American Health Values Survey
2020 update: A national survey explores how adults in the United States think about health on a personal, community and societal level.
Typology reflects diversity of values and beliefs toward health.
The American Health Values Survey explores how adults in the United States think about health on a personal, community, and societal level. The survey measures the importance of personal health, how individuals define health and how it manifests in everyday behaviors. There are also measures of what adults in the United States believe about the social determinants of health, the role of government in addressing them and what they value most for their own communities.
The Robert Wood Johnson Foundation worked with researchers from NORC at the University of Chicago to better understand the extent to which health is a shared value in the United States.
The survey has been conducted two times. Data for wave 1 of the survey was collected in 2015–2016 with wave 2 administered in 2019–2020. A probability-based, representative sample of adults living in the United States was surveyed by phone (landline and cell), online, or mail for each wave. The wave 1 data set included 10,574 respondents. The wave 2 data set included 8,261 respondents.
Noteworthy trends from 2016–2020:
- More adults say health should be a top priority for the Federal government (increase from 32% to 43%) and that the government generally should do more to promote health.
- More adults recognized that it’s harder for African-Americans, Latinos and people with low-income to get healthcare. But only 36% recognize that discrimination within the healthcare system is a reason for poor health outcomes among African-Americans and 37% for Latinos.
- More adults say they value the importance of health equity and equality of opportunity in general. Adults reporting that our country should do whatever is necessary to make sure everyone has an equal opportunity to be healthy increased from 58% to 62%.
- More adults reported trusting in science and health experts (increase from 66% to 74%).
- Fewer adults believe that access to quality food, education, housing, job security and other determinants of health have a strong effect on health.
- Fewer adults report making personal health a priority in their daily life (decrease from 43% to 38%).
2020 Survey Findings
- 74% of respondents believe that some people have less opportunity to succeed than others, with the majority of people believing those with low incomes and African-Americans have less opportunity to succeed.
- About six in ten adults in the United States agree that the country should do whatever is necessary to reduce the large differences in income that exist in the nation.
- About half of adults in the United States agree that unhealthy neighborhoods are an important reason for the poorer health outcomes experienced by African-Americans and Latinos.
Overview of the Typology
Using the results from the survey, the researchers created a typology or classification of U.S. adults based on their health values and beliefs. There are six different groups within the typology: Committed Activists, Equity Realists, Equity Idealists, Self-Reliant Individualists, Disinterested Skeptics and Private-Sector Champions.
Most adults (55%) fall into one of the first three groups, which are generally supportive of efforts to build healthier and more equitable communities. About 33 percent fall into groups that are skeptical about the promotion of health and health equity in the United States (Self-Reliant Individualists and Disinterested Skeptics), and the remaining 12 percent fall into a group (Private-Sector Champions) that has mixed views.
What follows is a breakdown of each group, the values they care about, their demographics, and other distinguishing characteristics.
This group, which makes up 18% of the survey sample, has views that are completely aligned with efforts to promote health and health equity in the United States.
Committed Activists tend to:
- Embrace social equity and solidarity values
- Believe in the importance of social determinants of health
- Recognize that healthcare disparities exist
- Support government action in health
In terms of demographics, Committed Activists are more likely to:
- Be non-white, females
- Have lower incomes, but higher education
- Reside in big cities, urban suburbs
- Identify as liberals, Democrats
This group, which makes up 19% of the survey sample, is also supportive of health equity promotional efforts, though not as much as Committed Activists.
Equity Realists tend to:
- Embrace social equity and solidarity values
- Give less importance to the social determinants of health
- Recognize that healthcare disparities exist
- Support government action in health
In terms of demographics, Equity Realists are more likely to:
- Be younger and have higher incomes and education
- Reside in big cities, urban suburbs
- Identify as liberals, Democrats
This group, which makes up 18% of the survey sample, is for the most part supportive of efforts to promote health equity in the U.S. with some caveats.
Equity Idealists tend to:
- Embrace social equity and solidarity values
- Doubt the importance of social determinants of health
- Doubt the existence of healthcare disparities
- Support government action in health
In terms of demographics, Equity Idealists are more likely to:
- Be older female
- Have lower incomes and less education
- Reside in rural, faith-driven America
- Identify as moderates, Independents
This group, which makes up 12% of the survey sample, has mixed and sometimes conflicting views about health and health equity.
Private-Sector Champions tend to:
- Embrace social equity and solidarity values
- Believe in the importance of social determinants of health
- Doubt the existence of healthcare disparities
- Be skeptical about government action related to health promotion, but care about building healthy communities as long as private groups and individuals lead
In terms of demographics, Private-Sector Champions are more likely to:
- Be much older females
- Have lower incomes and less education
- Reside in urban suburbs
- Identify as conservatives, Republican
This group, which makes up 16% of the survey sample, is broadly skeptical about health and health equity promotional efforts underway in the United States.
Disinterested Skeptics tend to:
- Care less about social equity, and solidarity values
- Dismiss healthcare disparities, social determinants of health
- Be less supportive of government action in health
In terms of demographics, Disinterested Skeptics are more likely to:
- Be White, males
- Reside in faith-driven, rural America
- Identify as conservatives, Republican
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Differences Across Subgroups
Researchers further analyzed the 2016–2020 data with a specific focus on identifying differences across three subgroups of interest: racial/ethnic, geographic, political culture, and the rural/urban divide.
Race-Ethnic Differences
The issue brief and top-line report shows that most people of Black, Latin, and Asian or Pacific Islander heritage support proactive health equity efforts, while only half of White Americans do.
Trends between 2016–2020 show the proportion of people who are skeptical or conflicted about health equity has grown. There were across-the-board beliefs that racial and ethnic health disparities exist, but a significant decrease in the number of people who believe that social or environmental factors contribute to those health disparities.
Political Culture Differences
The issue brief and top-line report shows that the vast majority of Democrats support proactive health equity efforts, as did a slight majority of Independents. Republicans tended to exhibit self-reliant beliefs or skeptical views towards inequities in health.
Following 2016–2020 trend analyses between blue, purple, and red states, researchers cautioned reliance on state-level findings. Elections are often won by small margins. While it is important to appreciate partisan differences on the issues, health equity advocates should not write off whole groups of states or portions of the nation when planning and executing health equity strategies.
Urban and Rural Differences
The issue brief and top-line report analyzed similarities and differences among rural and urban populations. It revealed that between 2016–2020, skepticism of health inequities rose among rural populations. Skepticism rose marginally (by two percentage points) among urban dwellers as well. Despite that, large proportions of adults in both urban and rural America are supportive of efforts to promote population health and access to healthcare. It is thus important for advocates and activists to not ignore either group in their planning and outreach efforts.