A study that reveals the pitfalls of using the social determinants of health to influence public health policy may also shed some light on the differing opinions Democrats and Republicans have about health care reform. In an effort to understand what influences attitudes about preventive health interventions, Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2008–2010), Sarah Gollust, Ph.D., looked at the characteristics of people most likely to support or reject public health activities designed to prevent type II diabetes.
Gollust and her team found that “exposure to a social determinants message in the media led to a divergence between Republicans and Democrats opinions,” about supporting government-funded programs created to lower diabetes rates among adults and children. “These results signify that increasing public awareness of the social determinants of health may not uniformly increase public support for health policy action,” Gollust said.
The study, “The Polarizing Effects of News Media Messages about the Social Determinants of Health,” reported on the attitudes of 2,490 people. The group was ethnically diverse; roughly 50 percent female and it included Republicans, Democrats and Independents ages 18 and up. Participants were given mock news articles about type II diabetes that were identical except for phrases about causal factors and then asked if they supported a number of government-based interventions designed to prevent or manage diabetes. One article attributed diabetes to genetics, another to the behavior of people with the disease, a third offered no information about the cause, the last attributed the disease to social determinants defined as the “circumstances in which people lived,” such as poor neighborhoods.
There were no significant differences in response to the different versions of the articles among people of different races, genders, or people who said they or their family members were living with diabetes. The only groups that showed a significant divergence in response to the information were Democrats and Republicans—upon viewing the same article describing social determinants, 32 percent of Democrats agreed that social factors played an important causal role in diabetes, compared to 16 percent of Republicans. Independents were in the middle. Democrats and Republicans also differed in their support for health interventions after they viewed the social determinants message.
“Our research indicates that there’s something about the social determinants message that makes some people less likely and others more likely to support policies aimed at addressing illness,” Gollust said. “We asked about policies that included snack taxes, healthier foods in schools and government subsidies to make fruits and vegetables more affordable. In public health, there’s an emphasis on the social determinants, but there should be an understanding of how this type of discussion influences public opinion.” Gollust noted that the social determinants message may have activated feelings toward a particular group because it mentioned the poor or touched on values about personal responsibility for health. The study also offered the media a unique opportunity to understand how messages may influence attitudes about health and public policy.
Gollust was the lead researcher and her team included Paula M. Lantz, Ph.D., a sociologist at the University of Michigan and director of the RWJF Scholars in Health Policy Research program at the University of Michigan and Peter Ubel, M. D., director of the Center for Behavioral and Decision Sciences Medicine at the University of Michigan, who won an RWJF Investigator Award in 2007.
The Robert Wood Johnson Foundation Health & Society Scholars program is a national program that funds multidisciplinary collaborations in the field of population health.