confidence in local institutions–new data

For the Robert Wood Johnson Foundation, RAND’s Social and Economic Well-Being Team conducts a regular and large representative survey of National Health Attitudes (authors: Katherine Grace Carman, Anita Chandra, Sarah Weilant, Carolyn Miller, and Margaret Tait.) It includes items about civic engagement as well as health and healthcare and other topics. I look forward to detailed analysis that examines which kinds of Americans answer each question in various ways and how the various topics relate to each other.

For now, here is my graph showing simple topline responses to a question about the impact (whether positive or negative) of various “groups or organizations” on health.

None of these groups and institutions scores very well. Only two (local nonprofits) barely satisfy a majority of the population as being good for health.

To be specific, respondents were asked about about “Local organizations that provide health services (e.g., health care, public health)” and “Local organizations that provide other social services (e.g., food assistance, job training) such as faith based orgs, nonprofits.” It’s interesting that the perceived health impact of these two types of groups was about the same. You might guess that health-service organizations would have a bigger impact. Perhaps people understand the importance of the social determinants of health, such as employment. Or perhaps the mention of “faith-based orgs” in the latter question boosted its score.

Local businesses were rated higher than any government entity and higher that other residents. Of course, businesses provide goods and services that benefit health; the drug store and the vegetable aisle of the supermarket are really important. Still, this answer shows a gap between public opinion and the progressive view that the net impact of business is probably negative, or at least less positive than the net impact of government. (Just 1.6% thought that the impact of local business was very negative.)

As in almost all surveys, local government scores better than state government, which scores better than federal government. In this case, the information is somewhat ambiguous because respondents are asked about “local government,” and then about “leaders” at the state and federal level. It’s not clear whether the difference in their responses results from the change in scale or the shift from government to leaders. After all, the most evident federal leader is Donald J. Trump. Still, I suspect that if the question had been about government (not about leaders) at each level, confidence would have decreased with scale.

One response to these data might be: See, most Americans are not aligned with strong progressive proposals to increase the imprint of the federal government on health. They trust business much more. But some respondents may think the government helps less than local businesses do because the government is insufficiently ambitious. In any case, these data may support policy recipes that involve more federal funding–with a key delivery role for local nonprofits and local businesses, including your neighborhood drug store and supermarket.

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About Peter

Associate Dean for Research and the Lincoln Filene Professor of Citizenship and Public Affairs at Tufts University's Tisch College of Civic Life. Concerned about civic education, civic engagement, and democratic reform in the United States and elsewhere.