Public health vs. politics

<h1>Public health vs. politics</h1>

<p>Increasingly, people’s health choices align with their political identities rather than medical advice.</p>

<p>Written by Paul Adepoju</p>

<p>This <a rel="canonical" href="https://harvardpublichealth.org/policy-practice/political-and-public-health-structures-are-increasingly-intertwined/">article</a> originally appeared in<a href="https://harvardpublichealth.org/">Harvard Public Health magazine</a>. Subscribe to their <a href="https://harvardpublichealth.org/subscribe/">newsletter</a>.</p>

<p class="has-drop-cap">In his victory speech, President-Elect Donald Trump promised that campaign ally and anti-vaccine activist Robert F. Kennedy, Jr. will “make America healthy again” under his administration. Kennedy’s views on a variety of public health matters were once seen as fringe, but they’re now poised to influence, if not determine, national policy.</p>

<p>That’s happening amid a global shift that is seeing access to care, health care costs, and public trust are entangled with political and ideological divides.</p>

<p>Kai Ruggeri, a professor of health policy and management at the Columbia University Mailman School of Public Health, is among the authors of a study about the effects of global political polarization on health. <a href="https://www.nature.com/articles/s41591-024-03307-w" target="_blank" rel="noreferrer noopener">Published in <em>Nature Medicine</em></a>, the study finds that people’s health choices align with their political and social identities rather than with medical recommendations—a circumstance that could have profound implications for public health and health care delivery. This trend toward affiliation-based decision-making is particularly pronounced in the U.S., but it is visible elsewhere—including Switzerland, France, Denmark, Canada and New Zealand, according to the study.</p>

<p>In an interview with Paul Adepoju for <em>Harvard Public Health</em>, Ruggeri points out that health care has long been a politically charged issue, but the level of polarization today reflects a new reality: People are not just choosing one side; they’re actively pushing against the other.</p>

<p><em>This interview was edited and condensed.</em></p>

<p><strong>HPH</strong>:<em> </em>What made you decide this was a subject worth investigating?</p>

<p><strong>Kai Ruggeri</strong>: Obviously, in any election, health is going to be central. Whether it’s a specific health issue, like in 2020 when it was COVID, or if you go back to 2008 when marketplace health insurance was a key issue, health care is always a major component of elections, not just in the U.S. but around the world.</p>

<p>And it’s inherently political. In recent years, with growing polarization, health issues on the election agenda likely influence people in different directions. We’re seeing groups moving away from overlapping views, and this shift influences health care-related topics specifically. The study aimed to track these patterns globally, though we found much of the data was U.S.-focused.</p>

<p><strong>HPH</strong>: Were there any unique findings that stood out to you in the study?</p>

<p><strong>Ruggeri</strong>: Since we didn’t use original data in this study, I can only speak to patterns we observed. We’re seeing rising animosity between groups. People are not just closely aligned with their group; they’re strongly against the other. This entrenched polarization isn’t about liking one’s own group; it’s about wanting the other group to fail, almost like sports team rivalries, but in health care. This shift affects public health—it complicates stopping infectious diseases, [and it] raises avoidable health care costs, lowers life expectancy, and leads to higher avoidable mortality rates.</p>

<p><strong>HPH</strong>: Is this really a uniquely American problem, or is it exaggerated due to intense media coverage?</p>

<p><strong>Ruggeri</strong>: Like many issues, it may seem exaggerated because it’s so heavily covered in the United States, which creates a self-fulfilling prophecy. It starts being talked about, gets picked up, and just rolls from there. However, these patterns exist in other places too. The U.S. wasn’t the first to experience health divisions tied to ideology. Other countries have seen similar or even more extreme levels before. But one hopeful aspect is the role of trusted voices. Engaging trusted voices can really make a difference globally. People will turn to those they trust, so if trusted voices provide good health guidance, it can mitigate this division.</p>

<p><strong>HPH</strong>: What role did trusted voices play during the COVID-19 pandemic, and what can we learn from that?</p>

<p><strong>Ruggeri</strong>: One of the lessons from COVID was the importance of staying ahead of questions and concerns that arose rapidly. It was challenging because some issues developed too quickly to address directly, but a major takeaway was that engaging trusted voices could positively impact public health. Trusted voices are essential to addressing people’s concerns, even if it means accepting ongoing questions. Health agencies need to convey that it’s okay to ask questions and that responses will continue as new information comes in.</p>

<p>Introducing uncertainty is also helpful because people may misinterpret absolute statements. For instance, if they’re told a vaccine is effective but know someone it didn’t work for, they may question its efficacy. Conveying that no outcome is guaranteed—while emphasizing overall benefits—can build trust in the long run.</p>

<p><strong>HPH</strong>: In interpreting and accepting the findings, are you concerned that polarization might affect how your study itself is received?</p>

<p><strong>Ruggeri</strong>: There will always be people or groups who aim to create division. The real challenge [for public health leaders] is getting ahead of it. Emphasizing responses to concerns rather than simply addressing the divisions themselves is where we can find hope.</p>

<p><strong>HPH</strong>: What changes do you hope to see?</p>

<p class=" t-has-endmark t-has-endmark"><strong>Ruggeri</strong>: I’d like to see health agencies engage directly, publicly, and actively with trusted voices—community leaders, faith leaders, and so on. They need to provide accurate information in ways that also invite people to ask questions.</p>

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