When considering determinants of an individual's health outcomes, doctors and researchers consider personal factors like age, race, gender or socioeconomic factors such as education quality, economic stability or health care access. A new study from the University of Kansas adds to the evidence that political ideology can be a social determinant of health, especially during public health crises.
Researchers have long considered that a person's association with an ideological view may have bearing on health behaviors on a long-term basis, such as embracing bans on public smoking to prevent lung cancer, or opposing vaccines due to concerns about secondary effects, but the COVID-19 pandemic provided a unique opportunity to study how it plays into behavior during a public health emergency. For the study, the authors conducted two surveys and a review of studies on ideology and health, finding that political beliefs did influence attitudes and health behavior during the pandemic.
"What this study shows is political partisanship and ideology seem to be one of the most significant drivers of health behavior when it comes to COVID-19," said lead author Mugur Geana, associate professor of journalism and director of KU's Center for Excellence in Health Communications to Underserved Populations. "The U.S. Department of Health and Human Services defines social determinants of health as the conditions in the environments where people are born, live, learn, play, worship and age that affect a wide range of health outcomes. Because ideology depends on group affiliation and influences interpersonal relationships, we think it should also be considered a social determinant of health."
That finding is especially important to remember in a time of significant political polarization in the United States, wrote Geana and co-authors Nathaniel Rabb and Steven Sloman of The Policy Lab at Brown University. The study was published in the journal SSM-Population Health.
For the study, researchers first conducted a convenience sample survey on social media through the Center for Excellence and Health Communications to Underserved Populations, followed by a survey with a nationally representative sample through Brown's Policy Lab. Respondents were asked about their political ideological beliefs as well as their knowledge of COVID-19, attitudes and beliefs related to COVID-19 risk factors, and demographic information. The surveys, conducted in late 2020, also asked where people received information on the pandemic, if they intended to get vaccinated, if they had COVID-19 themselves or knew anyone who did, if they wore masks and practiced social distancing, and other related questions. Data analysis from both surveys suggested that ideology was a significant predictor for all dependent behavioral variables, and in most cases, the strongest one.
For the third part of the study, authors conducted a review of 181 papers on the emerging COVID-19 behavioral literature and analyzed the results from 44 selected studies that examined ideology's influence on health behaviors. It was shown to be a significant predictor of responses in 79% of the studies' estimates, and it had the largest effect on COVID-19 related behaviors in 39% of these. No other variable, such as age, gender, education or race/ethnicity, was the best predictor in nearly as many studies.
The three sources of data, taken together, contribute to the growing body of knowledge that individuals' political ideology will influence how they behave in relation to their own health and that of the public. That has significant potential ramifications on public health as well as for health policy and strategic communications.
"It was obvious we expected to see differences in attitudes and behaviors based on political partisanship, but we wanted to know how much of an impact it has, and if our findings reflect those from other studies," Geana said. "Much to our surprise, we found that ideology was the best predictor of COVID-19 related behavior. When we take that all in, it suggests that in times of crisis, which the pandemic was, and in a polarized society, ideology is a significant driver of how people behave when it comes to their health."
Geana said the study was not intended and should not be used to advocate for any ideology or argue that any ideology is right or wrong. The purposed was to contribute to the body of knowledge of how ideology influences health behavior in times of crises and to create awareness about this phenomenon for policymakers, health officials and health communicators, especially in the hyperpolarized climate of the United States.
Geana has conducted similar studies into how Kansas residents received information on the pandemic and assessed risk, as well as comparing how the United States and Chile, two seemingly different nations, approached the crisis. Together, these studies show the importance of considering multiple variables, including ideology or political partisanship, when assessing health behavior, and promotes understanding that one message will not resonate equally with all in terms of health interventions and when addressing the valid concerns people may have in regard to their health.
"This shows we need to keep an open mind and be sure the messages for the health interventions we are designing are appropriate for the audience we are trying to reach at that moment in time," Geana said.
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