Striving towards health care for all

12 World Health • 47th Year, No.5, September-october 1994 Striving towards health care for all Kathryn E. Johnson The health care debate in the USA has focused largely on access and financing, and very few people are asking whether reform will enhance health status and quality of life. The Healthcare Forum re- cently conducted a nationwide study on "What creates health? Individuals and communities respond", which took a fresh approach to looking at the issues of health and health care reform, leadership, and the role of the community. The study provides an up-to-the-minute picture of peo- ple's values, expectations and con- cerns about their communities and about leadership at both community and national levels. The study was conducted for The Healthcare Forum by DYG, Inc., the social science research firm founded by Daniel Yankelovich, in coopera- tion with the National Civic League and funded in part by the W.K. Kellogg Foundation. Using both qualitative and quantitative research ranging from a national survey to an extensive literature search, DYG explored the American public's views on what is important to com- munity life in the 1990s and what is needed to build a future of healthier communities. The main research was through a nationally representa- tive telephone survey of 1000 Americans from all socioeconomic groups, aged 18 and older, conducted between 7 and 21 February 1994. Aspirations and desires The study showed that Americans believe their health is dependent on a broad range of issues beyond access to health care and financing, those surveyed indicating that their per- sonal health was directly related to America's symbol of public values and expectations. The USA is embroiled in a broad national debate that will lead to a maior reform of the health care system. The United States is embroiled in a broad national debate that will certainly reform the country's health care system through the next decade. But do the alternatives and issues that consume politicians and policy-makers reflect the public's values and aspirations concerning health? Citizens are probably the most underutilized resource in the community. the health of their communities. The study also points to a failure on the part oftoday's leaders to address the issues that most concern the American public. In addition, the research clearly indicates that Americans believe that any agenda to promote healthier communities should include policies for dealing simultaneously with community issues such as crime, jobs, strength- ening of families, and the environ- ment. The study provides great insight into the aspirations and desires of the American public: • There is clearly a growing appre- ciation for a new concept of health, one that moves away from the ideas of health as the absence of disease and the result of med- ical intervention, to a broader definition that includes both personal responsibility and qual- ity of life. In fact, the public equates "healthy community" with "quality of life", and recog- nizes that one's own health is somehow related to the health of one's neighbours. • There is growing caution about what national health care reform means. Of those polled, 69% support guaranteed health insur- ance for everyone, but they think "we should move to it step by step to make sure that we can afford it." • The public wants to play a more proactive role in the health of their communities. The majority of Americans place more confi- dence in themselves and people like them than in any government or nongovernmental institution. The results of this study and DYG's own research of social change suggest that public de- World Health • 47th Year, No.5, September-October 1994 Automatic distribution of newspapers in Washington . Well-informed citizens are an invaluable resource which can help build healthier communities. mand for attention to quality-of- life issues and building healthier communities will blossom in the USA over the next several years. After a prolonged period of cynicism and detachment, the American public appears reinvig- orated and committed to finding solutions to national, community and personal problems. • People are discouraged about the health of their communities and are struggling to balance their individual needs with their oblig- ations towards the community. Although Americans have been known for their optimism, they see innumerable obstacles to making their communities health- ier and have little confidence that any existing institution can rectify the situation. The public mood is now shifting towards the belief that we, as individuals and as communities, can and must solve the serious problems that face us. • The public lacks confidence in institutions that now provide leadership. Fewer than 30% have confidence in local government, business and community leaders as well as the media. State and federal officials and national business leaders fare even worse. People are considerably more confident in themselves and their friends to effect change than in conventional leaders. In fact, traditional sources of leadership are seen as obstacles to building a healthier community because people believe that traditional leadership - compartmentalized, competitive, command-and- control driven- has failed. • Family security dominates per- ceptions about healthy communi- ties. People indicated that a healthy community must include safe streets, a nurturing environ- ment for children, economic security, and clean air and water. Crime is the number one issue of concern, but Americans are equally concerned about the state of their family life and many are rediscovering the family-centred lifestyle. As we review the overall study findings, we see an American public -regardless of geographic region, A health centre in Washington. People are ready to become true partners of health professionals. 13 No home other than a street in New York . Public opinion recognizes that one's own health may be related to common quality of life. socioeconomic status, race, religion or educational level- frustrated by the quality of life they see ahead for themselves and their children. While they believe that change is needed in the current health care systems and they firmly support universal cover- age, they do not see the relevance of health care reform, by itself, to the overall well-being of their communi- ties. And yet, the people believe that, when armed with knowledge and minimal resources, they are able and willing to abandon narrowly defined self-interest and work in concert for the benefit of their communities. In the future, one can expect a shift away from the focus on individual- ism that marked the 1980s towards a greater willingness to give a higher priority to community needs. _ Citizens are now probably the most underutilized resource within the community. • Dr Kathryn E. johnson is President of The Healthcare Forum, 830 Market Street, San Francisco, CA 94 102, USA