In December 2024 the Rollins School of Public Health and the opinion polling company Gallup, partnered up to get a sense of which public health issues rank as the most important among Americans following the election.
The Rollins-Gallup Public Health Priorities Survey asked a nationally representative group of respondents who varied in age, race, gender, and education about a range of topics related to public health. In one question, the survey asked respondents to, “Please rank the public health issues that you think should be given the highest priority by government leaders at this time.”
View the full report here.
Americans' Public Health Priorities: Ranked
Coming in at places 14-10 are “reducing loneliness and social isolation,” “addressing health effects related to climate change and extreme weather events,” “improving health in rural communities,” “ensuring adequate care for mother and infant during pregnancy and after birth,” and “ensuring childhood vaccination against preventable diseases.” These rankings are surprising, particularly as it relates to climate change and maternal health.
- 2024 was the hottest year on record for the world since record keeping began, the increase in ocean surface temperature has contributed to an extreme hurricane season that devastated both Florida and Western North Carolina, and drier climates on the West Coast have resulted in volatile wildfires that are still burning throughout Southern California.
- These rather unnatural disasters have a huge impact on health, from contaminated drinking water, to housing insecurity, to exposure to toxic particles in the environment that can damage skin and lungs. Not to mention the emotional and physical stress of living both through a disaster, and thinking about the inevitability of the next.
- The U.S. has the highest maternal death rate of any high-income country. In 2022, we had 22 maternal deaths for every 100k live births. And when it comes to Black women in America, that number more than doubles.
- Two out of every three maternal deaths occur in the postpartum period, within 42 days after birth, highlighting a lack of support and care.
In the Top 10
Number 9: “preparing for emerging infectious diseases and possible future pandemics."
This survey was conducted before the Trump administration announced intent to withdraw from the World Health Organization. Would the survey reveal a different answer if it would have been conducted later? A few things to remember:
- It was through the WHO that China first began sharing the genetic sequence of the COVID virus with other countries and it’s what allowed us to so quickly identify areas of the virus that a vaccine should be built from.
- If we lose access to that sort of international collaboration, it’s only going to hurt us. Viruses don’t really care about international borders or who’s signed a pandemic preparedness treaty. They’ll come either way.
Number 8: “ensuring access to comprehensive reproductive health care.”
- It appears many people don’t prioritize comprehensive reproductive health (which includes things like birth control, sex ed, family planning, abortion and IVF), but even fewer prioritize health for people who DO get pregnant.
- And people wonder why the birth rate in this country keeps dropping. From 2014 to 2020 the annual birth rate has decreased about 2% each year.
There was a tie for 7th. The first topic is "reducing childhood hunger."
- 7.2 million children live in households that are uncertain they will be able to acquire enough food to meet the needs of everyone in the household throughout the year, and over 800,000 kids live in households without enough food to go around.
Food assistance through financial based safety net systems like Supplemental Nutrition Assistance Programs (SNAP, commonly known as “food stamps”), or WIC (a supplemental food program for women, infants, and children) are critical to addressing food insecurity.
- SNAP provides assistance to an estimated 42 million people a month (12% of the U.S. population), and 12 million women, children, and infants are eligible for WIC.
- As of this recording on January 29, 2025, the status of these programs is…murky. First the Trump administration appeared to halt all funding to assistance programs, and then they clarified that programs that benefited Americans directly (including SNAP) were excluded from the funding freeze.
- Prior to the freeze (which at this time has been temporarily blocked by a judge), Republican lawmakers had proposed a number of changes regarding caps on benefits and changes to eligibility.
- School lunches are another way that kids receive nutritious meals. In fact, some research has shown that school lunches are the most nutritious meals that some kids receive.
- The Community Eligibility Provision allows schools to bypass the burdensome work of validating family meal applications, by allowing schools where at least 25% of kids access assistance programs like SNAP to offer free meals to all kids. It is not totally clear if it’s included or exempt from the funding freeze, should it go back into effect. Prior to the freeze, the House Ways and Means Committee proposed $12 billion in cuts to the school lunch program, including changing the required threshold of children who access assistance to 60% of students.
- It’s estimated this change would remove 24,000 schools from the program, limiting access to free or reduced cost meals for 12 million kids, and increasing the administrative burden schools face.
Tied for 7th: "preventing childhood deaths from gun violence."
- In 2022, gun violence was the leading cause of death in kids between the ages of 1 and 17.
- 7 kids a day died as a result of gun violence, and it was responsible for 30% of all deaths in the 15-17 age group.
- In September of 2023 the Biden administration established the White House Office of Gun Violence Prevention with the goal of coordinating federal response to mass shootings, expanding state and local partnerships to reduce gun violence, develop executive action on gun safety, and implement the Bipartisan Safer Communities Act and other legislation.
- The organization was able to do things like release a protocol for responding to mass shootings, take action to promote safe gun storage, and provide funding to improve mental health support, particularly in schools.
- Within the first hours of the Trump Administration taking office the pages for the Office of Gun Violence Prevention and all its documents and resources were removed from the White House website, and there has so far been no update regarding if the program will continue.
Number six: “ensuring adequate mental health care."
- Between 2021-2022, 23% of adults experienced mental illness in the last year. And 2022 had the highest number of suicides ever recorded.
- 25% of adults with frequent mental distress said they could not afford to see a doctor for it, and 10% of adults and 8.5% of kids have private insurance that doesn’t cover mental health care.
Number five: “addressing the opioid and drug overdose epidemic."
- This is actually an area where we appear to be making some much needed progress. Overdose deaths are declining for the first time in 5 years, and are under 100,000 deaths in a year for the first time since 2020.
This has been attributed to a number of changes like increased access to narcan, a drug that can reverse opioid overdoses, the removal of the X Waiver that limited physicians ability to prescribe treatments for substance use disorders, and the increased availability of drug testing supplies to prevent overdoses due to fentanyl contamination.
Number four: “strengthening safety net programs such as Medicare, Medicaid, and free health clinics.”
- Medicare is the federal health program for people over 65 and younger people with disabilities. It currently covers 66 million people in the U.S. and given that we are expected to hit 84 million adults over 65 in the next 30 years, it makes sense why people would want to make sure the system they’ve been paying into will remain available to them.
- Medicaid is the national health insurance and long term care program for low-income people, and it serves about 72 million Americans.
- As part of his first batch of executive orders, Trump revoked the Biden era order aimed at investigating ways to reduce the cost of prescription drugs for Medicare recipients, and rolled back planned expansion of the affordable care act and Medicaid.
Number three: “reducing chronic disease."
- Fighting chronic disease has been a cornerstone of the MAHA (Make America Healthy Again) movement.
- There’s been a lot of talk about restructuring agriculture. Many in the MAHA movement talk about diet as a factor for chronic disease and that the food industry has been putting profits over health. And while I agree that our current system of farm subsidies promotes the growing of certain crops which are then used in ultra-processed foods, designed for increased consumption, and that shifting subsidies to fruits and vegetables would incentivize farmers to grow them instead, increasing access, this administration doesn’t strike me as the kind to be interested in MORE regulations. But, I could be surprised.
- It is also worth noting that increasingly, we are finding infectious agents can lead to chronic illnesses, like how Epstein-Barr virus, commonly known as mono, is linked to the development of multiple sclerosis, or how infections with a number of viruses have been tied to the development of type 1 diabetes. So, maybe we should continue to think about them in the context of preventing chronic disease.
Number two: “ensuring safe water and food."
- In April of 2024 the EPA announced legally binding limits to the level of six PFAS (or forever chemicals) that could be in municipal water sources, with a grace period to allow cities to set up systems to monitor levels and filter water.
- An additional part of the plan to limit PFAS included setting limits on how much of the chemicals factories were allowed to discharge into the drinking water, but President Trump has just recently withdrawn that plan.
- As a result, municipalities will have to shoulder the cost of removing chemicals that might have been prevented from entering the water in the first place.
- Food and water safety really are two things that will rely heavily on regulations.
Number one: "improving health care access and affordability."
- The creation of the Affordable Care Act has been able to drive the rates of the uninsured to a historic low, but out-of-pocket spending on health care costs continues to grow.
- UnitedHealth Group, in their first meeting since the killing of the CEO of their health insurance unit, blamed the high cost of health care on hospitals and drug companies, while touting last year’s net $14.4 billion profit.