Support For Public Health Policies Research Articles

Undermining support for COVID-19 public health policies: an analysis of the impact of subversive conspiracy narratives on Czech General Practitioners.

Limited knowledge exists regarding the impact of COVID-19 conspiracy theories on the professional practice of general practitioners (GPs). This study aimed to identify the basic characteristics of GPs who endorse COVID-19 conspiracy beliefs and compare their level of support for COVID-19 health policies with GPs who do not believe in conspiracies. Between January and February 2021, a representative online survey was conducted among 1163 GPs in the Czech Republic. The sample was designed to be representative of members of The Association of GPs of the Czech Republic. The survey revealed that nearly 14% of the GPs surveyed believed in one or more COVID-19 conspiracies. The average age of GPs who endorsed conspiracies was 58, which was higher than the rest of the sample (average age of 50). GPs who believed in conspiracies were less likely to support COVID-19 public health policies and therapy recommendations, including vaccination. Logistic and linear regression analyses indicated that doctors who believed in conspiracies were 2.62 times less likely to have received a COVID-19 vaccine. Mediation analysis showed that approximately one-quarter (23.21%) of the total effect of trust in government information on support for public health policies was indirectly mediated by the endorsement of COVID-19 conspiracy beliefs. The study findings suggest a concerning association between belief in COVID-19 conspiracies and a reduced level of support for public health policies among GPs. These results underscore the importance of incorporating the 'conspiracy agenda' into medical authorities' more effective public health communication strategies.

Analysing public debates, to support productive engagement with politicians and stakeholders

Abstract Issue UK public health debates have become highly politicised. Sean Sinclair (SCS) conducted 37 semi-structured interviews with public health professionals to understand how this affects their engagement with stakeholders. Interviewees said it has become more difficult to gain stakeholder support for public health policies. They hypothesised that politicians didn’t listen to evidence regarding health outcomes. SCS counter-hypothesised that debates are not always about facts, but sometimes about values. If a politician's main concern is, say, economic growth or personal responsibility, then evidence of health outcomes will not address their concerns. Solution To understand people's values, SCS analysed UK public debates about four contentious issues: vaccine passports; lockdown; healthy living advice; and Prep (the HIV prophylactic). SCS used the techniques of argument analysis used in analytic philosophy, ensuring the structure of arguments was transparent, and so amenable to assessment. Results From the analysis, SCS developed a conceptual toolkit to allow public health professionals to analyse what motivates politicians from different points on the political spectrum. They can then tailor their evidence to show how a policy will deliver on a politician's concerns, or tweak the policy to mitigate the features that trigger scepticism. To assess the material, SCS presented it to public health professionals in qualitative discussion groups. Feedback indicated that it will help them engage more effectively with stakeholders, eg: ‘Makes me think about what argument might be most impactful, rather than my instinctive response.’ Lessons In any country that is politically divided over public health policy, this method can reveal new ways of arguing for policies, eg by appealing to a politician's own values. SCS has developed the expertise to help develop similar analyses in other countries. Key messages • In any country that is politically divided over public health policy, it can be difficult to gain stakeholder support for policies. Analysing public debates builds understanding of people's concerns. • This method can reveal new ways of arguing for policies. Public health professionals can tailor the evidence they present to show how a policy will deliver on each politician's concerns.

Priming COVID-19's consequences can increase support for investments in public health

Can messaging that emphasizes the costs of COVID-19 increase popular support for more proactive public health policies? People who experience disasters often become more supportive of policies to address their underlying causes, and the pandemic may have similar spillover effects for public opinion. To test this idea, the study implements a survey experiment in Italy, Germany, and the United States in which half of the respondents were randomly assigned to a prime about the impact of the pandemic prior to answering questions about their support for public health policies. The results show that respondents who received the prime became more favorable toward increased government spending on domestic and foreign public health programs alike. These treatment effects were consistent across countries, across two different surveys in the United States conducted at different points in time, and across partisan subgroups. However, the treatment did not consistently increase support for more active and intrusive government policies to address specific public health challenges like smoking or HIV/AIDS. The results suggest that public health advocates may benefit from messaging that connects COVID-19 to the need for public health funding beyond the context of the pandemic.

A National Portrait of Public Attitudes toward Opioid Use in the US: A Latent Class Analysis.

Opioid overdose rates have steadily been increasing in the United States (US) creating what is considered an overdose death crisis. The US has a mixture of public health and punitive policies aimed to address opioid use and the overdose crisis, yet little is known about public opinion relating to opioid use and policy support. Understanding the intersection of public opinion about opioid use disorder (OUD) and policy can be useful for developing interventions to address policy responses to overdose deaths. A national sample of cross-sectional data from the AmeriSpeak survey conducted from 27 February 2020 through 2 March 2020 was analyzed. Measures included attitudes toward OUD and policy beliefs. Latent class analysis, a person-centered approach, was used to identify groups of individuals endorsing similar stigma and policy beliefs. We then examined the relationship between the identified groups (i.e., classes) and key behavioral and demographic factors. We identified three distinct groups: (1) "High Stigma/High Punitive Policy", (2) "High Stigma/Mixed Public Health and Punitive Policy", and (3) "Low Stigma/High Public Health Policy". People with higher levels of education had reduced odds of being in the "High Stigma/High Punitive Policy" group. Public health policies are most effective in addressing OUD. We suggest targeting interventions toward the "High Stigma/Mixed Public Health and Punitive Policy" group since this group already displays some support for public health policies. Broader interventions, such as eliminating stigmatizing messaging in the media and redacting punitive policies, could reduce OUD stigma among all groups.

National identity predicts public health support during a global pandemic

Changing collective behaviour and supporting non-pharmaceutical interventions is an important component in mitigating virus transmission during a pandemic. In a large international collaboration (Study 1, N = 49,968 across 67 countries), we investigated self-reported factors associated with public health behaviours (e.g., spatial distancing and stricter hygiene) and endorsed public policy interventions (e.g., closing bars and restaurants) during the early stage of the COVID-19 pandemic (April-May 2020). Respondents who reported identifying more strongly with their nation consistently reported greater engagement in public health behaviours and support for public health policies. Results were similar for representative and non-representative national samples. Study 2 (N = 42 countries) conceptually replicated the central finding using aggregate indices of national identity (obtained using the World Values Survey) and a measure of actual behaviour change during the pandemic (obtained from Google mobility reports). Higher levels of national identification prior to the pandemic predicted lower mobility during the early stage of the pandemic (r = −0.40). We discuss the potential implications of links between national identity, leadership, and public health for managing COVID-19 and future pandemics.

The role of race and scientific trust on support for COVID-19 social distancing measures in the United States.

Pundits and academics across disciplines note that the human toll brought forth by the novel coronavirus (COVID-19) pandemic in the United States (U.S.) is fundamentally unequal for communities of color. Standing literature on public health posits that one of the chief predictors of racial disparity in health outcomes is a lack of institutional trust among minority communities. Furthermore, in our own county-level analysis from the U.S., we find that counties with higher percentages of Black and Hispanic residents have had vastly higher cumulative deaths from COVID-19. In light of this standing literature and our own analysis, it is critical to better understand how to mitigate or prevent these unequal outcomes for any future pandemic or public health emergency. Therefore, we assess the claim that raising institutional trust, primarily scientific trust, is key to mitigating these racial inequities. Leveraging a new, pre-pandemic measure of scientific trust, we find that trust in science, unlike trust in politicians or the media, significantly raises support for COVID-19 social distancing policies across racial lines. Our findings suggest that increasing scientific trust is essential to garnering support for public health policies that lessen the severity of the current, and potentially a future, pandemic.

Impact of a New SARS-CoV-2 Variant on the Population: A Mathematical Modeling Approach

Several SARS-CoV-2 variants have emerged around the world, and the appearance of other variants depends on many factors. These new variants might have different characteristics that can affect the transmissibility and death rate. The administration of vaccines against the coronavirus disease 2019 (COVID-19) started in early December of 2020 and in some countries the vaccines will not soon be widely available. For this article, we studied the impact of a new more transmissible SARS-CoV-2 strain on prevalence, hospitalizations, and deaths related to the SARS-CoV-2 virus. We studied different scenarios regarding the transmissibility in order to provide a scientific support for public health policies and bring awareness of potential future situations related to the COVID-19 pandemic. We constructed a compartmental mathematical model based on differential equations to study these different scenarios. In this way, we are able to understand how a new, more infectious strain of the virus can impact the dynamics of the COVID-19 pandemic. We studied several metrics related to the possible outcomes of the COVID-19 pandemic in order to assess the impact of a higher transmissibility of a new SARS-CoV-2 strain on these metrics. We found that, even if the new variant has the same death rate, its high transmissibility can increase the number of infected people, those hospitalized, and deaths. The simulation results show that health institutions need to focus on increasing non-pharmaceutical interventions and the pace of vaccine inoculation since a new variant with higher transmissibility, such as, for example, VOC-202012/01 of lineage B.1.1.7, may cause more devastating outcomes in the population.

COVID-19 conspiracy beliefs, health behaviors, and policy support.

Conspiracy theories have been proliferating during the COVID-19 pandemic. Evidence suggests that belief in conspiracy theories undermines engagement in pro-health behaviors and support for public health policies. Moreover, previous work suggests that inoculating messages from opinion leaders that expose conspiracy theories as false before people are exposed to them can help to prevent belief in new conspiracies. Goals of this study were to: (a) explore associations between COVID-19 conspiracy beliefs with SARS-CoV-2 vaccine intentions, cooperation with public health recommendations, and support for public health policies among U.S. adults and (b) investigate trusted sources of COVID-19 information to inform strategies to address conspiracy beliefs. A cross-sectional, online survey was conducted with 845 U.S. adults in April 2020. Data were analyzed using analyses of variance and multivariable regressions. One-third (33%) of participants believed one or more conspiracies about COVID-19. Participants who believed conspiracies reported that their intentions to vaccinate were 3.9 times lower and indicated less support for COVID-19 public health policies than participants who disbelieved conspiracies. There were no differences in cooperation with public health recommendations by conspiracy belief endorsement in the multivariable regression analysis. Although there were some key differences in trusted sources of COVID-19 information, doctor(s) were the most trusted source of information about COVID-19 overall with 90% of participants trusting doctor(s). Doctor(s) may play a role in addressing COVID-19 conspiracy theories before people are exposed to them to promote COVID-19 prevention efforts.

Public Understanding of Ebola Risks: Mastering an Unfamiliar Threat.

Ebola was the most widely followed news story in the United States in October 2014. Here, we ask what members of the U.S. public learned about the disease, given the often chaotic media environment. Early in 2015, we surveyed a representative sample of 3,447 U.S. residents about their Ebola-related beliefs, attitudes, and behaviors. Where possible, we elicited judgments in terms sufficiently precise to allow comparing them to scientific estimates (e.g., the death toll to date and the probability of dying once ill). Respondents' judgments were generally consistent with one another, with scientific knowledge, and with their self-reported behavioral responses and policy preferences. Thus, by the time the threat appeared to have subsided in the United States, members of the public, as a whole, had seemingly mastered its basic contours. Moreover, they could express their beliefs in quantitative terms. Judgments of personal risk were weakly and inconsistently related to reported gender, age, education, income, or political ideology. Better educated and wealthier respondents saw population risks as lower; females saw them as higher. More politically conservative respondents saw Ebola as more transmissible and expressed less support for public health policies. In general, respondents supported providing "honest, accurate information, even if that information worried people." These results suggest the value of proactive communications designed to inform the lay public's decisions, thoughts, and emotions, and informed by concurrent surveys of their responses and needs.

Injury News Coverage, Relative Concern, and Support for Alcohol-Control Policies: An Impersonal Impact Explanation

Research on the impersonal impact hypothesis suggests that news (especially print) coverage of health and safety risks primarily influences perceptions of risk as a societal issue, and not perceptions of personal risk. The authors propose that the impersonal impact of news—impact primarily on concerns about social-level risks—will mediate effects of news stories on support for public health policies; such effects substantively matter as evidence suggests health policies, in turn, have important effects on protective behaviors and health outcomes. In an experiment using 60 randomly selected violent crime and accident news stories manipulated to contain or not contain reference to alcohol use as a causative factor, the authors find that the effect of stories that mention alcohol as a causative factor on support for alcohol-control policies is mediated by social-level concern and not by personal-level concern. In so doing, the authors provide a theoretical explanation as well as empirical evidence regarding the potential for news coverage—including breaking or episodic news—to influence health-related public policy.

Reporting risk, producing prejudice: How news reporting on obesity shapes attitudes about health risk, policy, and prejudice

News reporting on research studies may influence attitudes about health risk, support for public health policies, or attitudes towards people labeled as unhealthy or at risk for disease. Across five experiments (N = 2123) we examined how different news framings of obesity research influence these attitudes. We exposed participants to either a control condition, a news report on a study portraying obesity as a public health crisis, a news report on a study suggesting that obesity may not be as much of a problem as previously thought, or an article discussing weight-based discrimination. Compared to controls, exposure to the public health crisis article did not increase perception of obesity-related health risks but did significantly increase the expression of antifat prejudice in four out of seven comparisons. Across studies, compared to controls, participants who read an article about weight-based discrimination were less likely to agree that overweight constitutes a public health crisis or to support various obesity policies. Effects of exposure to an article questioning the health risks associated with overweight and obesity were mixed. These findings suggest that news reports on the “obesity epidemic” – and, by extension, on public health crises commonly blamed on personal behavior – may unintentionally activate prejudice.

From awareness to action on the social determinants of health

The following editorial continues the series of editorials in the International Journal of Public Health on the WHO Commission Report on the Social Determinants of Health (CSDH, WHO 2008; Siegrist 2008; Vagero 2008; McQueen 2009; Koskinen and Puska 2009; Potvin 2009; MadarasovaGeckova 2009). In its final principle of action, the WHO Commission (CSDH) recognized the need to raise public awareness of the social determinants of health. Raised awareness should consist, according to the report, of a better understanding among actors, practitioners, and the general public of how population health is affected by social determinants (WHO 2008). Raised awareness may be the first step on a long path to action on the social determinants of health ultimately improving the public’s capacity for action (Madarasova-Geckova 2009). Yet, to close the gap will require more than raised awareness, it will require community-based action in a variety of forms. To contribute more broadly to the development of diverse communitybased initiatives in addressing the social determinants of health, the CSDH could have recognized a wider range of health promotion strategies within the report. Within the health promotion literature, there are a range of approaches and strategies for considering how to facilitate group and community willingness to address the social determinants of health. These range from more cooperative and collaborative models to those that assume more of a political conflict perspective. The relevance and appropriateness of specific approaches and strategies are context specific, and there is no one size that fits all. With these ideas in mind, it is worth considering certain assumptions about community action favored within the report. The CSDH report assumes that raised awareness about the social determinants of health will lead politicians and community groups to cooperate and work together in bringing about change. Using the analogy of a ‘‘nutcracker effect,’’ the commission describes the cracking of health inequity as coming from the cooperative action and joint pressure of top-down policy making and bottom-up community action (WHO 2008). To what degree does raised awareness translate into action? At the community level, research is mixed in support of this assumption. In Canada, an association between individual recognition of the structural causes of health inequities and a person’s willingness to support social policies to address those inequalities has been found Reutter et al. 2002). In the United States, however, it was recently shown that a person’s receptivity to a message on the social determinants of health is conditioned in part by their prior political beliefs (Gollust et al. 2009). After being exposed to a social determinants framing on a message about diabetes, Democrats expressed a higher level of support for public health policies, while Republicans expressed a lower level (Gollust et al. 2009). Advocates seeking to mobilize broad public support to address health Spencer Moore is Assistant Professor in the School of Kinesiology and Health Studies at Queen’s University, Kingston, Ontario, and Researcher at the centre de recherche du Centre Hospitalier de l’Universite de Montreal. He also holds a New Investigator Award from the Institute of Aging of the Canadian Institutes of Health Research.