When Health Issues Become Politicized, Public Learning Falls Like A Rock
“This week is critical,” said Illinois Wesleyan University Professor Greg Shaw.
Shaw is a political scientist. He studies health care policy. And he said his research shows the rhetoric around a public health crisis affects what people know about it, their behavior, and the outcome. It matters a lot.
“It’s not a question of capacity to learn, but a matter of will,” said Shaw.
Shaw said there are two broad categories of historical example. In the first, the public understands the measures taken to combat a public health crisis as an unambiguous good, such as polio and SIDS, in which behaviors changed and there were better outcomes. The second category involves a divided public narrative such as AIDS and the Affordable Care Act (ACA), in which delays in raising the level of public knowledge cost lives. He said the coronavirus could fall into the second category, although the nation is still early in its response and he has seen shifts in the last week.
“I am concerned that we are in the very week where this narrative is going to go one of two ways. Either we are going to take it seriously and fight it even at the expense of the economy, or we’re not,” said Shaw.
President Donald Trump has extended social distancing to the end of April and recent statements have been both more somber and more focused on public health outcomes, Shaw acknowledged.
“We’ll see whether that pivot persists,” said Shaw.
He said history tells a cautionary tale about the importance of seeking good information instead of just their partisan priors.
The split opinion to date, he said, has cost lives and will cost more because the virus gained more of a toe hold in the U.S. than if more measures had been put in place three months ago. And to the extent there is still a partisan split in the value placed on an aggressive response, it will take longer to turn things around and cost more lives.
The Salk vaccine that would eventually end the polio crisis became available in 1954 and the Gallup organization did extensive polling for more than a year on whether parents were willing to have their children vaccinated. From the very beginning, Shaw said, Gallup found this was not "a politically conflictual issue at all."
“75% to 80% both said they thought it would work and that they were eager to have their children vaccinated,” said Shaw. “So, here’s (President Dwight) Eisenhower even willing to share the vaccine with the Soviet Union, right? So it was about as far from a political issue as I can imagine.”
Shaw said public learning showed people quickly understood it was effective. The government didn’t start keeping records of vaccination until 1959, but the number of polio infections dropped from 35,000 per year to 5,000 per year within two years.
“Lots of people were taking advantage of this. And when they did start keeping track of vaccinations the rates were very high, approaching 90%. And by the way you can’t explain that away with mandates because mandatory vaccines for polio vaccines weren’t fully in place until about 1980,” said Shaw.
He said public knowledge and behavior fell right in line with what public health officials would want.
A potential qualifier is that in the 1950s, the common received culture among power groups, the national narrative expressed by media, and political divisions were far less splintered than they became later. Could that have contributed to the more unified response to polio than is happening today?
“So, let’s go look at Sudden Infant Death Syndrome (SIDS) in the early '90s,” said Shaw.
In 1990, the American Academy of Pediatrics got the message out that parents really need to put their kids to bed without all sorts of fluffy blankets and on their backs.
“And the SIDS mortality rates fell from in the vicinity of 120 children per 100,000 infants per year in 1991 to below 60 within two years and it’s now about 50,” said Shaw. And that was in the early '90s when we were arguing about gay marriage and Bill Clinton and sex in the White House and so forth.”
It wasn’t politicized. Parents listened to the experts and changed their habits, said Shaw.
There is extensive data. The CDC polled Americans on their attitudes about AIDS starting in 1983 and continuing almost every other month for the rest of the decade.
“This is as good as it gets in terms of evidence, right?” said Shaw.
Mistaken belief and misinformation about catching AIDS from a toilet seat or by holding hands or from coworkers hovered around 50% for a long time.
“No better than half of Americans understood AIDS transmission through the entire 1980s,” said Shaw.
Shaw said a couple of things were going on. The Reagan administration did not lead. The president didn’t mention AIDS in a news conference until 1985 and until 1987 in a speech. And polling showed about 40% of Americans affirmed through most of the 1980s they thought AIDS was God’s punishment for immoral behavior.
“So here you have a divine justice narrative in lieu of a public health narrative,” said Shaw. “A variety of things happened, and we ended up with stagnant learning, though happily it changed later.”
There was a radical change over three years starting in 1991, once the Ryan White and Magic Johnson stories became known and more health information came out.
“The public can learn about a given issue if the information context will shift,” said Shaw. “The public can come along, but the conditions have to be right.”
Do people shy away from learning if there is a divided narrative?
Affordable Care Act
The Kaiser Family Foundation did a monthly survey about the ACA and what people knew about it from the month before it was signed for about seven years.
“Democrats beat Republicans on every positive benefit of the law. Democrats had reason to want to learn that, and they did, and they beat Republicans in learning about factual provisions of the ACA. However, Republicans beat Democrats on the Achilles' heels of the law, principally the individual mandate. Republicans understood the individual mandate and what it does. Whereas Democrats didn’t want to learn that because it was a really controversial element of the law,” said Shaw.
“We’re potentially at a tipping point this week where you have folks who are genuinely concerned about the virus – they are generally more urban and they tend to be Democrats, and they tend to be women who take this seriously,” said Shaw.
He said several polls over the last three weeks show that those people pay attention to public health officials and not the White House.
“They support notions of social distancing and even the notion that the economy will have to be sacrificed to fight this thing,” said Shaw.
On the other side is the "ubiquitous rhetorical force" of Trump, Shaw said. In January Trump said the coronavirus was not a serious problem. In mid-February he said it was not going to be a pandemic.
“And so when you look at how concerned his followers are compared to Democrats and how many changed behaviors they report making in their lives, Republicans don’t take this as seriously, in large part because their leader didn’t take it seriously,” said Shaw.
Over the last week, Shaw said friends of the president have also waged a social media war against Dr. Anthony Fauci, a leading expert voice on the pandemic.
“He once said something flattering about Hillary Clinton. He gestured and had body language at a White House press conference. He’s not a loyal foot soldier and therefore he’s not a very good virus specialist either,” said Shaw.
Trump does exercise leadership in shaping the response, said Shaw. But he is also a symptom of an antiintellectual thread that runs through right-wing populism.
Shaw acknowledged it would be easy for people in less densely populated areas of the country to be pre-disposed to place lesser importance on the disease because they view it as an urban issue that would not be likely to come to their areas.
“And to the extent that the president goes to South Carolina in late February and says, ‘This is the Democrats' new hoax,’ that reinforces the predisposition of people to disbelieve,” said Shaw. “Rural people could have been tipped the other way. Rural people got the polio vaccine too. But, they got reinforced.”
He said he also wants to caution Democrats not to discount the impact of the pandemic response on lives and the economy.
“I’d love it if what people could do here is two-fold. One is to become more deliberate about their information sources, to seek out serious professional journalism as opposed to their social media feed. But, also to become open to the possibility their pre-constructed narrative, either I hate Trump or I love Trump, whatever that is, that things might be more nuanced than that,” said Shaw.
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