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SciPoll 818: What factors contribute to the United States lagging other countries in public health?

DOI:http://doi.org/10.63565/scipinion.scipoll.818

If you could implement ONE policy change to improve the United States health outcomes, which would have the greatest impact?

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(156 Answers)

Answer Explanations

  • Other (please specify)
    user-663996
    Decrease the influence of lobbyists on members of Congress.
  • Other (please specify)
    user-277129
    Impeach your president 
  • Other (please specify)
    user-475102
    The insurance companies have too much power and should not be dictating the way healthcare is provided to the US population. They are 100% money driven and do not care about the patients at all. The biggest challenge is that their power is so big that it reaches the Government and makes them virtually untouchable by them.
  • Other (please specify)
    user-751315
    Intensify public education to include science and logic, in order that our next generation will choose politicians more wisely.
  • Addressing income inequality through economic policy
    user-578886
    Providing everyone with the ability, to earn a living and secure their basic needs would allow people to adopt more healthy patterns for themselves and spend less time fighting each other for scraps. 
  • Universal healthcare coverage
    user-745157
    Average lifespan is highly affected by child mortality. Attention to the health of prospective mothers and infants would help a lot. Public healthcare also drives an interest from governments in trying to promote healthier lifestyles. 
  • Other (please specify)
    user-247418
    Educate and incentivize citizens to take greater responsibility for their health.
  • Addressing income inequality through economic policy
    user-823481
    Reducing income inequality would have the greatest and most sustained impact on U.S. health outcomes because it targets the root social and economic conditions that drive disease and mortality. Economic inequity influences nearly every determinant of health—access to nutritious food, stable housing, education, healthcare, and safe environments. Evidence shows that nations with narrower income gaps have longer life expectancy, lower chronic disease rates, and better mental health. By improving wages, strengthening social safety nets, and expanding access to early education and childcare, economic policy can create the structural foundation for better health across all communities.
  • Other (please specify)
    user-684526
    A push for more physical activity combined with greater preventive care emphasis.
  • Other (please specify)
    user-223241
    Nutrition education for physicians and the general public. Most physicians have very little to no training in nutrition and do not spend time educating patients as to the role diet plays in health. Overregulation will not solve the problem. If an individual is eating a box of sugared cereal, the elimination of red dye is not the issue. The consumption of empty calories is. Soda is another example--some municipalities attempt to curb soda consumption through a tax but this ultimately does not change consumer behavior. 
  • Universal healthcare coverage
    user-570658
    Everything else flows from universal basic coverage.
  • Universal healthcare coverage
    user-868575
    Better healthcare coverage for the poorest citizens would prevent long-term health complications and reduce the overall health care cost burden. 
  • Massive investment in preventive care programs
    user-234128
    If preventive care is defined broadly and there is increased competition between health care providers
  • Universal healthcare coverage
    user-461871
    See above.
  • Universal healthcare coverage
    user-47615
    As mentioned above, this would provide all US citizens with access to healthcare, and ideally, preventive care.

  • Comprehensive mental health reform
    user-510547
    This one can be fixed with great impact 
  • Other (please specify)
    user-451765
    Focus on DENIAL, readiness to change and self=management through Shared decision making
  • Universal healthcare coverage
    user-367398
     
    The US health system should integrate a variety of models: 
    ·        Universal Coverage:  Everyone is included, ensuring continuous access to care. 
    ·        Bargaining Power: Either as a single payer (like Canada) or through tightly regulated non-profit sickness funds (like Germany), these systems negotiate aggressively with providers and drug companies to control prices.  
    ·        Simplified administration: a unified system drastically reduces the administrative overhead spent on billing, marketing, and profit. 
    Focus on Public Health: By controlling costs and guaranteeing access, these nations free up resources and have a stronger impetus to invest in population-wide prevention, as it saves the single system money in the long run 
  • Addressing income inequality through economic policy
    user-956542

    Here is the reasoning:


    While Universal Healthcare Coverage is a very close second and is essential, it primarily fixes a downstream problem—treating people after they get sick. Addressing income inequality is an upstream solution that prevents people from getting sick in the first place.


    Why Addressing Income Inequality Has the Greatest Impact:

    1. It Targets the Fundamental Cause: Income is the single strongest predictor of health status. Poverty and low income are directly linked to higher rates of chronic disease, mental illness, and lower life expectancy. By directly raising the floor for the most vulnerable, you attack the root of the health disparity.
    2. It Amplifies All Other Interventions: A person with a stable income, safe housing, and reliable nutrition is:

      • Better able to access and benefit from universal healthcare (e.g., they can afford transit to appointments, copays, and have the stability to manage chronic conditions).
      • More likely to have the time, resources, and mental bandwidth to engage in preventive care and make healthier food choices.
      • Less vulnerable to the marketing of unhealthy products and more able to afford healthier alternatives.
    3. Broad, Cross-Cutting Impact: Economic policies like a higher minimum wage, expanded earned income tax credits, and child tax credits, and investments in affordable housing don't just affect "healthcare"—they affect every aspect of a person's life that influences health (the Social Determinants of Health). This creates a multiplier effect on well-being that a purely medical intervention cannot match.

    In essence, you cannot medicate your way out of poverty-induced stress, poor nutrition, and unsafe housing.     By providing economic stability, you create the foundational conditions for health, upon which all other interventions—like universal healthcare and preventive programs—can then be much more effective.


    Therefore, while universal healthcare is a moral and practical necessity, addressing income inequality would have the deepest and most transformative impact on the overall health of the American population.







  • user-146840
     Stricter regulations on the food industry (sugar, additives, marketing) :  More stringent laws governing the food sector (marketing, sugar, and additives): The prevalence of ultra-processed foods is the primary cause of America's chronic disease crisis, even though universal coverage and preventive care are essential. At the population level, obesity, diabetes, and cardiovascular disease would be directly decreased by controlling sugar intake, limiting dangerous additives, and prohibiting aggressive marketing, particularly to minors. This upstream intervention is the most effective lever for enhancing long-term results since it deals with health issues before they become problems. 

  • Universal healthcare coverage
    user-540700
    the major difference between the US and all other developed countries with better overal population health data is the absence of universal healthcare coverage in the US, while these other countries have universal health care in some form. In several countries it is entirely free, in other countries the contribution depends on the income, so free or almost free for the poor, and paying a reasonable fee for those who can afford it. This has to be covered with taxes, but the return to citizen health in most countries is considered worth it.
  • Addressing income inequality through economic policy
    user-402166
    Many (though not all - for example, see chemical exposure) of the health conditions documented in the MAHA assessment and strategy reports are downstream effects of income inequality and poverty. Addressing these issues through economic policy will likely have the greatest effect on health outcomes.
  • Universal healthcare coverage
    user-267787
    If we remove the private system that is expensive but without improvement in health outcomes we could decrease costs, improve access and improve longterm health through preventative care. But all of these policies are important and we could implement multiple at once we have an increased change for significant change. 
  • Addressing income inequality through economic policy
    user-933382
    Poverty is the root of all problems 
  • Addressing income inequality through economic policy
    user-520432
    Tackling wealth inequality through wealth redistribution will transform the health of a majority of US citizens.
  • user-449711
    National Healthcre sales tax on food, beverage sales based on caloric intensity (calories per gram), alcohol and nicotine content.  To help pay for low income health care. 
  • Addressing income inequality through economic policy
    user-884738
    Universal healthcare a close second
  • Universal healthcare coverage
    user-476126
    Universal healthcare actually addressed some of the other improvements on this list.  A universal healthcare program is likely to have investment in preventative care programs, for example. 
  • Universal healthcare coverage
    user-784583
    We need universal access for all. Something akin to Medicare for all ages.
  • Addressing income inequality through economic policy
    user-158538
    I believe addressing income inequality through economic policy would have the greatest impact because income underpins nearly every social determinant of health. When people earn enough to afford nutritious food, safe housing, and healthcare, they are far more likely to live healthier, longer lives.

    Currently, the United States has one of the widest wealth gaps among developed nations. This inequality directly shapes access to education, job stability, stress levels, and lifestyle choices — all of which affect physical and mental health. Low-income families often rely on cheap, ultra-processed foods, have limited access to safe environments for exercise, and delay medical care because of cost.

    By implementing fair wage structures, expanding tax credits for working families, and improving social support systems, economic policies can reduce these disparities. In turn, this would lead to better population-level health outcomes, lower rates of chronic disease, and improved life expectancy. Addressing income inequality doesn’t just help individuals — it creates a healthier, more resilient society overall.

  • Other (please specify)
    user-940530
    As mentioned before, education is the most important. There are many clever health experts who know about the adverse effects of processed foods, ill effects of excess sugar in the diet, risks that arise from inactivity, alcohol, etc, but they have not passed this enlightenment on to the general public. It almost seems that the more we know about healthy lifestyles, the less healthy the general public becomes. I have spoken to many people that think that their unhealthy life choices are good for them, for example eating organic highly processed foods, drinking a lot of wine for heart health, taking high doses of supplements to improve energy, prevent diseases or enhance life expectancy. You have start integrating these healthy practices at a young age so that it becomes a lifelong habit that they can pass on to their friends and family. 
  • Universal healthcare coverage
    user-745678
    Mental health included with equity across populations will promote overall health
  • Massive investment in preventive care programs
    user-97011
    Investment in preventive medicine holistically addresses contributions from income disparity, exposure to harmful materials, over medication etc
  • Stricter regulations on food industry (sugar, additives, marketing)
    user-229823
    The MAHA report frames diet as a primary driver of America’s health gap and says the single greatest step is to put whole foods at the center of healthcare. Today over half of U.S. calories, and nearly 70% of children’s calories, come from ultra-processed foods (UPFs), which are strongly linked to obesity and metabolic disease.  

    Grocery shelves are dominated by UPFs and their heavy additive load (dyes, sweeteners, emulsifiers). The report highlights concerns about behavioral effects in children (e.g., hyperactivity with certain dyes) and the cumulative/synergistic risks from multiple additives consumed together, risks current testing often misses.  

    Because 90% of U.S. medical costs are tied to chronic conditions, moving population diet away from UPFs delivers broad downstream savings that even universal coverage can’t achieve on its own. 

    What the policy should include (briefly):

    Sugar and UPF standards: set upper limits/tiers for added sugars; front-of-pack warnings and/or excise taxes on sugar-sweetened beverages.

    Additive reform: close GRAS loopholes; ban or phase out high-risk additives (e.g., certain dyes, titanium dioxide) and require cumulative-exposure assessment. 

    Protect kids: restrict marketing of UPFs to children and raise nutrition standards for school meals, WIC, and SNAP to bias toward minimally processed, whole foods.

    Procurement & pricing: federal purchasing and farm programs that make whole, minimally processed foods the default and more affordable. 

    Rationale: Improving healthcare coverage enhances access to treatment, but reshaping the food environment alters the baseline risk for nearly everyone, every day, especially children, producing the most broad-based and sustainable population-level improvements in public health outcomes.
  • Universal healthcare coverage
    user-725842
    I would be more inclined to Implementing universal healthcare coverage, paired with major sustainable investments in preventive care programs, would have the greatest impact on improving U.S. health outcomes. WHO and OECD reports consistently show that nations with universal or near-universal systems, such as Norway, Sweden, Finland, Denmark, Japan, and Switzerland, achieve superior results in life expectancy, child health, and preventable disease rates despite spending less per capita.

    Universal coverage ensures equitable access to preventive care, reduces delays in diagnosis and treatment, and removes financial barriers that disproportionately harm low-income and minority populations. At the same time, scaling preventive health investments would reduce disease incidence and long-term costs by addressing modifiable risk factors such as poor nutrition, obesity, sedentary lifestyles, and unmanaged chronic conditions.

    Together, these reforms would shift the U.S. model from reactive, treatment-based care toward proactive, prevention-oriented health management, directly aligning with the Make America Healthy Again (MAHA) report’s call to focus on root-cause prevention, nutrition reform, and community-based health programs to build a more resilient and equitable population.
  • user-206197
    Universal coverage is not just about fairness; it is the foundation on which every other health reform depends irrespective of their advancement. When everyone can afford to see a doctor, fill a prescription, or get preventive care without fear of bankruptcy, we catch disease earlier, manage chronic conditions better, and reduce medical debt that drives stress and poverty.

    Countries with universal systems whether publicly funded like the UK or hybrid models like Germany spend less and live longer because access to care is consistent and proactive, not delayed until crisis hits. It also helps close racial and socioeconomic health gaps that are widening in the U.S.

    That said, coverage alone won’t fix everything. We would still need to tackle diet, environment, and inequality. But without universal access, every other reform fights uphill. It is the difference between a health system that reacts to illness and one that builds health.

  • Redesigning cities for walkability and public transit
    user-253845
    A national health renewal strategy should combine universal healthcare coverage with major investments in prevention and income supports (e.g., EITC, CTC, child care, and nutrition programs) that reduce inequality at its roots. Redesigning cities for walkability and public transit would improve daily physical activity, safety, and equitable access to opportunity. In parallel, fostering a healthier information climate—by curbing excessive screen time and reducing ideological polarization—would strengthen mental well-being, belonging, and civic trust. Expanding opportunities for volunteering and community engagement would further reinforce social connection and shared purpose. Together, these efforts would advance population health far more effectively than medical care alone.  
  • Universal healthcare coverage
    user-821097
    Universal healthcare coverage would have the greatest impact on improving U.S. health outcomes. It would ensure everyone has access to necessary medical care, reduce health disparities, and enable earlier diagnosis and treatment of conditions. This foundational change could also support other initiatives, such as preventive care and mental health reform, by making them more accessible to all.
  • Universal healthcare coverage
    user-151126
    Universal healtcare combined with the courage to identify people not needing treatment ensuring the money spent wise.
  • Universal healthcare coverage
    user-272301
    Preventive care programs would need to involve health care delivery. Health professionals would need to ensure ‘easy’ and ‘appropriate’ care delivery. Appropriate behavioural approaches would need to be understood and delivered. 
  • Addressing income inequality through economic policy
    user-914188
    Wealth inequality is the biggest contributor to health outcomes as shown time and time again by public health studies that nearly always adjust or control for socio-economic status in any statistical analyses.
  • Universal healthcare coverage
    user-496928
    Universal healthcare coverage should be a comprehensive model. 
  • Massive investment in preventive care programs
    user-279844
    See again what I replied above at question #2
    Preventive care must be put in place since the very beginning of every US citizen life. Much can be done about that and despicably, it has not been done yet ! Precision medicine and precision safety of medicines (see for instance De Pretis, F., van Gils, M., & Forsberg, M. M. (2022). A smart hospital-driven approach to precision pharmacovigilance. Trends in Pharmacological Sciences, 43(6), 473–481. URL: http://dx.doi.org/10.1016/j.tips.2022.03.009) shall be what should be guiding such a change.
  • Addressing income inequality through economic policy
    user-965103
    As explained above. Reducing income inequality would have a major impact on many more proximal risk factors for poor health outcomes. It's the first step in prevention. There's no point explaining to people they should eat healthier, if they can't afford the healthy food. There's no point in urban redevelopment, if people can't afford to live in the nice renovated neighborhoods anyway.
    Besides, when picking any of these other suggestions, you'd still be stuck with poor housing, chronic stress, pollutants, and a lot of other risk factors.
  • Universal healthcare coverage
    user-657460
    See comments on preceding question.
  • Other (please specify)
    user-543438
    REQUIRED vaccination or limiting access to schools and other public places until vaccination has been received.
  • Universal healthcare coverage
    user-839240
    I believe that everyone deserves access to good healthcare irrespective of income and this is a service, the government should
    be able to provide to its citizens.

  • Other (please specify)
    user-271773
    While it is tempting to choose stricter regulation of food industry, that choice is biased and overly simplified.  Regulation aimed at improving health should be considered in light of the competing policy goals of HHS, USDA, and FTC funding.  Availability, affordability, and ease of preparation of nutritious food should be the goals of the attention to regulation, and the actions should cross government lines between agencies and funding committees in Congress.  The "food industry" term should include, for example, current USDA farm support policies, policies addressing income inequality, policies affecting built environments causing food deserts, investment in preventive care, health care insurance coverage. as well as the companies and that rely on current GRAS food additive and dietary supplement regulatory implementation. 
  • Universal healthcare coverage
    user-869302
    Consistent access to healthcare would eliminate one of the biggest effects of inequality in the US. It would also potentially free workers from sticking with a bad job solely because of health insurance and that increased mobility could raise wages.
  • Universal healthcare coverage
    user-426175
    All is important, strict regulations in food industry, requirement of pure water; Closure any polluting industrial plants, diminishing overmedicalization; preventive care programs are essential. Diminishing the inequalities in the income; Increasing the taxes considerably comparably to the new deal level, up to 90% for very rich.
  • Universal healthcare coverage
    user-53122
    This works very well in almost all advanced economies and could do so in the US. Pessimistic that this will happen as there are too many vested interests in keeping it profit-driven.
  • Stricter regulations on food industry (sugar, additives, marketing)
    user-709065
    The role of appetite control is important to prevent the many chronic diseases.
    RELEVANT REFERENCES
    1. Appetite dysregulation and obesity in Western Countries Ian J Martins · First edited by Emma Jones,; LAP LAMBERT Academic Publishing., 
    2. Nutrition increases Survival and Reverses NAFLD and Alzheimer's disease Ian J Martins ·First Edition edited by Alina Berdos, 01/2015; LAP LAMBERT.,  
  • Stricter regulations on food industry (sugar, additives, marketing)
    user-558408
    If I could implement one policy change to improve health outcomes in the United States, I would focus on stricter regulation of the food industry, because the nation’s leading causes of illness and death — obesity, diabetes, cardiovascular disease, and certain cancers — are all closely linked to dietary factors driven by the modern food environment.
  • Universal healthcare coverage
    user-231028
    It is important that everyone has access to health care
  • Universal healthcare coverage
    user-445218
    IMO, it is the only effective way to go as evidenced by other country's experience.
  • Universal healthcare coverage
    user-511592
    other factors are secondary. If people can't afford or access healthies options, they won't chose them.
  • Redesigning cities for walkability and public transit
    user-708958
    One of the cheapest initiative that I believe can help to modify life style.
  • Universal healthcare coverage
    user-274801
    FYI : The French healthcare system | Expatica France
    As of 2016, a new healthcare system known as Protection Universelle Maladie (PUMa – “universal sickness protection”) replaced the previous Couverture Universelle Maladie (CMU). PUMa extended coverage to French citizens who have additional needs, and expanded access to state universal healthcare for foreigners.
    Healthcare is free in France. However, care must be taken to avoid abuse by certain practitioners or patients.
  • Universal healthcare coverage
    user-679764
    Universal healthcare coverage would alleviate much of the hopelessness and dispair that drives unhealthy behavior.