Robert J. Blendon

Experiences of Hurricane Katrina Evacuees in Houston Shelters: Implications for Future Planning

OBJECTIVES To shed light on how the public health community can promote the recovery of Hurricane Katrina victims and protect people in future disasters, we examined the experiences of evacuees housed in Houston area shelters 2 weeks after the hurricane. METHODS A survey was conducted September 10 through 12, 2005, with 680 randomly selected respondents who were evacuated to Houston from the Gulf Coast as a result of Hurricane Katrina. Interviews were conducted in Red Cross shelters in the greater Houston area. RESULTS Many evacuees suffered physical and emotional stress during the storm and its aftermath, including going without adequate food and water. In comparison with New Orleans and Louisiana residents overall, disproportionate numbers of this group were African American, had low incomes, and had no health insurance coverage. Many had chronic health conditions and relied heavily on the New Orleans public hospital system, which was destroyed in the storm. CONCLUSIONS Our results highlight the need for better plans for emergency communication and evacuation of low-income and disabled citizens in future disasters and shed light on choices facing policymakers in planning for the long-term health care needs of vulnerable populations.

Health News and the American Public, 1996-2002

The Kaiser Family Foundation/Harvard School of Public Health Health News Index, a series of 39 surveys with a total of over 42,000 respondents from 1996 through 2002, measures how closely Americans follow major health stories in the news and what they understand about the issues covered in those stories. On average, four in ten adults reported following health news stories closely. The public reports paying the most attention to stories about public health, followed by health policy and disease-related stories. While knowledge about health news varies, individuals who follow health news stories closely are significantly more likely to give the correct answer to knowledge questions about those stories.

The Public's Response to Severe Acute Respiratory Syndrome in Toronto and the United States

Using data from 13 surveys of the public, this article compares the publics response to severe acute respiratory syndrome (SARS) in Ontario (specifically, Toronto), the other Canadian provinces, and the United States, which had substantial differences in the number of SARS cases. Findings suggest that, even at a relatively low level of spread among the population, the SARS outbreak had a significant psychological and economic impact. They also suggest that the success of efforts to educate the public about the risk of SARS and appropriate precautions was mixed. Some of the community-wide problems with SARS might have been avoided with better communication by public health officials and clinicians.

Public Response to Community Mitigation Measures for Pandemic Influenza

Results from a national survey indicated that most persons would follow public health officials’ guidelines.

Health insurance markets and income inequality: findings from an international health policy survey

OBJECTIVE To assess disparities in access to health care, financial burden of medical bills and perceived quality of care between those with above average incomes and those with below average incomes in five nations and to examine the relationship inequities in care experiences to health insurance coverage. DESIGN Cross-sectional analysis of a random survey of adults in 1998. SUBJECTS 5059 adults ages 18 and over in five English-speaking countries: Australia, Britain, Canada, New Zealand and the United States (approximately 1000 per country). MAIN OUTCOME MEASURES Failure to receive needed care, difficulty getting care, waiting for elective surgery, problems paying medical bills, failure to fill prescriptions due to cost, perceived quality of medical care received and of most recent doctor visit. RESULTS There were two to three-fold differences between those with above and below average incomes on measures of access to care in the US, Australia and New Zealand. In Britain and Canada indicators of access of to care were similar for the two income groups. Problems paying medical bills were most prevalent in the US, yet significant differences by income also existed in Australia, Canada and New Zealand. Those with below average incomes were more likely to have not filled a prescription due to cost in Australia, Canada, New Zealand and the US, with gaps by income most severe in the US. Ratings of quality of doctor visit were significantly different for the two income groups in the US, but not other countries. CONCLUSIONS The analysis finds striking differences among countries in the relative equity of health care experiences. In general, care experiences are more unequal in three countries such as the US, Australia and New Zealand where systems have relatively greater reliance on private health insurance and markets. Greater inequality in care experiences is also associated with more divided public opinion regarding the need for system reform and the direction of recent policy changes. In Canada and Britain where care experiences are more equal of the health system are similar across income groups. Reliance on private insurance and patient user fees appears to lead to more divided views of the overall health system as well as inequity in access to care.

Using Opinion Surveys to Track the Public's Response to a Bioterrorist Attack

To communicate effectively with the public during an emergency, health officials need to find out in real time what Americans know and believe, whom they trust, and what actions they are taking in response to the crisis. Short-duration surveys can provide vital information to guide public officials in their response to events and their communication efforts. Prior research has shown that such surveys, when statistically re-weighted, can offer timely results without unacceptable risk of bias. Using examples from public opinion surveys during the anthrax attacks of 2001, this article examines the role such surveys can play during a public health crisis.

Novel pandemic A (H1N1) influenza vaccination among pregnant women: motivators and barriers

We sought to examine motivators and barriers related to monovalent 2009 influenza A (H1N1) vaccination among pregnant women. We conducted a national poll of pregnant women using a random online sample (237) and opt-in supplement (277). In all, 42% of pregnant women reported getting the vaccine. Vaccination was positively associated with attitudinal factors including believing the vaccine is very safe or benefits the baby, and with provider recommendations. Women in racial/ethnic minority groups, women with less education, and women <35 years were less likely to get the vaccine and had differing views and experiences. Despite H1N1 vaccination rates that are higher than past seasonal influenza rates, barriers like safety concerns may persist in a pandemic. Messaging from providers that encourages women to believe the vaccine is very safe and benefits their baby may be compelling. Messaging and outreach during future pandemics may require customization to increase vaccination among high-risk groups.

Uncompensated Care by Hospitals or Public Insurance for the Poor

Results from two recent surveys of access to medical care, one nationwide and the other in Arizona, were analyzed to determine the consequences of reductions in Medicaid coverage for low-income Americans and the accompanying shift of responsibility for their health care to clinics and hospitals that provide uncompensated or subsidized care. The analysis indicated that in 1982, low-income persons received substantially less care from physicians if they resided in states without Medicaid programs or with only limited programs. In Arizona, the only state at the time without a Medicaid program, poor children saw physicians 40 percent less often, and poor rural residents saw physicians 22 percent less often, than poor residents of states with Medicaid programs; the proportion of poor Arizona residents refused care for financial reasons was almost double that in states with Medicaid programs. In addition, poor residents of states with the highest proportions of their low-income populations covered by Medicaid fared better than those in states with less extensive coverage. Moreover, poor elderly Americans were found to have comparable access to health care, regardless of where they lived, as a result of almost universal coverage under Medicare. Thus, this analysis suggests that the growing reliance on uncompensated care provided by hospitals and clinics may not be an effective substitute for public insurance and may adversely affect the health care received by the poor.

Who needs Medicaid

Faced by a worsening economy and a powerful public mandate to decrease taxes and non-defense government expenditures, many are calling for additional cuts in spending for Medicaid-a large, not very popular program that pays for the medical care of many of the nations poor. Available evidence suggests that Medicaid has been far more valuable than is commonly realized: It serves a broad cross-section of the American people, its adoption coincides with major improvements in the health of Americans, and its costs per recipient are about the same as the costs of care per person for all Americans of similar age. Not widely recognized is the programs importance to the financial well-being (if not the very survival) of any major teaching hospitals and the majority of nursing homes in this country. Public and professional awareness of the accomplishments of this program may be a crucial factor in determining whether the cuts will spare many of the gains in access to medical care that have been made during the past two decades. If we do not wish to reduce needed medical services to the poor, health-care institutions and health professionals will have to cooperate with each other and with the government in developing less costly ways of delivering high-quality care.

The academic medical center: a stressed American institution.

In recent years, relations between academic medical centers and the government have become increasingly adversarial. Although the centers and the government were formerly partners in a number of health ventures, to the mutual benefit of both, the climate is now too often confrontational. It is a confrontation in which there will be no winners, but the larger society may be the loser. A number of pressures on academic centers have helped to contribute to this situation. The federal sector and academic medical institutions must understand one another better and rediscover effective ways to preserve the special strengths of academic medicine in this country.