Mistrust in Government and Polarization in Health Behaviors during COVID-19

• In Event: Misinformation, Political Polarization and Health Behaviors

Abstract

In 2019, the Global Health Security Index (GHSI), ranked the US as number one in the world in terms of its pandemic preparedness (Cameron, Nuzzo, and Bell 2019). Yet, by mid-2020, the US was number one on a very different metric- the number of excess deaths beyond those expected in non-crisis conditions (Islam et al. 2021). What accounts for the dramatic failure of the US to mount a cohesive and effective response to the pandemic? Low and declining trust in public health institutions (PHIs) associated with heightened political polarization, the rise of populism, anti-intellectualism and the politicization of science have each been implicated in the difficulty in securing broad compliance with public health measures during the pandemic (Gollwitzer et al. 2020; Merkley and Loewen 2021). Public trust is considered to be the foundation of the legitimacy of public institutions and a functioning political system. Research on political psychology suggests that when people are anxious about a threat or a crisis, that they do tend to trust experts most of the time (Albertson and Gadarian 2015). Further, when people are anxious about a threat, they will accept policies that protect the public but that may threaten others’ liberties, which they might not support under “normal” circumstances. However, this dynamic changes when an issue becomes politicized. When an issue becomes politicized, people look to their preferred politicians for cues about how they should respond, contributing to polarization in health beliefs and behaviors. This suggests that trust is dynamic and can be built or degraded and that disease politicization is not inevitable. The unfolding of the pandemic provides us with an opportunity to examine how public trust affects compliance with emergency response measures in real-time.
Following Albertson & Gadarian’s (2015) contention about public trust in experts during crises, this paper explores the evolution of trust in PHIs (i.e., CDC, HHS, WHO) over the course of the pandemic by using eleven waves of longitudinal data from 5,699 US adults (68,036 responses) collected by the Understanding America Study (UAS) project from Dec. 2020 to Jul. 2021. Specifically, we examine whether 1. Trust in PHIs in the US decreased overall and became more polarized along partisan lines as the pandemic continued; 2. Changes in public trust correlate with compliance with pandemic mitigation measures (e.g., mask wearing, social distancing, vaccination intentions).
Preliminary results suggest that the public has had consistently high overall trust in PHIs (from 98% in the first wave to 88% in the last wave), but the public’s trust and anxiety about the pandemic became sharply polarized along partisan lines a few months into the pandemic in the US. Specifically, distrust in public health institutions increased sharply among Republicans and Independents within a few months of the first case being detected, while trust PHI stayed stable or even increased slightly among Democrats. Compliance with public health measures also became polarized along partisan lines, and low trust in PHIs was associated with lower compliance with public health measures: Compared with people who trust PHIs, people who distrusted PHIs were considerably less like likely to get vaccinated (42%p difference), less likely to report consistently wearing a mask (44%p difference), less likely to avoid public spaces (34%p difference), and less likely to avoid contact with people with high risk (32%p difference), when all other covariates were controlled. The analysis further examines psychological and behavioral patterns of PHI distrusters to suggest government strategies for risk communication and messaging in public health crises.
These findings suggest that while most of the public does trust PHIs most of the time, the politicization of the COVID-19 response has contributed to polarization in trust and compliance with mitigation efforts in ways that are harmful to public health.

Reference
Albertson, Bethany, and Shana Kushner Gadarian. 2015. Anxious Politics: Democratic Citizenship in a Threatening World. New York, NY: Cambridge University Press.
Cameron, Elizabeth E., Jennifer B. Nuzzo, and Jessica A. Bell. 2019. Global Health Security Index: Building Collective Action and Accountability. https://www.ghsindex.org/wp-content/uploads/2019/10/2019-Global-Health-Security-Index.pdf.
Gollwitzer, Anton et al. 2020. “Partisan Differences in Physical Distancing Are Linked to Health Outcomes during the COVID-19 Pandemic.” Nature Human Behaviour 4(11): 1186–97.
Islam, Nazrul et al. 2021. “Excess Deaths Associated with COVID-19 Pandemic in 2020: Age and Sex Disaggregated Time Series Analysis in 29 High Income Countries.” The BMJ 373.
Merkley, Eric, and Peter John Loewen. 2021. “Anti-Intellectualism and the Mass Public’s Response to the COVID-19 Pandemic.” Nature Human Behaviour 5(6): 706–15.

Authors

• Yongjin Choi, London School of Hygiene and Tropical Medicine

• Ashley M Fox, SUNY at Albany