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Purpose: Despite increased national attention to improving rural health, rural Native American populations face unique problems that are often unseen in aggregate research on the rural United States. The objective of this study was to examine rural Native Americans' experiences with serious problems across domains important to health, using rural Whites as a comparison group. Methods: Using 2 probability‐based national telephone surveys (2017 and 2019), we examined rural Native American adults' reported problems in health care, discrimination, police and safety, and housing. We then compared Native American‐White differences in reported problems across domains. Findings: Among rural Native American adults, 33% reported recent problems accessing health care when they needed it, 28% reported they or family members recently experienced major problems paying for medical bills, and 28% reported recent problems with health care quality. Several Native American‐White differences were reported, including experiencing racial violence (34% vs 5%, P <.001), discrimination in health care (19% vs 3%, P =.003), unfair police treatment (27% vs 5%, P =.002), and major housing problems (48% vs 26%, P <.001). Conclusions: Rural Native American adults report ongoing and widespread problems with health care, discrimination, the police, safety, and housing. These findings support many national policy recommendations to improve federal funding and oversight for programs serving Native American populations living in rural areas. [ABSTRACT FROM AUTHOR]

A review of 47 national surveys conducted between 1978 and 1997 shows that many Americans do not believe the War on Drugs has been a success. However, many want the war to continue and most favor severe penalties for the sale, possession and use of drugs. They seem to prefer preventive efforts over drug treatment, perhaps because they perceive many drug treatment programs as ineffective. Many Americans support the prescribing of marijuana for certain illnesses but do not support the legalization of marijuana or other drugs. Most Americans get their information about illicit drug use from the media., This article presents what Americans think about the policies subsumed under the label of the "War on Drugs." It is based on an analysis of 47 national surveys conducted between 1978 and 1997. The major results are that most Americans rely on the mass media for information about the scope of the drug abuse problem; Americans do not think that the Wars on Drugs have succeeded, but they do not want to quit on these efforts; weak support exists for increasing funding for drug treatment; support for preventive education has increased during the 1990s; criminal justice responses remain very popular; for many, illicit drug use is a moral rather than a public health issue; the public supports allowing physicians to prescribe marijuana for severe illness, but opposes the general legalization of marijuana and other illicit drugs; and needle exchange programs are supported by a bare majority, but only when they are told that the American Medical Association supports these programs.

Health care reform is no longer a priority among Americans but many still favor action on specific goals. During the 1996 election, only half of eligible voters voted and many voters were senior citizens and those in the upper income bracket. Most voters believe that health care has become more expensive. Many are concerned about the number of uninsured Americans, especially children. They do not support reductions in entitlement programs such as Medicare and Medicaid. They also favor some regulation of managed care plans.

The repeal of gun control laws was a prominent element of Patrick Buchanan's 1996 Republican primary campaign. A number of Republican candidates for the House of Representatives and the Senate [...]

About 34 million Americans could be experiencing severe health problems because they can not get the medical treatments they need or can not pay for them. Researchers conducted telephone interviews with 3,993 Americans and asked them if they had recently been unable to get medical care or could not pay for it. Thirty-one percent reported being uninsured, unable to get medical care or unable to pay for care. Uninsured participants were more likely to have these problems, but 58% of those unable to pay their bills were insured. Up to 28 million insured Americans may be unable to afford adequate health care.

Recent opinion polls suggest that many Americans support limited gun control but draw the line at a total handgun ban. According to 14 opinion polls done between 1959 and 1996, 41% of American households owned guns in 1994, down from 48% in 1973. Ownership of shotguns and rifles has dropped while ownership of handguns has risen. Gun ownership is highest in the South and The Rocky Mountain states. A majority of Americans believe that gun ownership is a Constitutional right even though the Supreme Court and the American Bar Association disagree. Most Americans support limiting the sale of guns to people with a criminal history, as well as the Brady Act and the registration of handguns. They also support the ban on semiautomatic weapons but only 40% would support banning all handguns. Less than one-third support laws that allow civilians to carry handguns. Even those who do not own guns fear that strict gun control laws will result in a total handgun ban.

Most voters in the 1994 congressional elections want the legislators to initiate moderate health care reform, although most did not cast their ballots based on a candidate's stand on health care issues. Researchers surveyed 17,618 voters, 1,005 of whom were Californians, to elicit public opinion about health care. Candidates' experience or their ethics and character influenced voters more than candidates' stand on national issues. Many voters disapproved of Congress' performance or had little trust in the government. Voters in two surveys deemed health care the top priority for the new Congress and 41% supported congressional approval of modest health care reforms. California's Proposition 186 that would have established a statewide single-payer health care system failed miserably. Most Californians who voted against the initiative felt it called for excessive government involvement.

African Americans seem to have poorer health, greater difficulty affording basic necessities, and more problems with employment and discrimination than whites. Between February and June of 1992, researchers surveyed 1,897 families, 1,337 of whom were low-income to examine the occurrence of various health and social welfare problems within the last year. Thirty-three percent of African Americans were in fair or poor health compared to 14% of whites. Thirty-two percent of African Americans and 17% of whites experienced health-related financial difficulties. Two to three times more African Americans had difficulty affording basic necessities than whites. Only 19% of low-income African Americans and 7% of whites received support from at least two public assistance programs. Eighteen percent of African Americans and 12% of whites had difficulty finding a job. Two percent of whites and 14% of African Americans experienced racial or ethnic discrimination.

Physicians in 1994 may not support significant changes in the health care system, although they do seem to support some central principles of reform. Between June and July of 1994, researchers interviewed 495 U.S. physicians about health care reform. Of these, 201 had been previously interviewed in March of 1993. Fifty-one percent of physicians advocated only minor adjustments to the health care system. Forty-six percent of physicians surveyed in 1994 and 74% of physicians surveyed in 1993 supported fundamental restructuring of the health care system. Over half of all physicians advocated three principles of reform: universal coverage, a decrease in the quantity of paperwork, and reform of the malpractice system. Interest in health care reform has decreased as more physicians suspect that reform will undermine their independence and patient care. Physicians express minimal confidence in politicians' ability to guide health care reform.

Polls taken between 1992 and April 1, 1994 found that health care continues to be one of the three most important issues in the country. Crime and the economy remain the most pressing problems, but health care is the issue citizens think the government can and should address. Most Americans feel that the system has major problems or is in crisis, and most feel that there should be universal basic coverage. Funding for universal coverage should come either from taxes, employer contributions or savings from budget cuts. However, the polls do not clearly differentiate between the funding Americans want and that which they expect. Most would like to have a basic health plan provided to those who otherwise would not have one, but they would also like the option to buy more services if they can afford to. There is little consensus on how to control the cost of the system or who should administer it. The urgency of the health care crisis is unanimously felt. However, there is less agreement on how to fix the problem.

Abortion is a controversial topic among both members of the general population and the medical community. Researchers reviewed public opinion surveys about abortion conducted between 1962 and 1993. The surveys were conducted by three different public opinion organizations. Approximately half the participants in a 1992 survey thought abortion was morally wrong, and approximately half thought it was not. Forty-seven percent of US citizens think that abortion is equivalent to murder, and 45% think that it is not. Only 28% of the individuals questioned in one 1992 survey thought that abortion should be illegal. Fifty-two percent of those answering another 1992 survey did not support government funding of abortions for low-income women. Nearly two-thirds of Americans support a federal law that forbids harassment or violent crimes against abortion clinic patients or staff.

Many of the Cambodian refugees interviewed in a refugee camp in Thailand had psychological problems that may predict future difficulty in readjusting to life in Cambodia. More than half of the 993 Cambodian refugees who participated in the study had symptoms that correlated with a diagnosis of major depression. Many also had symptoms of post-traumatic stress disorder. Participants in the study were randomly selected from five regions in the Site 2 refugee camp on the Thailand-Cambodia border. Interviews were conducted in Khmer. From 1975 to 1979, under the Khmer Rouge regime, 83% of all participants lacked food or water. Many reported being forced into labor, separated from their families, unable to get needed medical treatment and subjected to brainwashing. More than 53% also reported the murder of a family member or friend. Social programs and health programs designed to aid the Cambodians after repatriation must take into account the very high levels of psychological and physical trauma endured by the refugees both during the time of the Khmer Rouge and during their stay at the refugee camp., Objective.--To assess the long-term impact of trauma and confinement on the functional health and mental health status of Cambodian displaced persons living on the Thailand-Cambodia border. Design.--Household survey of 993 adults randomly selected from household rosters. Household sample selection by multistage area probability sample. Setting.--Site 2, the largest Cambodian displaced-persons camp on the Thailand-Cambodia border. Participants.--Adults 18 years of age and older selected at random within households; 98% of eligible persons selected agreed to participate. Results.--From 1975 through 1975 (Khmer Rouge regime), more than 85% reported lack of food, water, shelter, and medical care, brainwashing, and forced labor; 54% reported murder of a family member or friend; 36% reported torture; 18% reported head injury; and 17% reported rape or sexual abuse. During the refugee period between 1980 and 1990, 56% reported lack of food or water, 44% reported lack of shelter, 28% reported lack of medical care, 24% reported brainwashing, and 8% reported torture. Since 1980, reports of murder of a family member, head injury, and rape/sexual abuse have decreased to 5%. Reports of experiencing combat situations and shelling attacks have remained consistent between the two time periods, approximately 44% and 30%, respectively. From 1989 to 1990, 25% reported experiencing lack of food or water, and 5% to 10% reported serious injury, combat, and shelling conditions. More than 80% said they were in fair or poor health, felt depressed, and had a number of somatic complaints despite good access to medical services. Fifty-five percent and 15% had symptom scores that correlate with Western criteria for depression and posttraumatic stress disorder respectively. Fifteen percent to 20% reported health impairments limiting activity, and moderate or severe bodily pain. Despite reported high levels of trauma and symptoms, social and work functioning were well preserved in the majority of respondents. Conclusions.--Reports of extensive trauma, poor health status, and depressive symptoms of this population are of concern in predicting future morbidity and mortality. The health and mental health needs of Cambodian displaced persons and their impact on social and economic behavior should be addressed now that the Cambodians have been repatriated.

Policy experts and the general population agree on the need for substantial reform in the nation's health care system but differ markedly in their perception of the issue and its causes and solutions. According to 28 national surveys taken between 1990 and 1993, Americans see cost to them personally as the main health care issue. Experts, however, view the health care problem as a symptom of a sick economy and link it to slow growth and the budget deficit. Experts blame the problem on factors such as the public's demand for costly medical technology, the third-party payer system and an aging population. The public views malpractice, greed and fraud as the root of the problem. Experts' solutions all call for some measure of public sacrifice and increasing the public's sensitivity to the high cost of medical care. A plan that may be acceptable to both parties would ensure universal access to care funded both privately and publicly. It would have a regulatory system that maintained government oversight but that left day-to-day operations to others.

Universal health care coverage and cost containment may reduce access to sophisticated medical technology and the quality of certain types of medical services. A study surveyed physicians' level of satisfaction with their health care system in the US, Canada and the former West Germany. Canada and West Germany are two industrialized countries with programs for universal health care coverage and cost containment. Among 1,628 physicians who were surveyed about their level of satisfaction with their health care system, 602 were from the US, 507 were from Canada and 519 were from West Germany. Twenty-three percent of the US physicians were satisfied with their health care system, compared with 33% of the Canadian physicians and 48% of the German physicians. Seventy-three percent of the US physicians were concerned about patients' inability to afford health care, compared with 25% of the Canadian physicians and 15% of the German physicians. Canadian physicians were more likely to have limited access to sophisticated medical technology. German physicians were concerned about the reduced quality of certain types of medical services.

The majority of the US people may want President-elect Bill Clinton to increase health care coverage and contain costs associated with health care. Several studies examined public and voter opinions on health care reform during 1992 and on the night of the 1992 presidential election. The individuals who were surveyed rated health care reform among the top three priorities in the 1992 presidential election. They were split approximately evenly between preferring Clinton's plan for health care reform, George Bush's plan and an individual-payer plan for national health care insurance. One of their main concerns was containment of health care costs. Fifty percent were willing to pay an additional $20 each month for national health care insurance. Some individuals were willing to pay higher taxes to provide universal health care coverage. Most of these individuals preferred higher taxes on alcohol and cigarettes.

Several 1991 events have focused attention on euthanasia, physician-assisted suicide and right-to-die legislation. The results of several national opinion polls show that Americans are becoming more aware of these issues, and that many want to have more choices if they are faced with a terminal illness. In 1950, 34% of Americans favored legalized euthanasia, but 63% responded favorably in 1991. In 1991, 76% agreed that doctors should withdraw life support from terminally ill patients if they or their families request it. Sixty-four percent believe that doctors should be allowed to assist in a terminally-ill patient's suicide. Many Americans would consider ending their own life if they became a burden on their families or were in constant pain. Most would want to have life support withdrawn, but not food or water. Most respondents wanted doctors and family members to share these decisions, and 67% had discussed their wishes with family members.

There are seven issues that must be addressed by any proposal to reform health care financing in the US. Insuring all Americans would require either federally-guaranteed coverage or subsidies to allow individuals to purchase their own. Under federally-guaranteed coverage, the government would either fund a national health plan, require employers to 'play or pay' or require individuals to purchase their own insurance. Funding for guaranteed access would come from taxes, employers or from money saved by reducing payments to doctors and hospitals. Medicaid would either be retained, eliminated or replaced with another public insurance program. Coverage would either be minimal, average or comprehensive. Health care costs would be reduced by using a single payer or all-payer system, or encouraging competition among health services suppliers. The plan would be administered by state or federal agencies or many private insurers.

The health care needs of uninsured individuals in Massachusetts may not be guaranteed by the Massachusetts Health Security Act of 1988. The Massachusetts law requires that hospitals that care for uninsured individuals be compensated by surcharges on services to insured individuals, and that all employers provide health insurance to their employees. A survey of 1,066 Massachusetts households found that 84% of uninsured residents live in a household with an employed adult. Most of the employed adults in uninsured households work for small to medium-sized companies. The uninsured were more likely to have a serious illness than the general population, and are more likely to be unaware of the health care law. Employers are concerned about the rising cost of health insurance premiums that result from hospital surcharges for uninsured individuals., Objectives.--The debate in Massachusetts over the repeal of the first state-based "pay or play" universal health plan is discussed using data from a survey of 1066 Massachusetts households. The survey attempted to measure the problems of the uninsured, to estimate the likelihood that they would buy insurance if offered, and to calculate the proportion of the uninsured who would be covered under an employer mandate. Design.--A survey conducted in person and by telephone in 1066 households, with an oversample of uninsured households, using stratification, clustering, disproportionate sampling, and poststatistical weighting. Participants.--Adults aged 18 years and older who were knowledgeable about the insurance status of persons in their household. Main Outcome Measures.--Insurance status, employment status, access to and use of health services, and willingness to purchase health insurance. Results.--First, the present system of hospital-based uncompensated care in Massachusetts is inadequate by itself to meet the needs of uninsured residents. Uninsured persons are less likely than insured ones to seek medical care for chronic health problems and serious symptoms requiring evaluation. Second, 83% of uninsured families and 24% of uninsured individual respondents would purchase one of several insurance options with 30% of the cost subsidized. Last, the employer mandate provisions of the legislation would cover 43% of the uninsured in Massachusetts. Conclusion.--In the current economic climate, the political viability of the universal health care plan and similar national initiatives is uncertain given the intractable conflict between perceptions of the financial stability of small businesses that do not offer insurance and the health care needs of uninsured individuals. (JAMA. 1992;267:1113-1117)

A review of public opinion polls conducted between 1989 and 1991 shows that most Americans think AIDS is a serious health problem that will get worse in the future. Most people surveyed think they have a low risk of contracting AIDS, and half said they are not taking special precautions to protect themselves. Of those who know they are at risk, many are not taking precautions. Most people are becoming more tolerant of people with AIDS, but they may reserve this sympathy for those who contracted the disease through no fault of their own. Most of those surveyed think the government is not doing enough to combat AIDS. They want more information about AIDS, and they want the government to provide it. They believe doctors have an obligation to care for AIDS patients, but they also believe that all health care workers should be tested for the virus. Most also think that all individuals in high-risk groups should be tested. Americans seem to be equally divided on the distribution of clean needles to intravenous drug addicts. Most of those surveyed said all immigrants should be tested for HIV and barred from entering the US if they are positive. Some believe tourists should be tested.

Public opinion polls conducted in 1990 have revealed that over 70 percent of Americans would like to see some type of national health insurance. Public support for a program funded exclusively by the government has reached the highest level since World War II. But there are conflicting opinions about how such a plan should be designed, and this report discusses the points of disagreement as well as the points of consensus concerning national health insurance. The data were obtained from several hundred polls taken by 25 different survey organizations between the years 1938 and 1990. The findings included that Americans generally think everyone should have access to health care, but they do not feel as strongly about this as citizens of certain countries in Europe. While 73 percent favored a national health insurance plan, the level of support dropped to under 40 percent if sacrifices would be necessary, such as limiting the choice of physicians and waiting to obtain medical care. Americans are also unwilling to accept more than a modest tax increase in order to fund national health insurance; only 22 percent would pay over $200 a year to support medical care for all. These attitudes are probably based upon the perception by the American public that taxes are already too high, even though in the US, taxes are the next to lowest out of the 18 wealthiest industrial nations. Americans are also less in favor of redistributing the wealth from the richer to poorer citizens, as compared with European citizens. The authors conclude that it will be difficult for the public to agree upon, and support passage of, any single national health insurance plan. Five principles to be incorporated into any such plan, in order to increase the chance of passage, are proposed. (Consumer Summary produced by Reliance Medical Information, Inc.)