By Timothy S. Rich and Ian Milden, Western Kentucky University

As the coronavirus pandemic places an extraordinary burden on healthcare systems around the world, support for foreign health aid in the United States has never been more important.

When do Americans support foreign health aid? Are they more supportive if it's to right a previous wrong? Surveys consistently show that the American public overestimates the amount of foreign assistance the U.S. provides, while some evidence suggests that the public is more supportive of certain types of assistance, such as health aid. We address whether the public is specifically supportive of much-needed aid to the Marshall Islands.

Cold War-era nuclear testing by the United States in the Marshall Islands resulted in irradiated crops and major health issues for generations of Marshallese. The United States government offered health assistance to the Marshallese through Medicaid in the 1980s, but stripped it away under welfare reforms in 1996. Many Marshallese have immigrated to the U.S. to receive treatment at clinics in places such as Dubuque, Iowa, but the care offered at these clinics is not always sufficient to meet the needs of the Marshallese. Senator Mazie Hirono (D-Hawaii) has been attempting to pass legislation to restore access to healthcare for the Marshallese through Medicaid. Hirono’s efforts are starting to win bipartisan support from Republicans with large populations of Marshallese in their districts, such as Congressman Steve Womack (R-Arkansas) and Congresswoman Cathy McMorris Rodgers (R-Washington State).


Photo Credit: Wikimedia Commons

Castle Bravo nuclear weapons test over Bikini Atoll, Marshall Islands. March 1, 1954

While few Americans may be familiar with the Marshall Islands, this case provides an opportunity to identify the extent in which the American public would support the expansion of medical assistance based on how the issue is presented. We expected two factors would influence support. First, that aid provided via Medicaid would trigger respondents to consider their pre-existing and possibly partisan views on government activity in healthcare. Second, emphasizing that the U.S. government promised assistance would elicit support for maintaining commitments.

To address public opinion on public health interventions, we conducted an online experimental web survey, recruiting 1200 American respondents via mTurk Amazon on March 11.

We first provided a basic explanation of the issue:

In the 1950s, the U.S. tested nuclear weapons in the Marshall Islands, irradiating crops, and generating continued health issues for generations of the native population (approximately 53,000 residents). Provided free health care through Medicaid under the Reagan administration, these benefits were ended under welfare reform in the 1990s.

Respondents then were randomly assigned one of four prompts to evaluate on a five-point Likert scale (strongly disagree to strongly agree):

Version 1: The U.S. should provide medical aid to the Marshall Islands.

Version 2: The U.S. should provide medical aid to the Marshall Islands via Medicaid.

Version 3: The U.S. should provide medical aid, as promised, to the Marshall Islands.

Version 4: The U.S. should provide medical aid, as promised, to the Marshall Islands via Medicaid.


Overall, we find that over two-thirds of respondents supported providing medical aid, while both versions that mention the earlier promise of assistance increases support by approximately five to seven percent. Focusing just on respondents who identified as Democrats, all three latter versions correspond with an eleven to nineteen point increase, the greatest support on version 3. Moving on to Republicans, support overall is considerably lower, although a majority of respondents still support medical aid. Predictably, version 2 that emphasizes Medicaid sees a modest decline in support, while versions with a passing reference to previous commitments increases support. Additional statistical tests find that controlling for gender, age, education, income, and religious service attendance produce largely consistent results.

Our findings suggest that, despite considerable partisan difference in support, the public would not object to the expansion of aid to the Marshallese. Reasons for lower support from Republicans could include ideological concerns about the size and scope of government, and opposition to foreign aid or foreign engagement, to xenophobia among some partisans. In contrast, higher support among Democrats may be due to the broader range of ethnic diversity within the party and general support for expanding access to healthcare. The strong support across party lines suggests that members of Congress should be comfortable supporting medical aid for the Marshallese.


Photo Credit: AP/ TPG Images

While the findings of our survey signal strong support among Americans for helping the Marshallese, it would be improper to suggest that this would apply to all forms of foreign aid. The commitment to help the Marshallese is a small one, which makes it easier for many Americans to support. Our findings are more likely applicable to cases where the U.S. government wronged a small group of people and the costs of redress are lower.

The significant increase in support for helping the Marshallese when we specified that the United States promised to help the Marshallese shows that the promises of the U.S. government matter to American voters. This is not to say that all of the U.S. government’s promises are equal, but it shows that a promise matters when following through with that promise is the right thing to do.

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TNL Editor: Nicholas Haggerty (@thenewslensintl)

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