WHAT WORRIES AMERICANS MOST ABOUT THEIR CHILDREN

Researchers Surprised That Health Care Is Not High on Most People's Agenda

Ask American adults to name the most serious problems facing children, and
one answer overwhelms the rest: drugs. Crime and the breakdown of home life
rank a distant second and third, respectively.

Concern about health care and the ability to pay for it hardly get
mentioned. Injuries, the leading cause of death among children, doesn't
even make the list. Nor does smoking, the leading cause of preventable
illness in all Americans. The only disease mentioned by at least 1 percent
of adults is AIDS.

When the Harvard School of Public Health reported last week on its
nationwide survey, "American Attitudes Toward Children's Health Care
Issues," health care was conspicuously absent.

The findings suggest that the "family values" agenda has caught on with the
public more than the "health care" agenda, said Robert J. Blendon,
professor of health policy and political analysis at both the Harvard
School of Public Health and the Kennedy School of Government, who directed
the study.

"Poverty, day care, health insurance these are off the radar screen,"
Blendon said.

He said he was surprised that poverty didn't rank higher as a concern when
one out of five American children lives below the poverty line, and
surprised as well that concern about crime rose sharply even as crime rates
fell.

At a time when states are trying to figure out how and whether to
take advantage of a new federal law aimed at boosting Medicaid coverage of
otherwise uninsured children, the results are troubling to health officials.

In the Harvard survey, only 29 percent were aware of the new law or the
effort to expand coverage of uninsured children. Adults with uninsured
children were no more aware of the new legislation than other adults were.

"We were sort of staggered by that," Blendon said. "What's clear is that
people don't even know there's going to be a debate about this. There's
just no public following of this legislation."

The nationwide opinion poll was designed by the Harvard School of Public
Health and conducted by the Survey Research Center at the University of
Maryland in College Park. About 1,500 randomly selected adults were
interviewed by telephone during September and October.

When a 1986 Harris poll, using identical language, asked adults to name
critical problems facing children, drugs were also farandaway the top
concern. But the other rankings changed sharply in the past 11 years.

Child abuse and sexual abuse, mentioned as a top concern by 28 percent of
adults in 1986, plummeted to 1 percent this year. Crime leaped into second
place, mentioned by 24 percent, compared with 4 percent in the earlier
poll. Concern about breakdown of home and family life remained strong, but
dropped from 46 percent to 22 percent. Alcohol fell slightly from 9 percent
to 8 percent. Nearly twice as many adults mentioned education as an
important concern this year compared with 1986.

Neither health care nor poverty made it into the Top Ten list of concerns
in either the 1986 or the 1997 survey.

"Health care, poverty, alcohol and smoking didn't even make it onto the
list," said Ruby P. Hearn, senior vice president of the Robert Wood Johnson
Foundation, which funded the survey. "The public agenda as revealed in the
survey is much narrower than we think it needs to be."

Hearn expressed concern that the public, although clearly frightened by the
dangers of illegal drugs, remained unworried about related health problems.
"Very few kids just start taking drugs," she said. "They start drinking or
they start smoking, and that's what leads them to drugs." One in six
eighthgraders, she noted, say they recently have gone on a drinking binge,
according to the University of Michigan's latest national survey.

Like Blendon, she also worries that the public misunderstands the new
federal initiative on children's health insurance coverage. "The federal
legislation did not take care of the problem," Hearn said. "It created an
opportunity for states to take care of the problem."

About 11 million American children lack health insurance. The bipartisan
Balanced Budget Act passed by Congress and signed into law by President
Clinton in August includes a $24 billion measure aimed at expanding health
coverage for many of those 11 million children. The new law encourages
states to increase their Medicaid budgets and thus take advantage of
higher federal matching funds to expand coverage to families with annual
incomes up to twice the poverty level, or more than $32,000.

"A lot of families in that range are doing without, because they have not a
clue that they are eligible," said Sarah C. Shuptrine, founder and
president of the Southern Institute on Children and Families, a nonprofit
organization focusing on the disadvantaged in 17 southern states and the
District of Columbia.

"The ball is in the court of the states now," Shuptrine said. "The federal
government has acted. It's an incredible opportunity for the states."

But the latest survey suggests that the public still misunderstands
Medicaid, the federalstate health program for lowincome families. People
tend to think of Medicaid as a program only for the poorest families,
Shuptrine said, when in fact it may cover children in workingclass
families well above the poverty line.

"We need to uncomplicate those messages for parents," Shuptrine said.

In Maryland, for example, families with incomes up to 133 percent of the
federal poverty level are eligible for Medicaid. An estimated 168,000
children in Maryland are uninsured but do not qualify for Medicaid. Gov.
Parris N. Glendening (D) has vowed to expand coverage to include families
making more than twice the federal poverty level, including families with
incomes up to nearly $38,000.

Other states, including Arkansas, Missouri and South Carolina, have made
similar moves. But advocates of expanded health coverage for children worry
that public unawareness, as documented in the Harvard poll, may doom the
effort in other states.

"What this means," Harvard's Blendon said, "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."

Other findings in the Harvard survey also have important implications for
policymakers, Blendon said. They show that the public is inclined to trust
nurses and doctors on these issues more than they would public officials or
insurance plans or socalled experts.

"If I were making a big push for children's legislation," Blendon said, "I
would start by rounding up all the nurses and pediatricians I could before
I'd go after the governors and the commissioners.

"I'd be rounding up [former surgeon general C. Everett] Koop long before
I'd be rounding up Harvard professors."

PROBLEMS FACING CHILDREN

Q: What do you think are the two or three most serious problems facing
children in America today?

1986 Percent

1. Drugs 52

2. Home life breakdown and related problems* 46

3. Child and sexual abuse 28

4. Poor quality education 9

4. Alcohol abuse 9

1997 Percent

1. Drugs 56

2. Crime 24

3. Home life breakdown and related problems* 22

4. Poor quality education 17

* Combined data

Q: What do you think are the two or three most important HEALTH problems
facing children in America today?

AIDS 23 percent

Infectious diseases (besides AIDS) 17 percent

Drugs 15 percent

Smoking 11 percent

Cancer 10 percent

Alcohol 7 percent

Inability to pay for medical care 4 percent

Poverty, injuries and accidents, child or sexual abuse 1 percent or less

NOTE: Percentage is of adults who named a given problem.

SOURCES: Harvard University; Robert Wood Johnson Foundation; University of
Maryland; Harris Survey

© Copyright 1997 The Washington Post Company