes into account the fact that respondents with both a landline and cell phone have a higher probability of selection in the combined sample and also adjusts for the household size for the landline sample. All statistical tests of significance account for the effect of weighting.

The margin of sampling error including the design effect for the full sample is plus or minus 3 percentage points. Numbers of respondents and margins of sampling error for key subgroups are shown in the table below. For results based on other subgroups, the margin of sampling error may be higher. Sample sizes and margins of sampling error for other subgroups are available by request. Note that sampling error is only one of many potential sources of error in this or any other public opinion poll. Kaiser Family Foundation public opinion and survey research is a charter member of the Transparency Initiative of the American Association for Public Opinion Research.