This week, the Henry J. Kaiser Family Foundation released results of a survey that aimed to find out what Americans think about the country’s role in global health. The February 2012 telephone poll asked a variety of questions, including whether US spending on global health is at an appropriate level. Other questions went beyond health to explore, for example, foreign aid in general.

The Kaiser Family Foundation (KFF), an operating foundation, has offices in Menlo Park, California, and Washington, DC. It maintains an online gateway on US Global Health Policy, which is chock-full of data, KFF publications, news, a “policy tracker” describing “the latest action” from Congress and the Obama administration, webcasts, a helpful glossary, and more—all centered on global health.

For many years, the foundation has focused special attention on South Africa. Through its Program for Health and Development in South Africa, it continues its longstanding commitment to help the country “develop the people, plans and programs to aid in establishing a more equitable national health system and a successful democracy.”

Now back to the survey results!

On May 21, the KFF released a survey report, 2012 Survey of Americans on the U.S. Role in Global Health. Designed and analyzed by the foundation and carried out by Braun Research under the direction of Princeton Survey Research Associates International, the survey focused on efforts by the United States to improve health in developing countries. (For detailed information on the survey [methodology and toplines], see page 26–41 of the report.)

Respondents were asked to name the “most urgent health problem facing developing countries.” (They could select two health problems.) The top four responses were AIDS or HIV (the percentage putting this at the top of the list in 2012 fell to 28 percent from the 44 percent recorded in 2010), hunger/malnutrition, health care access, and clean drinking water.

Two-thirds of all respondents supported global health spending—reporting either that they believed the amount being spent is just about right or that the amount of spending is too little.

When asked about benefits to the United States of its funding health improvement efforts in developing countries, 70 percent of survey respondents said doing so “helps protect the health of Americans by preventing the spread of diseases like SARS [severe acute respiratory syndrome], bird flu, and swine flu.” A somewhat smaller percentage believed that health funding helps U.S. national security.

However, the KFF noted a couple of caveats. Two-thirds of those polled said that “given the serious economic problems” facing the United States and the world right now, the United States “cannot afford” to increase spending on health improvement for people in developing countries. And respondents were torn as to whether additional funding from the United States will actually “make a meaningful difference” in health improvement in developing countries and were “deeply skeptical about how much U.S. money actually reaches people on the ground” in such places, the report explained.

Most respondents believed that some health aid awarded by the United States to developing countries is wasted because of corruption. Across the survey responses, the average estimate of money lost through corruption is 47 cents of every dollar, KFF researcher Liz Hamel told GrantWatch Blog. (Drew Altman, the foundation’s president and CEO, commented in his monthly column, “Based on the evidence I have seen, the public’s perception is a gross over estimate, but perhaps surprisingly, this is not a subject that has been extensively and rigorously studied, especially with regard to U.S. aid.”)

Most (79 percent) respondents believed that, compared with “other wealthier” countries, the United States “is already doing its fair share or more” as to improving health in developing countries, the report noted.

Sixty-three percent of those surveyed preferred that the United States participate in multilateral approaches, “so that other countries will do their fair share and these efforts will be better coordinated.”

Most respondents recognized “the important role” of the United States, the report said. Realistically, a majority (62 percent) felt that if US foreign aid spending were decreased, illnesses and death in developing countries would increase. Also, 68 percent of respondents predicted that other countries with wealth “would not step in” to fill the gap created by reduced aid from the United States.

As for the HIV/AIDS epidemic, 62 percent of respondents viewed it as just one of many global problems that the United States and other wealthier countries must consider when determining allocation of resources, while 32 percent called it a “global emergency” that necessitates a “special funding effort” regardless of other existing problems.

More than half of respondents said that the news media spends too little time on coverage of health issues in developing countries.

Some analysis

The KFF reports that “providing people with accurate information has the potential to move opinion significantly.” For example, without being given any background information, 54 percent of respondents said that too much foreign aid was being distributed. But once respondents were told that only about 1 percent of the federal budget is spent on foreign aid, that figure dropped to just 24 percent. The foundation also noticed that specifics carry weight: the idea of aid for improving health in developing nations is more popular than foreign aid in general.

Interestingly, the report says that global health seems to engender “more bipartisan consensus” than other areas, such as domestic health policy and spending. Why? It may be, the KFF repport says, because many people feel supporting global health is a moral issue. In fact, 51 percent of respondents in the KFF survey said that the most important reason for US spending on improving health in developing countries is “because it’s the right thing to do.”

Mollyann Brodie of the KFF and her colleagues there worked on the survey.

Editor’s note: Watch for the July 2012 issue of Health Affairs, which will be a thematic issue on PEPFAR (the United States President’s Emergency Plan for AIDS Relief). The issue’s release date is July 9, 4 p.m.