Priority of Public Health Issues among Policy Makers after an Economic Recession

Background:  Policy at the state and local level can often have a greater impact on the public’s health than individual-based approaches.  Elected and appointed officials have an essential role in protecting and improving public health.  Despite this important role, little systematic research has been done to assess the relative importance of public health issues compared to other policy issues in times of economic hardship.  This study assessed attitudes of Hawaii decision makers in 2007 and 2013 to determine if priorities differed before and after the economic recession.  Methods: Elected and appointed state and county officials were mailed surveys in both years.  Respondents rated the importance of 23 specified problems, of which 9 asked about specific public health issues.  Results:  The survey was completed by 126 (70.4%) respondents in 2007 and 133 (63.0%) in 2013.  Significant mean decreases were seen in five public health issues: climate change, pedestrian safety, government response to natural disasters, access to healthcare, and pandemic influenza.  Obesity was the only public health issue to increase in importance between surveys.  In relative ranking, only drug abuse and obesity were among the top ten priorities across both time points.  Lack of public health training, pandemic influenza, and government response to natural disasters were among the bottom five priorities. Conclusions:  Among Hawaii’s policy makers, many public health issues have a lower priority after the economic recession than before it.  Additional education and advocacy is needed to keep public health issues on the minds of decision makers during economic decline.