Sarah Gollust, Paula Lantz, and Peter Ubel have a notable article in the December issue of the American Journal of Public Health that looks at the social determinants of health and assesses the role the media plays in conveying messages about health care–in this case diabetes. What they find is that messaging matters, but as much because of who hears the message and how they hear it as because of the message itself.
Okay, let me back up. First things first, the authors define the social determinants of health as “the nonmedical, social, economic, political, or environmental factors that influence the distribution of health and illness in the population.” According to a large body of literature the authors cite, people tend to be more supportive of assisting people whose illness is the result of such social determinants rather than poorly exercised personal choices–a.k.a. irresponsibility. So, it should be the case that if the media sells the social determinants message, people should be more open to addressing the problem through collective action. “Should be” is the operative phrase.
Using an internet-based survey, the investigators randomly presented one of four scenarios about diabetes to study participants. Diabetes was depicted as caused by genetic predisposition, behavioral choices, or social determinants. The fourth group–used as a control–did not attribute a cause of diabetes. After presenting one of these four scenarios to participants, the study proceeded to ask participants about their level of agreement with several public policy options designed to confront the problem of diabetes:
- Public school bans on fast food concessions
- Government incentives for grocery stores to establish locations in which there are currently few
- Trans-fat bans
- Government investment in parks
- Regulating junk food advertisements
- Imposing taxes on junk food
- Subsidizing the costs of healthy food
What the authors found is interesting. While participants exposed to the social determinants message were more likely than other groups to believe that social determinants played a key role in the development of diabetes, the approval of public policy solutions was highly correlated with political party affiliation with Democrats significantly more likely to support public policy solutions and Republicans more likely to oppose such solutions. In fact, when exposed to the social determinants message, Democrats and Republicans reacted in completely different ways. It is almost as if Republicans have been conditioned to reject such messages, while Democrats have been conditioned to accept them. The authors go on to try and discuss what their findings mean. Here’s what I think they mean: The world–as in the U.S. world–is broadly divided into two groups: those who view the country as the aggregate of individuals and those who view the country as a society. The message of social determinants resonates with the latter, but not the former. Therefore, a variation on the message is needed if widespread consensus is to be reached.
We’ve all seen this before: Either the person has no bootstraps or they’re too lazy to pull themselves up by them. Nevermind the fact that pulling oneself up by one’s bootstraps makes absolutely no sense in the first place. The take home message is this: Crafting your message to convey your point is critical, but it is equally critical to understand your audience and their prejudices so that your messages will be maximally effective. Otherwise, you’re likely to polarize the population around your issue. Who knew?!