title: Attitudes of Policy Makers in Hawaii toward Public Health and Related Issues before and after an Economic Recession in the United States.
abstract: BACKGROUND
  Legislation and regulation 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 elected and appointed decision makers in Hawaii 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 at both time points. 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 117 (60.9%) in 2013. Among the public health issues, five saw significant mean decreases. These variables included 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 across the two time points. In terms of relative ranking across the time points, only drug abuse and obesity were among the top 10 priorities. Lack of public health training, pandemic influenza, and government response to natural disasters were among the bottom five priorities.
  
  
  CONCLUSIONS
  After the economic recession, many public health issues have a lower priority among Hawaii's policy makers than before the downturn. Additional education and advocacy is needed to keep public health issues on the minds of decision makers during tough economic times.
authors.affiliation: Department of Public Health Sciences, University of Hawaii at Manoa , Honolulu, HI , USA ; School of Public Health, Texas A&M University , College Station, TX , USA.
authors.forename: Jay E
authors.initials: JE
authors.lastname: Maddock
authors.affiliation: Department of Public Health Sciences, University of Hawaii at Manoa , Honolulu, HI , USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: McGurk
authors.affiliation: Department of Public Health Sciences, University of Hawaii at Manoa , Honolulu, HI , USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lee
keywords: Hawaii; decision makers; economics; health policy; public health