AIDS Is No. 1 Health Issue in State Poll

Almost one in three Californians believes AIDS is the most important health care issue the state faces today and one in five says the greatest significance should be attached to health costs, according to a new health poll that also found lowered concern about the two leading killer diseases.

Only 5% of the Californians polled rank cancer as the most pressing health problem and only 3% point to heart disease. Moreover, drug abuse strikes only one Californian in 100 as the state’s most significant health issue. It is a prioritization whose rational underpinnings were questioned even by the pollster who took the survey.

Despite the state’s identification with trends and fads in drug use, only 19% of Californians responding to a new Gallup Poll say they have experimented with drugs--though 35% of people 25 to 34 admit to having done so.

The poll’s findings were released Monday at a press conference. The poll was jointly sponsored by SRI Gallup Hospital Market Research, a Gallup affiliate, the Hospital Council of Southern California, three other regional hospital associations and the California Assn. of Hospital and Health Systems.

Health Official Puzzled

The ranking of acquired immune deficiency syndrome as the state’s top health priority troubled Ken Kizer, director of the state Department of Health Services. “I don’t know if it is rational or not,” he said, emphasizing that “I don’t mean to minimize the seriousness or the concern about AIDS.

“But the down side of that concern is that it may lead us to irrational public policy. I think we have to recognize AIDS as a very serious problem. We also have to recognize that we know how it’s caused and how it can be prevented and that we don’t need for paranoia and unfounded fears to dictate public policy here.”

Dr. Laurens White, a San Francisco tumor specialist and president of the California Medical Assn., said he believes media saturation of AIDS coverage has focused so much attention on the disease and its potential to affect vast numbers of people that its identification as the state’s top health issue is understandable.

“I don’t think it’s in the long run rational,” White said. But “in the short run, AIDS is the thing that frightens people.

“For the young, cancer is something that happens to older people. Drug abuse probably just doesn’t involve them. The thing that shocks me is that tobacco is not on there (on the list of top health priorities). Just in terms of numbers, more people are going to die of smoking than are going to die of AIDS, even in the No. 1 state in the country. “I’m dismayed we have not convinced the people of California how dangerous smoking is.”

In a reprise of a statewide health issue survey first conducted in late 1986 and released the following January, the poll also found that in the intervening months Californians have become less optimistic about their personal futures--with the proportion of respondents saying they “strongly agree” they are excited by their futures dropping from 47% to 31%.

The proportion of Californians who strongly agree they are excited about their jobs dropped from 45% in 1986 to 27% this year. George Gallup Jr., who directed the new poll, said the survey uncovered what may be a sign of growing public concern about the future of the economy.

“When people talk about happiness and satisfaction with their lives, economics are right at the center of those feelings,” Gallup said. “They have the perception that things are not going so well.”

Kicking the Habit

At the same time, poll officials found that in the critical 18-to-24 age bracket, many Californians have cut back on smoking in the last two years. They also found that there is an emerging consensus in the state that health care is a right, not a privilege, and that government-funded programs should provide care for the elderly and poor. Additional taxes on tobacco and alcoholic beverages were identified as specific means to finance such coverage. An increase in sales tax was rejected by a significant margin.

And 74% of Californians believe the federal government should devise a universal national health insurance program. A May, 1987, nationwide sampling conducted by SRI Gallup for The Times revealed that 63% of respondents endorsed national health insurance.

In California, the concept of universal health coverage enjoyed its greatest support among people 18 to 24, 87% of whom endorsed it. The strength of support in younger people mirrored national observations made in the earlier poll for The Times. About equal percentage of whites, blacks and Latinos joined in.

Heads of households

The poll involved telephone interviews with 1,008 California heads of household conducted in January. While SRI Gallup surveyors made a significant attempt to correct racial and ethnic imbalances in the 1986 poll, the cross-section of Californians interviewed this year appeared to indicate that the poll remains a survey primarily of middle- and upper-middle class Anglos.

The survey sample was made up of 79% white, 5% black, 9% Latino and 3% Asian. Only 24% of the family units involved had incomes of less than $20,000 a year.

Of all the poll findings, the health care rankings appeared to be the most potentially provocative. Identifications of the most pressing health issue in the state were provided by respondents and were not selected from lists supplied by interviewers, according to Robert Neilsen, an Irvine-based SRI Gallup official.

How They Rank

In all, 31% of Californians identified AIDS as the state’s most pressing health issue, with rates for men and women nearly identical; the level of education made little difference.

After AIDS, 20% of respondents said the cost of health care was the most pressing issue, followed by 5% who identified cancer; 3% each who suggested care for the elderly, heart disease or providing care to the poor; 2% each for health insurance costs and smog or pollution, and 1% each for drugs and drug abuse, the need for preventive health care, a shortage of catastrophic health care insurance and smoking.

Gallup said the California findings were at least somewhat in concert with other national poll results in terms of identifying AIDS as the top priority, but significantly at odds with other nationwide perceptions. He said a 1987 national survey found that 48% of Americans perceived AIDS as the most pressing issue, while 19% identified cancer and 13% heart disease.

A poll conducted last March for the American Assn. of Blood Banks found the top three health concerns, in order, were cancer, AIDS and heart disease.

But Gallup and experts on public health issues noted that the public perception of the comparative gravity of AIDS conflicts with its status as a killer--cancer and heart disease strike and kill far more people than AIDS. In 1987, for instance, an estimated 483,000 people died of cancer, with 965,000 new cases, according to the American Cancer Society.

AIDS, by contrast, has struck a total of 57,024 Americans so far, of whom 31,836 have died.

Kizer noted that, even in California, heart disease and cancer significantly outstrip AIDS. He said that on the average day in 1986, the last year for which completely comparable state figures are available, 125 people died of cancer and 185 of heart disease while 5 died of AIDS. Kizer said the high ranking accorded AIDS by Californians and the low ranking for drug abuse are seemingly at odds since health officials believe the biggest AIDS-related threat in the state is from intravenous drug users who contract the disease.

“For the average Californian,” Kizer said, “they have much more to fear from cancer and heart disease than they do from AIDS. Even under the worst-case projections, AIDS will only begin to approach some of the other top 10 causes of death in California.”

But Gallup and White agreed that the media’s coverage of AIDS has instilled a degree of fear in the public far beyond the effects of the disease thus far.

“Is it rational? No, not entirely,” said Gallup when asked about the identification of AIDS as the top health priority. “I think the factor of alarm is certainly there, and the fact that there is no clear answer in terms of cure adds to the feeling that it is the most urgent health problem because there are no solutions. I can see why people think that way.”

Gallup said that if he had been a respondent questioned by his own pollsters, his personal rankings of critical health issues would be, in order: cancer, Alzheimer’s disease, AIDS, alcoholism and drug abuse.

The ranking of AIDS “really doesn’t make rational sense; I’m kind of shocked at the results,” said Ruth Roemer, a UCLA professor of public health who is the immediate past president of the American Public Health Assn. “Grave as the AIDS epidemic is, it is actually affecting a very small number of persons. It seems to me it should be much lower down (on the priority list). I think care for the elderly would rank much higher and I would rank drug abuse much higher.

“If people are really serious about being concerned about AIDS, one of the keys is to control the drug-abuse problem.”

Publicity Over AIDS

Stephen Gamble, president of the Hospital Council of Southern California, said the AIDS results initially were a surprise “until somebody pointed out the publicity that AIDS has received.

“AIDS should not have this prominence at this early stage (of its life span as a public health problem) but I think it will nonetheless. I personally believe AIDS is going to change the way health care is delivered and financed in this country. I’m not sorry to see it get that attention, but I’m not sure it’s getting the attention for the right reasons.”

In answers to related questions, 55% of Californians said they think government agencies are doing too little about AIDS, while just 4% thought government was doing too much; 29% said programs are about right.

In other findings, the poll discovered that:

--While half of the Californians see federal, state and county governments as appropriate funders of health care for people who can’t afford it, Kizer and other experts said that only 8% identified those funds as coming from taxpayers or taxes.

--82% favor increasing cigarette, cigar or alcoholic beverage taxes as a means of paying for health care for the poor, but only 36% believe sales tax levels should be raised.

--Overall smoking levels in the state remained virtually unchanged between 1986 and 1988, with about one-fourth of Californians admitting to smoking. Rates rose in several age brackets, but in the crucial group of 18 to 24, where smoking rates had been increasing nationally for several years, California recorded a drop from 28% to 19%.

--46% of the smokers have tried to quit in the last year, about the same proportion as in 1986.

--70% regard access to health care as a right, but among people older than 65, a third or more of Californians disagree with that concept.

--66% said they exercise regularly, with 17% in formal fitness programs and 15% through membership in health clubs and fitness centers.