12HealthThe concern of Americans with their health and fitness has grown into one of the nation's top priorities. But health-related values have shifted a great deal in recent years.A generation ago, people felt their health was the responsibility of the doctor rather than their own. Health was defined as the absence of disease, and disease was visualized as caused by germs, viruses, infections, and other invasive entities that physicians were trained to diagnose and banish. It was not unusual to hear people wax eloquent on the importance of good health while actively pursuing the couch potato way of life, demolishing fat-marbled steaks, and smoking several packs of cigarettes a day. As long as the definition of health as the absence of disease prevailed, people did not see how their behavior made much difference to their health one way or another.Today, Americans endow health with a much more positive meaning, and they have come to accept much greater personal responsibility for their health, while appreciating how their behavior (and the behavior of others) affects their health. Americans are increasingly conscious of the importance of prevention, of acting prudently with respect to the environment, and of taking a long-run perspective in recognition of the new possibility of living a long, vital life. People have expanded their definition of health to include their emotional well-being, the importance of loving relationships, of enjoying a sense of achievement, and of reducing the stress in their life.Today, the focus on fitness and a healthy, vibrant appearance is being reinforced in several ways: by its connotations of pleasure, because it is a morally justifiable way to be preoccupied with oneself, and because one does not need a lot of money to be physically fit.Leaders concerned with health policy are constrained by health related values that limit their flexibility. Health care is regarded as a maximum entitlement. An April 1987 Harris poll shows that a whopping 91 percent endorse the view that "everybody should have the right to the best possible health care -- as good as the treatment a millionaire gets." More than seven out of ten Americans believe that "health insurance should pay for any treatment that will save lives, even if it costs one million dollars to save a life." Fewer than one out of four political leaders (23 percent) agree with this statement.People have odd ideas about health insurance. If people are covered by insurance, they do not see health care as costing them money. The only costs people clearly associate with health care are the out-of-pocket costs they themselves incur. The old attitude, "When it comes to my health (or my spouse's or parents' or children's health), money is no object," remains as potent as ever.There is a huge gap between the experts and the public on the burning issue of how to control health care costs. To explain rising health care costs, experts emphasize the increasing number of older people in the population (the average person over 65 costs our health care system more than three times the amount spent on a person between the ages of 19 and 64) and the explosive costs of technological innovations in medicine. When average Americans are confronted with this reasoning, they find these ideas new and shocking. In their view, technology should reduce costs, not raise them, and most people have never considered the idea that a price tag is associated with the graying of America.xviii[36]People have their own well-formed convictions about why health care costs are rising: experts see technology and the aging of America, but the public sees greed, high doctors' fees, corruption, drug company profiteering, unnecessary testing, malpractice, overbilling, duplication, and waste. The common view is that too many people are skimming vast amounts of money from the reservoir of dollars flowing through the health care system. Everyone has a horror story to tell, and all the horror stories are vivid, concrete, personal, and persuasive to those who experience them. The experts see skyrocketing health care costs as essentially a new problem caused by factors the system has not dealt with before. The public sees the problem as a very old one, the age-old human failing of greed and failure to resist temptation.xix[37

The most frequently measured aspects of sexual morality are moral approval (or disapproval) of premarital sexual relations, married people having sexual relations with someone other than the marriage partner, and people who are not married living together.A fifty-year-old Roper survey in March 1943 asked, "Do you consider it all right, unfortunate or wicked when young men have sexual relations before marriage?" Only 14 percent felt it was "all right," 42 percent thought it "unfortunate," and 37 percent condemned it as "wicked." When the same question was asked about women, a mere 5 percent found it acceptable, 43 percent thought it was "unfortunate," and 46 percent "wicked." Almost twenty years later, in June 1962, the Gallup poll asked a cross-section of women whether in their opinion it was acceptable for a woman to have sexual relations before marriage with "a man she knows she is going to marry." An overwhelming 87 percent of women, married and unmarried, said it was emphatically not acceptable. As recently as July 1969, a 68 percent majority of the public continued to condemn sexual relations before marriage as morally wrong. But shortly thereafter, the pattern began to change year by year until by 1990 it had totally reversed, with only one out of three now condemning premarital sex as morally wrong (33 percent), and 60 percent saying it is not morally wrong.xiv[32] (An exception is made for young teens (14 to 16 years old). The overwhelming majority of Americans condemn premarital sex for these youngsters as morally wrong.In sharp contrast, moral condemnation of extramarital sex has not budged for many years. An 84 percent majority rejected it as "morally wrong" in the early 1970s; in 1990 an 84 percent majority continued to condemn it, an unchanging pattern of public response to extramarital sex over a nearly twenty-year period.xv[33]On the question of people living together without benefit of marriage, Americans are divided and no clear-cut pattern emerges. In the 1970s a majority (52 percent) had come to feel that cohabitation was not a moral issue but merely a question of individual lifestyles.xvi[34] A decade's experience, however, has revealed some hesitancy and reservations, with the majority (54 percent) now expressing doubts about its morality.xvii[35]Many other aspects of our changing social morality are worthy of discussion, for example, values regarding strict punishment for crime versus leniency and compassion, tolerance for diverse lifestyles, orientation toward the present versus the future, absolutism in moral norms versus situational ethics, and so on. All are relevant to our concerns but cannot be covered in this chapter.

6Comparing their lives with those of their parents, people acknowledge that some things will be more difficult and others easier. By 49 percent to 30 percent, they think they will have more difficulty than their parents did in finding the money to put kids through college and by 41 percent to 32 percent they think owning a home will be more difficult. Conversely, however, by 47 percent to 14 percent, they believe it will be easier for them to be in good physical health. Of equal importance, by 44 percent to 16 percent they think it will be easier to have an interesting job and even easier (by 42 percent to 31 percent) to earn enough money for a good living. [18]These findings show that Americans today realize that they are better off in many ways than their parents were. But at the same time, they are aware that many of the new values and lifestyles threaten the family -- an institution that has come to mean more to them now that it can no longer be taken for granted.The Meaning of SuccessOne of the most sweeping changes in postwar American cultural values relates to the meaning of success. In the 1950s Americans shared a certain definition. Success meant getting married, raising children who would be better off than oneself, owning a home and an automobile, and working one's way up the ladder of social mobility. The trappings of success were largely external and material, a matter of keeping up with the Joneses.When in November 1962 Gallup queried cross-sections of the public on the "formula for success in today's America," two answers dominated all others: get a good education (50 percent) and work hard (31 percent), followed by honesty and integrity (17 percent). Only 6 percent mentioned having a job that one enjoys doing, and a paltry 3 percent cited the importance of self-confidence and self esteem.Then came the 1960s campus rebellion and its iconoclastic attitudes toward the 1950s. For millions of college students the shared meaning of success shifted from owning a Cadillac to fulfilling one's unique inner potential.In the 1970s the majority of Americans were intrigued but still unconvinced of the virtues of the new outlook. A January 1971 Harris poll asked people, "Do you think the desire on the part of many young people to . . . turn their backs on economic gain and success . .. is a healthy or unhealthy thing?" Only 13 percent thought it healthy. In mid-decade (April 1974) the leading responses to a Gallup question about "what really matters in your own life," were a decent and better standard of living (31 percent), good health (25 percent), adequate opportunities for one's children (23 percent), a happy marriage and family life (15 percent), and owning one's own home (12 percent) -- all traditional, fifties-like conceptions.By the 1980s, however, most Americans were attempting to graft the new values onto the old ones. In response to a May 1983 Gallup question about which factors are most important for "personal success in America today," the top ranking ones were good health (58 percent), a job one enjoys (49 percent), a happy family (45 percent), a good education (39 percent), peace of mind (35 percent), and good friends (25 percent). Note that the traditional emphasis on education and family remains an important part of the definition of success, but newer values such as having a job one enjoys, peace of mind, and good friends have now been elevated to a status equal to or higher than the traditional ones. It is characteristic of the 1980s that people wanted material well-being and the new forms of inner fulfillment extolled in the 1960s and 1970s.[19]Now in the 1990s we are witnessing a further evolution of the shared meaning of success. Increasingly, Americans are coming to think of success as self-defined rather than conformity to the expectations of others. Over a five-year period, the DYG SCANSM has measured a significant increase in the ratio of those embracing a conception of success as self-defined. By 1987 it had already reached a 5:1 ratio (63 percent to 12 percent), and by 1991 it had grown to more than a 7:1 ratio (68 percent to 9 percent).[20]There are some modest demographic differences, mainly related to age and income. People between 40 and 60 with higher incomes (above $50,000 a year) lean slightly more often toward the self-defined measure of

The shift is a difficult one for our societies. Historically, marriage has been so squarely based on sharply defined roles for husbands and wives that when these expectations blur people have to relearn how to behave. As a result, there is a great deal of confusion: marriage becomes a major source of tension

The trend line on the acceptability of a woman for president could hardly be more dramatic: a 2:1 ratio of respondents saying they would not vote for a woman

As recently as 1968, a majority of white Americans (55 percent) endorsed the view that they had a right "to keep blacks out of their neighborhood if they wanted to, and that blacks should respect that right." NORC has asked this same question every year since 1968, and the trend line is unambiguous: by 1990, the 55 percent majority who felt they had a right to keep blacks out had dwindled to a 22 percent minorit

If Americans define success in their own terms, what do they mean by it? Money and tangible possessions are still dominant. By a two-to-one margin (40 percent to 22 percent), Americans in 1991 gave priority to the material over the intangible. Here the pattern has been markedly dialectic -- with a heavy emphasis on tangibles in the 1950s, a swing toward intangibles in the following few decades, and an edging back toward tangibles in the 1980s and 1990s. Demographic differences are pronounced and in the expected direction: the less educated and lower-income segments of the population emphasize tangibles because they do not have them. Those in the higher income brackets lean moderately toward intangibles because they have been better able to satisfy their material need

7success, while people younger than 40 with lower incomes lean slightly more often toward conformity to group definitions of success. Some minor gender, education, geographic, and race differences also occur. What is significant is not the differences but that all groups in the population follow the dominant pattern of shifting away from older, more objective, conformist definitions of success to more subjective definitions.If Americans define success in their own terms, what do they mean by it? Money and tangible possessions are still dominant. By a two-to-one margin (40 percent to 22 percent), Americans in 1991 gave priority to the material over the intangible. Here the pattern has been markedly dialectic -- with a heavy emphasis on tangibles in the 1950s, a swing toward intangibles in the following few decades, and an edging back toward tangibles in the 1980s and 1990s. Demographic differences are pronounced and in the expected direction: the less educated and lower-income segments of the population emphasize tangibles because they do not have them. Those in the higher income brackets lean moderately toward intangibles because they have been better able to satisfy their material needs.[21]What are the intangibles that Americans associate with success? The current emphasis is on quality of life. Glimpses of what Americans mean by quality of life can be seen in several studies:--Having good family and personal relationships with loved ones.--Getting one's time under control.--Saving money and getting one's finances under control (for example, less debt, being a smarter consumer by outfoxing the seller).--Reducing other forms of stress.--Doing more to enhance health and personal appearance.--Becoming more "green" conscious about the environment.[22]In the 1990s, Americans know they can not have everything, and they are adapting their definition of success in life to this new reality. People's feelings about being squeezed in the 1990s go deeper than recession or slowdown in economic growth. The affluence effect elevated the importance of expanded life choices and self-expressive values. And people are struggling to hold onto those values in an affordable form even under difficult economic conditions