At the same time, few Americans today mention concern about child poverty or health care, though a majority report that they would be willing to pay higher taxes to provide health insurance for children who lack it.

These are some of the principal findings from a survey released today by Harvard University, The Robert Wood Johnson Foundation, and the University of Maryland. The survey asked American adults to rate the "top problems facing American children." "Drugs" was listed by 56% of those surveyed, with "crime" a distant second at 24 percent. "Home life breakdown and related problems" was third at 22%, with "poor quality education" fourth at 17 percent.

These numbers contrast dramatically with what was reported by a Harris survey in 1986, when drugs was mentioned 52% of the time, home life 46%, child and sexual abuse 28%, poor quality education 9%, and alcohol abuse 9%. Indeed, in 1997, fewer than 2% of the public mentioned child or sexual abuse as a top problem.

"As we look toward the new century," says Robert J. Blendon, professor at Harvard University and director of the study, "three issues dominate the public's concern about the future of children in this country -- drugs, crime, and home life breakdown. Almost every other concern about the problems facing children has been overwhelmed by these issues."

What is striking in the most recent findings is the absence of problems that many experts consider to be the most important, such as childhood poverty and health care. Neither of these problems ranked among the top ten in either 1986 or 1997. Americans' failure to rank health care among the most serious problems children face appears to be related to two factors: (1) the belief by half of the public (50%) that children are better off now than ten years ago in getting health care when they need it; and (2) the belief of over half of the public (55%) that children in the United States are healthier than children in many other industrialized countries. This latter point has been refuted by many reports, most recently a November article in the journal Health Affairs reporting that, compared to 28 other industrialized nations, the United States ranks 23rd in infant mortality, 20th in life expectancy at birth for women and 21st in life expectancy at birth for men.

Although the public does not rank health care among its top concerns for children today, the survey found that Americans are very supportive of specific government programs that are designed to improve children's health. More than half of Americans list the following as very important government programs: children's immunizations (79%), community health care clinics (67%), special education (60%), Medicaid (56%), Head Start (54%), and prenatal care programs (53%). And more than half of Americans (51%) report that they favor government extending health coverage to children and are willing to pay more taxes for this purpose.

"When the public is reminded of government programs, those affecting children are among the most popular," says Blendon.

The low ranking of children's health care issues is also reflected in the finding that the public lacks awareness of the recently enacted legislation on children's health insurance. Earlier this year, the Congress passed and the President signed into law legislation to cover a significant portion of the 11 million uninsured children in the United States. The survey, taken in the two months immediately after passage of the children's health legislation (September and October), shows that the vast majority of the public does not know that any legislation to affect this problem was passed. Indeed, the most likely beneficiaries of the legislation (adults whose children lack health insurance) are no more likely to recall seeing such news stories (26%) than adults whose children are covered by health insurance (29%).

In addition, as states consider what to do about this issue, the survey shows that there is little public consensus. More than two thirds of the public (68%) believe that government should provide health insurance for uninsured children, but there is far less consensus on specific financing strategies. Though 51% would pay higher taxes, only 31 percent support giving tax credits to parents to buy private insurance, and only 16% favor expanding their state's Medicaid program. And fewer still -- only 4% -- felt strongly enough about the issue to have written or spoken to a public official on this subject during the year prior to the survey. This compares to the 17 percent of Americans who took similar action regarding the 1995 debate over Medicare and Social Security.

"What this means," says Blendon, "is that if a big push isn't made to increase public support for children's health care, any hope of extending coverage to the majority of the 11 million uninsured children could fizzle out at the state level."

"New federal legislation has given us one of those moment-of-truth opportunities to make sure that America's uninsured kids get the coverage they deserve," said Steven A. Schroeder, M.D., president of The Robert Wood Johnson Foundation. "It will be a national tragedy if these children don't get adequate health care because of a lack of public interest or political will at the state and local level."

In another finding, a majority of the public (62%) prefers not to re-allocate spending from health care programs that serve the elderly to those that serve children. In addition, women show far more support for a series of government programs for children than do men.

The survey on "American Attitudes Toward Children's Health Care Issues" was funded by The Robert Wood Johnson Foundation, the nation's leading philanthropy supporting health and health care in the United States. It was designed by the Harvard University School of Public Health, with assistance from the Survey Research Center at the University of Maryland at College Park. Survey analysis was done at Harvard. The survey of 1501 adults within the continental United States was conducted by telephone by the Survey Research Center, and the survey's margin of error is plus or minus 3 percentage points.

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