Yes, Boston University researchers say, as partisanship affects our health
During the pandemic, partisanship often influenced Americans’ decisions to take or reject COVID-19 vaccines. Photo by CDC via Unsplash
Public Health
Yes, Boston University researchers say, as partisanship affects our health
August 14, 2024
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- Rich Barlow
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Public health surveys inquire about our habits, from smoking to drinking to exercising. Should they also ask, Are you a Republican or a Democrat?
Yes—and your doctor should, too, say two health law, policy, and management scholars at the School of Public Health.
Matthew Motta, an assistant professor, and Timothy Callaghan, an associate professor, cowrote a recent commentary with two non-BU colleagues in the American Journal of Public Health. Their article notes that the partisanship-health nexus was revealed during COVID-19, when Democratic and left-leaning Americans put more importance on vaccination than Republicans and right-leaners.
Yet “zero of the 69 surveys conducted and publicly available from the Centers for Disease Control and Prevention…include a measure of partisanship,” spanning behavioral risk factors to nutrition, the authors write.
Callaghan says that the authors favor adding standard political-survey questions: Do you consider yourself a Republican, Democrat, or something else? Are you a strong or weak Democrat, or a strong or weak Republican? If you’re not affiliated with either party, are you closer to being a Republican or a Democrat?
“Public health is going to very much be on the ballot in 2024,” Motta says. “We’re already seeing questions related to former president Trump’s efforts to roll out the COVID-19 vaccine coming under fire from members of his own party.” Callaghan adds that public health researchers have long focused on social determinants of health such as education and income, and while those matter, “the political determinants of health matter, too. Politics impacts the world in which we live, and that in turn impacts our health.”
The authors spoke to BU Today about their article and its implications.
Q&A
With Matthew Motta and Timothy Callaghan
BU Today: How did you become interested in this topic?
Callaghan: We’re political scientists who work in the field of public health. We’ve noticed, over the course of the pandemic and the research we’ve done, that partisanship mattered to a lot of health attitudes and behaviors. We thought this an appropriate time to start pushing for public health officials and leaders and researchers to start including measures of politics and partisanship in their surveys. Almost no research does that. Our own survey research will include those measures, and they matter. Motta: There just aren’t that many political scientists doing public health research. All of us tend to know each other and work together quite a bit.
BU Today: Besides vaccination, what other health measures do partisans differ on?
Motta: We see it playing out too with regard to reproductive health access. With respect to the expansion of Medicaid [the federal-state health program for poor people] under the Affordable Care Act, blue states were eager to take it on; many red states refused. And there was a clear partisan dynamic at play with respect to extending health insurance to some of the most vulnerable members of society. I published some research suggesting that even if we were to develop a cure for cancer, if Joe Biden’s name were attached to it, Republicans would be more likely to reject it than Democrats. I’d go so far as to say that there’s often an asymmetric form of partisanship, where Republicans tend to be more likely to take aim at science. Callaghan: Matt and I have done research recently in the area of mental health—the 988 Lifeline is the 911 alternative for those in mental health crises. Republicans are less apt to support it [and] to use the lifeline because Republicans, being more conservative, are distrustful of mental health medicine, the way they’re distrustful of vaccination medicine. Republicans tend to be more individualistic—pull yourself up by your bootstraps—whereas Democrats tend to be more egalitarian, viewing society as a place where we’re trying to pull others up as well. We’re not trying to say that partisanship is the only thing that matters. Geography matters. Whether you live in an urban or rural area could matter as well. Your education, your income, your racial ethnicity, all of those things could still matter. And partisanship is tied to all of those things. Where you live, educational attainment, all of those things are influenced by your partisanship. Motta: I have a book coming out this fall where I look at the politicization of trust in scientific authority on the left and the right. Republicans and Democrats differ greatly in their trust in the scientific community and government, health, and science agencies.
BU Today: Should doctors and other clinicians also be asking these questions of their patients?
Motta: I’m not a clinician. [But] inasmuch as partisanship puts people at risk of not adhering to the best, evidence-based health behavior, I do think that’s something that is worth asking in those initial intake surveys. It can help doctors to have more constructive conversations [to] understand where their patients are coming from. Callaghan: Doctors having that additional piece of information is likely a good thing.
BU Today: What are the downsides to not asking about partisanship?
Callaghan: If we’re not accounting for it in our efforts to explain health attitudes and behavior, we’re missing a potentially relevant explanatory factor, which may elevate the role that other factors appear to play, when in fact they don’t. Not asking about partisanship is also a missed opportunity to make an effort to communicate with people. If Republicans and Democrats differ in their receptivity to evidence-based medicine, then that should help formulate the ways in which we try to communicate with people and speak to them on their own terms, to portray the science in a way that’s amenable to their world needs. We can’t do that if we don’t know the role that their different worldviews play in shaping them.
BU Today: Might survey respondents be put off by questions about their affiliation? And might some surveyors and clinicians be uncomfortable asking?
Motta: Most of those 69 surveys are online and anonymous. This reduces the tendency to modulate your own behavior in the presence of someone else. In an anonymous survey that I take online, no one’s watching me. Callaghan: One of the reasons government agencies and nonprofit organizations have been hesitant to ask questions about partisanship is, they don’t want to appear to be partisan themselves—we have mandates because of our tax status, we don’t want to appear to be pushing for one side of the aisle versus the other. We understand why you need to maintain a nonpartisan status. But asking a question about whether someone is partisan doesn’t make you partisan. It makes sure you’re collecting as much information as you can, so that we can make a healthier world. Partisanship is capturing a lot of things—social orientations, beliefs about the size of government, some of your moral beliefs. Motta: Vaccines, for example, are extremely moralized by religious identity. Tim and I have done research suggesting that people who strongly value bodily purity, who have a tendency to view their bodies as a temple, don’t want to put any foreign substances into it for risk of doing bodily harm. These tend to be people who are both highly religious, highly conservative.
BU Today: Virtually no religion objects to vaccination.
Motta: Their religion does not, but their party does. A friend of Tim’s and mine has a book coming out that shows that people tend to update their religious affiliations on the basis of their partisanship, more so than the other way around. We’re literally talking about questions of life and death and the afterlife being shaped by our partisanship.
BU Today: I’ll leave a church if I don’t like its politics?
Motta: Yes. I think that partisanship is the strongest force on earth when it comes to shaping social behaviors.
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