Nearly three-quarters (71 percent) of Americans support a substantial increase in federal spending on the nation's public health infrastructure, a report from the Robert Wood Johnson Foundation and Harvard T.H. Chan School of Public Health finds.

Based on a survey of more than thirteen hundred adults conducted in February and March, the report, The Public's Perspective on the United States Public Health System (51 pages, PDF), found that 72 percent of respondents said the activities of U.S. public health agencies are "extremely" (40 percent) or "very" (32 percent) important to the health of the nation. At the same time, the survey found that respondents were more likely to place "a great deal/quite a lot" of trust in nurses (71 percent) and doctors (67 percent) than in public agencies such as the Centers for Disease Control and Prevention (52 percent), local (44 percent) or state (41 percent) health departments, the Food and Drug Administration (37 percent), and the National Institutes of Health (37 percent).

According to the report, only 34 percent of respondents gave a positive rating to the nation's public health system, down from 43 percent in a 2009 survey, while 51 percent gave a positive rating to the medical system, up from 36 percent. The public was split, however, on its ratings for individual agencies, with 54 percent rating the CDC's job performance as "excellent" or "good," down slightly from 59 percent in the 2009 survey, and almost half rating the performance of the FDA (48 percent) and NIH (47 percent) as excellent or good, up from 44 percent and 42 percent in 2009. The survey also found that about a third of respondents said they were not familiar with the work of their local health department, while a quarter said the same of their state health department.

When asked to name the two biggest health problems facing the nation, respondents were most likely to say COVID-19 (59 percent), cancer (19 percent), obesity (19 percent), access to health care (15 percent), and mental illness (10 percent).

"Our nation's public health system entered the pandemic underfunded and understaffed — problems that have persisted for generations — and the consequences of this underinvestment over the past year have been devastating," said RWJF president and CEO Richard E. Besser, who previously served as acting director of the CDC. "It is heartening that strong majorities of the American public support more substantial public health funding, which will put us in a better position to prepare for and respond to future health emergencies. Public health must also use this moment to commit to addressing the systemic challenges to improved health and well-being — including structural racism and discrimination — that continue to consign too many people of color in this country to shorter, sicker lives."

(Photo credit: Centers for Disease Control and Prevention)