Americans Support US Working to Improve Health in Developing Countries

May 20, 2009

Efforts Seen as Helping Americans as Well as People in Poor Nations

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Questionnaire/methodology (PDF)

Despite the economic downturn, a large majority of Americans support US efforts to improve health in poor countries. This support is grounded in altruistic concern for the poor, but it also comes from a sense that in today’s interconnected world a health crisis anywhere could impact Americans and that with globalization, health is an increasingly global issue.

The poll of 1,004 Americans, conducted from March 25 to April 6, finds that 64 percent want the US government to make efforts to improve health for people in developing countries. The poll was conducted by in collaboration with, and with financial support from, the Institute of Medicine at the National Academies of Science.

A key reason for making such efforts is altruism. Seventy-five percent say these programs “express Americans’ key values–compassion, generosity and a desire to share knowledge.”

However, an even larger number agrees that such efforts serve the interests of Americans as well as others. An overwhelming 85 percent endorse the view that “these programs are important for the health of Americans as well as people abroad,” due to diseases like SARS and avian flu.

The American public shows equally strong support for programs to fight diseases that mostly strike abroad as for programs to fight diseases that strike at home. Eighty percent favor “conducting basic research on diseases, such as malaria and tuberculosis that primarily affect poor countries,” while as many (79%) favor “supporting programs to reduce death and disability from chronic diseases like cancer and diabetes, which affect poor as well as rich countries.”

“Most Americans see an overlap between problems of disease at home and problems of disease in poor countries,” comments Clay Ramsay, research director of “Though there’s generosity at work as well, they primarily see global health issues as in everyone’s interest to resolve.”

More broadly, Americans appear to be thinking of health as an increasingly global phenomenon: 80 percent agree that because of “increased travel and trade in food products, we need to think of health as a global problem requiring a cooperative global response.”

Interestingly, Americans’ support for global health programs is apparently undiminished by the fact that nearly all Americans overestimate the overall amount of development aid the US gives compared to other donor countries, as a percentage of gross domestic product (GDP). Eighty-seven percent believe the US gives more (69%) or as much (18%) as other donor countries as a percentage of GDP. In reality, the US ranks at the bottom of 22 OECD donor countries in this regard.

There may in fact be support for higher levels of spending if Americans had more correct information about actual relative spending levels. Asked how much the US should spend as compared to other developed countries, a 57 percent majority say the US should spend about the same percentage.

Support for Specific Programs

Child and maternal health in developing countries has long been, and remains, a very popular cause with Americans. Seventy-seven percent favor programs for “improving the health of mothers and children in poor countries”; only 23 percent are opposed.

Though controversy always swirls in the US around funding family planning programs in poor countries, 68 percent favor programs for “helping poor countries provide family planning and reproductive health services to their citizens,” with 31 percent opposed. Such majority support has been found in the past as well. In PIPA’s 1995 study on foreign aid, 74 percent wanted to either maintain (38%) or increase (36%) funding for family planning programs in poor countries.

One kind of program divides public opinion down the middle–programs about tobacco use. Only 50 percent favored “supporting international programs to reduce tobacco use in poor countries” (17% strongly, 33% somewhat), while 49 percent opposed them (17% strongly, 32% somewhat). It may be that some are uncertain about the effectiveness of programs whose success depends on others’ personal lifestyle choices.

Working Multilaterally

A majority thinks that in general, it is best to give aid through international efforts, rejecting arguments that when the US acts on its own it has more control over how aid is spent and gets more credit for results. Sixty-one percent agree that “When giving foreign aid, it is best for the US to participate in international efforts, such as through the UN. This way it is more likely that other countries will do their fair share and that these efforts will be better coordinated.” Only 37 percent prefer the view that “When giving foreign aid it is best for the US to do so on its own, because that way the US has more control over how the money is spent and will get more credit and influence in the country receiving the aid.

Consistent with this, in the global health field, an overwhelming majority–79 percent–favors the United States contributing to the work of the World Health Organization in “seek[ing] to deal with diseases worldwide.”

Support for New Strategies

Strengthening Poor Countries’ Overall Health Systems

There are questions in the health policy community about the proper balance in US government global health programs. Programs addressing specific diseases such as HIV/AIDS or malaria may be more easily understood by the public and accordingly receive stronger public endorsement. Directing additional support to country health systems, though, could help developing countries address non-communicable diseases, injuries, and chronic diseases as well as HIV/AIDS.

It turns out, however, that the public prefers to distribute global health aid so that helping poor countries strengthen their general health systems receives more support than it does today. Respondents were offered a question that explained the issue and asked respondents to allocate $100 of aid across a) specific disease programs or b) to help poor countries build up their health systems.

Americans divide aid for these types of programs fairly evenly, slightly favoring programs targeted at overall health systems. On average, the public allocates $55 to programs supporting overall health systems and $45 to programs fighting specific diseases. Among respondents, 36 percent assigned more than $50 to health systems, 38 percent precisely $50, and 20 percent less than $50. For fighting specific diseases, 20 percent assigned more than $50, 38 percent $50, and 36 percent less than $50.

For the American public, both goals appear to merit receiving US aid. The public seems to favor more balance than is currently present in US programs, and most favor using a substantial share to build up health systems in poor countries.

Visa for Health Professionals from Developing Countries

The US benefits from a large number of trained medical professionals from developing countries who immigrate and work here. Though many appear to be interested in assisting their home countries by returning temporarily to practice there, US visa arrangements make this difficult for those who are not yet American citizens. A change in visa regulations has been discussed that would allow foreign doctors and nurses to return to their home country to work temporarily, and to later come back to the US

Americans support such a visa arrangement. By a very large majority, 81 percent, the public thinks that this visa proposal is a good idea; only 18 percent think it is a bad idea.

Programs to Support Creation of Successful Vaccines

Infectious diseases are responsible for the deaths of millions of people each year in developing countries, but because these countries are poor, pharmaceutical companies may not be able to recover their research and development costs, even when new vaccines prove to be successful.

An advance market commitment by governments in developed countries that subsidizes the purchase of a successful vaccine by poor countries would provide a reliable market for such new drugs. A group of developed countries has recently used such a mechanism successfully to encourage the development of a vaccine against a pneumonia-related disease.

Two thirds (65%) of Americans support the US government participating in “a program that ensures that drug companies are adequately compensated if they create a vaccine” that would be used primarily in poor countries. Thirty-three percent are opposed.

Small Tax on International Airline Travel

A group of eight countries led by France has developed a program which applies a modest tax on airline travel to help the UN’s AIDS program purchase drugs for AIDS, tuberculosis, and malaria. This provides a source of support for global health efforts based upon international travel and commerce. France charges one euro for an economy class intra-Europe flight and four euros for a flight beyond Europe. Other participating countries in the group apply the tax only to international flights.

Majorities of Americans favor such a tax at the lower price level tested (one or two dollars) and at the higher level as well. A majority (57%) says that the US should join the group of countries in charging such a tax ($1-2) on international flights to support UN efforts to provide drugs; 41 percent say the US should not. At the level of a five-dollar tax, a slimmer majority is also in favor–53 percent say that the US should participate, and 44 percent say it should not.

The poll was fielded by Knowledge Networks using its nationwide panel, which is randomly selected from the entire adult population and subsequently provided Internet access. For more information about this methodology, go to The margin of error for this study is +/- 3.2 percent. is a project managed by the Program on International Policy Attitudes at the University of Maryland.

Full report (PDF)

Questionnaire/methodology (PDF)
Dataset for Download (SPSS format)



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