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

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."

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%).