Abstract

Republicans and Democrats responded to the COVID-19 pandemic in starkly different ways, from their attitudes in 2020 about whether the virus posed a threat to whether the pandemic ended in 2023. The consequences of COVID-19 for health equity have been a central concern in public health, and the concept of health equity has also been beset by partisan polarization. In this article, the authors present and discuss nationally representative survey data from 2023 on US public perceptions of disparities in COVID-19 mortality (building on a previous multiwave survey effort) as well as causal attributions for racial disparities, the contribution of structural racism, and broader attitudes about public health authority. The authors find anticipated gulfs in perspectives between Democrats on the one hand and independents and Republicans on the other. The results offer a somewhat pessimistic view of the likelihood of finding common ground in how the general public understands health inequities or the role of structural racism in perpetuating them. However, the authors show that those who acknowledge racial disparities in COVID-19 are more likely to support state public health authority to act in response to other infectious disease threats. The authors explore the implications of these public opinion data for advocacy, communication, and future needed research.

It is now well established that partisan differences in public perceptions about the COVID-19 pandemic in the United States emerged early in 2020 and have persisted into 2023, with a gulf between Republicans and Democrats in their attitudes about the pandemic, their beliefs about and engagement with the behaviors required to mitigate the virus's spread, and their support for state and federal policies implemented to protect the public (Gadarian, Goodman, and Pepinsky 2022). Americans even disagree about whether the pandemic is over; as of March 2023, 75% of Republicans said the pandemic was over, while 55% of independents and only 28% of Democrats said the same (Saad 2023). One particularly notable domain on which the parties diverge is their understanding of health inequalities in COVID-19. While many public health professionals and health researchers recognized stark inequalities in infections and mortality early in the pandemic (Williams and Cooper 2020), the same is not true of the public. In April 2020, only about half the public acknowledged socioeconomic and racial disparities in COVID-19 mortality, with a substantial partisan gap in perceptions emerging early in the course of the pandemic (Gollust et al. 2020).

Of course, social science research has demonstrated long-standing partisan or ideological differences in recognition of inequalities surrounding social status generally (Kluegel and Smith 1981) and around health outcomes in particular (Booske, Robert, and Rohan 2011). Thus, partisan gaps in public recognition of COVID-19 mortality disparities were not particularly surprising to observe. However, before the emergence of COVID-19, disparities in health outcomes—while always present and significant—rarely received much consistent attention in traditional news media (Gollust and Lantz 2009; Nagler et al. 2016). In contrast, the mainstream news media did attend to disparities in COVID-19 with some regularity, although more in certain news outlets than in others (Biswas, Sipes, and Brost 2021; Xu, Farkouh, et al. 2022; Xu, Lin, et al. 2022). Furthermore, public and media attention to racial disparities in COVID-19 corresponded with national attention to racial injustice, spurred by the police killing of George Floyd in Minneapolis. This discourse also fueled more attention to racism in political campaign ads that exposed the public to partisan cues to use in interpreting racial equity issues (see Fowler et al. in this issue). These conditions—preexisting partisan differences in perceptions of health inequalities, combined with more robust attention to racial inequality in the media and elite polarization surrounding the problem of racial injustice—contributed to and continue to feed mass public polarization in understanding of the grave and central public health problem of inequalities.

Indeed, multiple peer-reviewed studies as well as national polling efforts have consistently demonstrated partisan differences in recognition of inequalities (Gollust et al. 2022; Gollust and Haselswerdt 2023; Hamel et al. 2020), with little movement in mass opinion even following the unprecedented attention to racial injustice in the summer of 2020 (Gollust et al. 2022). Evidence from recent experimental studies also suggests that white respondents respond negatively when exposed to information about racial inequalities, including feeling less empathy, less support for policy, and less fearful of COVID-19 (Stephens-Dougan 2022; Skinner-Dorkenoo et al. 2022). Partisan gaps in perceptions of health equity, and in perceptions of public health more generally, have profound importance for public health policy makers and advocates seeking politically feasible paths forward to advance population health and reduce health inequities in 2024 and beyond.

In this article, we present and interpret new evidence from March–April 2023 on public recognition of and causal attribution for health inequities, specifically surrounding COVID-19, which builds on three previous waves, as well as evidence on public support for future public health authority to address emerging infectious diseases. We also explore the implications of this evidence for public health communication practice, advocacy, and electoral politics. While the formal declaration of the public health emergency ended in May 2023, the virus persists—both as a continuing source of infection and through its impact on the politics of public health.

A Snapshot of Public Perceptions of COVID-19 Disparities in 2023

To illuminate trends related to public opinion about health equity in 2023, we fielded an eight-question module in the NORC AmeriSpeak Omnibus survey from March 30–April 3, 2023 (N = 1,002). The Omnibus is a multiclient shared-cost survey that NORC conducts biweekly with a sample of approximately 1,000 US adults aged 18 years and older who are drawn from its probability-based AmeriSpeak panel. In all analyses reported below, we applied NORC survey weights to adjust for potential biases in sampling and nonresponse to yield nationally representative estimates.1

We designed the survey to build on a previous three-wave effort to track public perceptions of COVID-19 disparities in mortality by age, chronic illness status, race, and income (see Gollust et al. 2022 for more details on this study and the AmeriSpeak sample). The survey used the same measures to assess public recognition of disparities: respondents were asked to indicate the extent to which they agreed or disagreed (1 = strongly disagree, 5 = strongly agree) with four statements about COVID-19, each of which compared groups—older people vs. younger people, people with chronic diseases (such as diabetes and heart disease) vs. people without such conditions, poor people vs. wealthier people, and Black/African American people vs. white people—in their likelihood of dying from “complications from COVID-19 (coronavirus).”2

Figure 1 shows the declining proportion of the population over time agreeing (a combination of “strongly agree” and “agree” response options) that any of the four types of mortality disparities exist. This drop could be due, at least in part, to lower perceived risk of COVID-19 mortality over time, especially with the widespread availability of vaccines beginning in late spring 2021. Indeed, at the time of the survey, reported weekly hospitalizations and deaths were both at one of their lowest points since 2020 (CDC 2023). In April 2020, at the outset of the pandemic and when data on inequalities were just emerging, more than 80% of the population recognized the existence of disparities by age and chronic illness, and slightly more than half recognized those by income and race. By April 2023, fewer than 75% of the public agreed that older people were more likely to die of COVID-19 than younger people, or that people with chronic illnesses were more likely to die. Only 41% agreed in April 2023 that people who are poor are more likely to die than those with higher incomes, while only 33% agreed that Black people are more likely to die than white people. This decline in recognition of racial disparities might relate not only to declining public perceptions of mortality risk generally and a decline in attention to COVID-19 in the media (given the relatively low incidence and mortality) but also to a shift in public discourse surrounding inequity. After vaccines were widely available, some elite commentators drew from point-in-time data late in 2022—when mortality rates among whites were rising and the gap between racial groups was narrowing—to paint a picture of racial progress; however, this was an incomplete analysis that did not acknowledge the aggregate enormity of the racial burden of loss, particularly among Black and American Indian/Native populations (Del Rios, Chomilo, and Lewis Jr. 2022).

In our 2023 data collection, we also assessed whether the public recognized other types of mortality disparities, including three relative comparisons we did not ask about in earlier survey waves. Despite the documented elevated rates of mortality for these groups (Hill and Artiga 2022), we found that just 25% recognized that people of Hispanic/Latino ethnicity are more likely to die, and 27% recognized that American Indian or Native American people are more likely to die, both compared to white people. While there are very limited data to assess change in perceptions of these disparities over time, what little evidence exists suggests little to no change in the mass public's recognition. For instance, in fall 2020, 25% of a sample of nationally representative survey respondents selected Hispanic or Latino people as a group “harmed the most” by COVID-19, and only 16% selected Native American people (Gollust and Haselswerdt 2023). Finally, while in fact unvaccinated adults have a higher risk of dying than those who received the vaccines (Johnson et al. 2023), only 46% of respondents indicated that people who had not been vaccinated were more likely to die than those who had received the coronavirus vaccine. This is a stark misperception among the public.

Importantly, our previous work demonstrated persistent partisan gaps in recognition of disparities by income and race, but not by age and chronic illness (Gollust et al. 2022). Table 1 shows the breakdown of the 2023 public perception data by partisanship, demonstrating continuing wide gaps in recognition of disparities by political party affiliation (with those who lean toward one or the other party collapsed with that party). Other than the disparities by age and chronic illness (for which the smaller group of pure independents expressed lower levels of agreement, while Democrats’ and Republicans’ agreement was closer to equivalent), table 1 reveals substantial partisan gaps in recognition of all the other disparities assessed. For all these other groups, Democrats agree the disparity exists significantly more than Republicans do. Independents’ low level of recognition is generally indistinguishable from that of Republicans in terms of their point estimates, although given the small sample size (n = 176), the confidence intervals are very wide and so must be interpreted cautiously.

These partisan gaps are even more apparent in figure form. Figure 2 shows the percentage who agree with each of the disparities (combining “strongly agree” and “agree” response options), restricting to Democrats and Republicans only. These data clearly demonstrate that Democrats and Republicans have vastly different perceptions of the existence of social and racial group disparities in COVID-19.

Causal Attributions for COVID-19 Racial Disparities and Perceptions of Structural Racism

Next, we sought to understand the explanations respondents provided for racial disparities in particular in the context of COVID-19. Among the 331 survey participants who agreed or strongly agreed that there are disparities in COVID-19 mortality between Black and white people, we asked them to identify the top three causal attributions for these disparities, using a survey item adapted from the RAND “2018 National Survey of Health Attitudes” (Carman et al. 2019), which asked about income-related inequalities. We asked: “In a previous question, you agreed that Black/African American people are more likely to die of complications of COVID-19 than white people. What do you think are the top three reasons why this is the case?” Respondents were offered a list of options (in randomized order) adapted from those responses from the RAND item and could select up to three. The results are displayed below in table 2, first for the full sample and then by political affiliation. While the numbers are small—especially for independents and Republicans, since fewer among these groups agreed that there were disparities in the first place—some different patterns in attributions are evident (although the focus here is just on trends, not on statistical significance, given the small sample sizes).

Specifically, the most common rationale provided across all groups was “access to health care,” a cause that is systemic in nature. Another popular selection among Democrats and independents (but less so among Republicans) was “economic resources,” again suggestive of a systemic or structural causal attribution. The third most popular response among Democrats was “access to health information,” while among independents it was “genetics.” After “access to health care,” the next most popular responses among Republicans were “living and working conditions,” which tied with “genetics” (an individualistic explanation), followed closely by “beliefs about health” and “personal choices” (both individualistic). These specific rationales indicate that while structural explanations dominate overall, Republicans and independents endorse individualistic explanations more often than Democrats. To assess this distinction even more clearly, we created two new categories of causal attributions, “structural” (including access to health care, economic resources, living or working conditions, racism, and access to a good education) and “individual” (comprising genetics, personal choices, beliefs about health, and luck). Access to health information could cross both structural and individual levels, so we did not assign it to either categorization. We estimated whether respondents selected at least one structural explanation for COVID-19 disparities and then whether respondents selected at least one individual explanation, as these were not mutually exclusive. We found that 96% of Democrats (95% CI: 91% to 98%), 82% of independents (63% to 92%), and 72% of Republicans (56% to 84%) identified any structural cause, whereas 35% of Democrats (27% to 44%), 51% of independents (28% to 73%), and 64% of Republicans (49% to 77%) identified any individual cause.

Table 2 shows that only 21% of the overall sample identified racism as one of their three most important rationales for why racial disparities in COVID-19 mortality exist (26% among Democrats and about 15% among both Republicans and independents). This is quite low, especially considering broad public attention to racism as a public health crisis that emerged with attention to racial injustice generally since mid-2020. For instance, by 2023, 262 states, counties, or cities had passed formal declarations of racism as a public health crisis, according to the American Public Health Association (APHA 2023), generating local media attention. Additional studies have suggested that news media sources mentioned systemic racism as a cause of emergent COVID-19 disparities in 2020. This explanation was included in only 1 in 10 local TV news stories (Xu, Farkouh, et al. 2022), but was much more frequent (in fact, the most common causal attribution cited) in print news (Ash et al. 2023).

To further probe public attitudes about the link between systemic racism and health, we also included a question from a RAND/RWJF survey called “COVID-19 and the Experiences of Populations at Greater Risk” (Carman et al. 2021). This survey item first defined systemic racism as “policies and systems that reinforce racial discrimination and unfair treatment of some groups, such as where people get to live or who gets bank loans. This type of racism can be so embedded in the institutions and practices of society that it can still exist even if individuals don't want to discriminate.” After viewing this definition, respondents then were asked how much they agree or disagree with this statement: “One of the main reasons that people of color (e.g., African Americans, Latinos) have poorer health outcomes (e.g., higher rates of diabetes, more deaths from coronavirus (COVID-19)) than white people is systemic racism.”

Results again reveal an expected partisan gap in agreement that systemic racism is a cause of racial health disparities, with a scant 30% agreement overall, but 54% among Democrats, 17% among independents, and only 12% among Republicans. The complete distribution of responses is displayed below in figure 3 (values with confidence intervals are reported in online-only appendix table 1).

These values are lower than the RAND fielding of this item (wording unchanged). In fall 2021, RAND fielded this item in a general population survey and found that overall 41% agreed (21.2% strongly, 19.8% somewhat) with this statement (Carman et al. 2021). These findings suggest a decline of more than 10 percentage points in public agreement with the link between systemic racism and health in fewer than two years. This is in line with broader public opinion trends that signal a decline in support, for example, for the Black Lives Matter movement, down from its peak in June 2020 (Horowitz, Hurst, and Braga 2023).

Ongoing Partisan Differences in Support for Public Health Authority

Numerous research studies and polling efforts since 2020 have documented partisan and ideological differences in public support for governmental measures to mitigate the pandemic, such as restrictions on gatherings, business closures, vaccine mandates, and mask requirements (Barry et al. 2021; Gadarian, Goodman, and Pepinsky 2022), as well as in their support for the CDC's federal authority to act in health crises (Motta, Callaghan, and Trujillo 2023). Given the critical importance of state public health departments in implementing policies to mitigate future infectious disease threats (Gostin and Wetter 2023), we asked respondents to consider their ongoing support for state public health authority: “Overall, how much do you support or oppose the authority of state health departments to implement policies to reduce the spread of an infectious disease?” Table 3 shows overall support and the distribution of support for state public health authority. More than half (53%) of the full sample support the authority of public health departments to implement such policies. As anticipated, partisan differences are apparent here as well, with 75% of Democrats, but only 35% of independents and 39% of Republicans, expressing support for public health authorities.

In recent years, scholars have noted that public opposition to the state's authority to mitigate COVID-19 has been racialized. For instance, Stephens-Dougan (2022) observed that the 2020 GOP-led protests against state restrictions and business closures were largely white-led, and they surmised that evidence that people of color were hardest hit by COVID-19 could have stoked this backlash. Indeed, a few extant survey-based experiments have suggested a causal relationship between exposure to information about racial disparities and opposition to pandemic mitigation (Harell and Lieberman 2021; Skinner-Dorkenoo et al. 2022; Stephens-Dougan 2022). Cross-sectional survey data, however, have demonstrated that those with more awareness of disparities were actually more supportive of pandemic mitigation policies in 2020, all else equal (Gollust and Haselswerdt 2023).

It is unclear how recognition of the persistent racial disparities in COVID-19 is related to general support for public health authority in 2023, at the end of the official public health emergency. One might expect that those who are aware of the pandemic's harms to Black Americans may in fact be more supportive of government authority to implement policies that, if applied equitably, presumably could help to ameliorate future disproportionate harms against racial groups. To test this expectation, we ran a simple regression of public support for public health authority on respondents’ perceptions of racial disparities, adjusting for other probable predictors of public health policy opinion (partisanship, but also gender, age, educational status, income, and Census region; see online-only appendix table 2). Respondents who strongly agreed that there are racial disparities in COVID-19 mortality were more supportive (0.63 units on the 5-point policy support scale) of state public health authority, compared to those who strongly disagreed, adjusting for partisanship and other factors. This association is comparable in magnitude to partisanship: Republicans were 0.85 units less supportive (p < 0.001) and independents were 0.79 units less supportive (p < 0.001) than were Democrats. Men were also less supportive of such authority (−0.19, p = 0.04); no other demographic characteristics of respondents were predictive of support. These data indicate that, regardless of partisanship, those who correctly identify racial disparities in COVID-19 mortality in 2023 are more, not less, supportive of states’ authority to respond to emergent threats.

Discussion and Implications

For readers who believe health equity and the future protection of the public's health should be mass public priorities, these data are sobering indeed. It is challenging to take a sanguine view of data that describe middling public support for state public health authority, and large differences by partisanship in the recognition of health inequities that most in public health agree are glaringly obvious injustices. Furthermore, despite public health professionals’ prominent recognition of structural racism as the root cause of health inequities in the United States (Bailey, Feldman, and Bassett 2021), only a modest proportion of the public have so far accepted such an explanation. This finding suggests that public health communicators should not assume broad public understanding of the link between racism and health outcomes and, in fact, that they could expect resistance to such messaging given the lack of public recognition to date, across all political affiliations. At the same time, our findings demonstrate that structural explanations (such as access to health care) for racial disparities are the most popular among those who do perceive the existence of such disparities, even if the general public does not necessarily link such explanations to structural racism. A full understanding of the implications of these data requires considering how these trends came to be as well as the limitations of this brief data snapshot.

The persistent and stark partisan differences across recognition of most of the mortality disparities queried—by race, ethnicity, income, and vaccination status—demonstrate troubling differences in how the general public perceives key pandemic lessons. For public health professionals and social scientists, the fact that the pandemic caused vast mortality inequities and that vaccinated people were far less likely to die are truisms. These survey data suggest that the public does not share the same faith in these facts.

Scholarship on motivated reasoning suggests that partisan differences in understanding of the same sets of information can result when cues by partisan elites lead people to respond to information according to their partisan predispositions (a biased motivation, rather than an accuracy motivation) (Strickland, Taber, and Lodge 2011). Indeed, cues by partisan elites were abundant in 2022, with Republican political candidates frequently communicating—with a negative tone—about racial justice issues, leaving Democrats comparatively silent on these issues (see Fowler et al. in this issue). This can contribute to a negative or aversive response among Republicans (as well as to independents looking to such cues in campaign discourse) toward racial justice issues, which could help to explain lower levels of recognition of both racial disparities and of agreement that systemic racism is a cause thereof.

Furthermore, differences in where partisans get their health information could also explain these partisan gaps in perceptions. Evidence suggests that media sources differed in how they covered health inequities, both with regard to the type of media that featured such stories (i.e., agenda-setting) and how they were framed (Nguyen et al. 2023; Reedy, O'Brien, and Hurst 2023; Xu, Lin, et al. 2022). For instance, one study found that liberal news sources covered health inequities more often than conservative news did (Nguyen et al. 2023). We do have some contemporaneous data to contribute about potential information environment-related correlates with beliefs about COVID-19 disparities. In the same survey, we asked respondents where they sought information from in the past month (recall, this would encompass March 2023, a time when COVID rates were waning although still very much active, and the official public health emergency had not yet ended). From a list of sources, we asked respondents to select which, if any, they used (see responses in table 4).

These data show what political scientists have known for some time (Iyengar and Hahn 2009): Democrats and Republicans rely on different media sources for their information. While the most common source for all groups was local TV news with no differences by partisanship, we see that Democrats report getting health information from national network news much more than Republicans do, while Republicans tend to turn to Fox News. Democrats also attend to their state or local health departments more than do Republicans, while Republicans rely on information from friends or family more than do Democrats. Independents’ health information sources are more variable—sometimes looking more like Democrats and, for other sources, more like Republicans. Given documented differences in how news outlets covered the pandemic (e.g., Sinclair-owned stations covered masking with more controversy; Fox News devoted more attention to misinformation) (Motta, Stecula, and Farhart 2020; Neumann et al. 2023), and other work demonstrating that divergent media exposure predicts public behaviors and beliefs (Borah et al. 2023; Chung and Jones-Jang 2022; Motta, Stecula, and Farhart 2020), it is likely that health inequities were covered differently across the sources selected by partisans as well, contributing to gaps in public awareness and understanding.

Another important implication from these data is the need to better understand the views of independents. Although our sample was quite small, the trends suggested that independents were not moderate with respect to their opinions surrounding health equity and public health issues; they tended not to recognize social inequities or structural racism, and they supported state public health authority at similarly low levels as Republicans. More work is needed to further characterize the attitudes of independents toward public health, given the small sample sizes in this data collection. As others have shown, many in this category do not self-identify as moderates ideologically, and even those who do are not more likely than the rest of the electorate to support moderate policies (Broockman 2016; Klar 2014). These trends suggest that the “movable middle” on health equity issues may in fact be more resistant than advocates might hope, with implications that an electoral strategy centering issues of health equity may not be as successful at shifting the so-called median voter.

When considering the broader implications of these data for advocacy and organizing around health equity, however, it is also important to clarify their limitations. First, these data only concern perceptions of the existence of health disparities in COVID-19 and their causes—not what should be done about them. These data do not tell us anything, for instance, about public support for policies to mitigate health inequity. While social science research has long suggested that people's understanding of the causes of social issues relate to their perceptions of solutions (i.e., people who appreciate the systemic causes of a problem are more likely to support a policy approach to resolve it, versus a more individualized approach) (Iyengar 1991; Weiner 1993), it is not necessarily the case that broader majorities of the public than illuminated here would resist particular solutions to advance health equity by targeting systems. For instance, Medicaid expansion, which remains a popular policy among the public (Grogan and Park 2017), would advance health equity even if not stated explicitly in those terms. Furthermore, other equity-enhancing policies such as expanding the minimum wage and guaranteed sick leave also have majority support, at least in 2020 (Topazian et al. 2022), and young adults across the political spectrum support more policy attention to housing reform (Alberti, Orgera, and Alvarado 2023). Other work suggests that policies to implement vaccines more equitably garner robust public support, especially when the justification for such policies connects them to place-based inequities rather than race-based inequities (Schmidt et al. 2022). These data suggest that programs and policies that would advance health equity may have more support than the current snapshot would suggest.

Second, these data describe a cross-section of the general public: a majority-white national sample. With only 1,002 respondents, our data are limited in the extent to which we can describe the views of subgroups, including those for political independents as noted above, but also for other geographically or racially defined communities. Nationally there does not appear to be a popular or widespread understanding that structural racism is a cause of health inequity. However, political coalitions to advance solutions to health inequities will likely be most effective when oriented around a particular local community; thus, evidence of locally defined perceptions of health equity and of support for policies, and organizing efforts that account for local attitudes, will likely be more helpful in building political demand for health-promoting policies than the national perspective provided here (see, e.g., Iton, Ross, and Tamber 2022; Michener 2023).

Furthermore, these data do not center the views and perspectives of those most affected: the people experiencing disproportionate health and social burdens. Academic research examining public opinion regarding racial justice too often focuses on examining the attitudes and reactions of the presumed or explicitly white public, which is a narrow theory of policy change that views majority white support as critical to political feasibility (Niederdeppe et al. 2023). Understanding the attitudes and political mobilization potential among people of color—and their reactions to explicit identification of systemic racism as a causal attribution—are important directions forward. So too is considering a community-organizing approach to building grassroots power for policy objectives, rather than a traditional political model that hinges on often illusory majority support (Heller et al. 2023; Iton, Ross, and Tamber 2022; Michener 2023). Moreover, efforts to assess public understanding of structural racism are in their relative infancy, methodologically speaking. The construct validity of the RAND measure adapted here has not, to our knowledge, been established, and more research is needed to better diagram how the public conceptualizes and understands structural racism.

In sum, these findings continue to support the need others have stated for more work (including research as well as actual interventions) to “depolarize” public health and to rebuild public trust in science. While public health has always been political, interventions are needed to disrupt the persistent linkage of Democratic political affiliation with support for public health. Partisan cues appear to be “sticky”—that is, they are hard to dislodge once they become attached to an issue (Fowler and Gollust 2015), whether that be the Affordable Care Act or COVID-19. Some evidence-based interventions that are emerging that might be helpful in combating this politicization of public health science could include message-based approaches (i.e., identifying effective communication content) or source-based approaches (i.e., identifying effective messengers of that communication). With regard to messaging, one potentially promising strategy is interventions that “inoculate” audiences through a message warning about strategic politicization, in an effort to build audiences’ resistance to future politicized messaging when it inevitably happens (Fowler et al. 2022). Other possible strategies include communication approaches that encourage open-mindedness (Groenendyk and Krupnikov 2021) or help to educate people about the nature of scientific progress (Nagler et al. 2023). Another approach thought to have potential is self-affirmation, or affirming an individual's value or worth as a way to dislodge a partisan interpretation, but this approach appears to be less effective at reducing partisan defensive processing (Lyons et al. 2022). Identifying the right messengers to communicate about public health and/or health equity is another approach. Copartisan sources can help to establish the credibility of public health in some instances (Sylvester et al. 2023).

Finally, there may be more common ground in public perspectives on public health and health equity than our data suggest, especially when looking at particular subgroups. For instance, a new survey examining the views of people aged 18–24 suggests that health equity is a more consistently popular objective across Democrats and Republicans than it would appear to be when looking across all adults (Alberti, Orgera, and Alvarado 2023): more than 75% of all of these Gen Z respondents agreed that access to health care is a human right. This finding is promising, as it suggests that generational change could shift the public agenda to prioritize justice and equity concepts and policies, and that advocates and policy makers seeking to advance health equity should devote more attention to engaging younger generations. Furthermore, our findings suggest that the most popular explanations for racial differences in COVID-19 outcomes are structural, rather than individualistic, which is promising if it suggests a structural understanding of solutions as well. Despite the limits of cross-sectional surveys, using survey-based knowledge—such as the survey of young adults noted above, or the data presented in this article—offers helpful insights for future investigations of which communication approaches are most effective in engaging groups and advancing public understanding of public health and/or health equity. Research evidence that reveals how various messaging approaches describing the imperative of health equity (albeit possibly using different words or phrases) might resonate with different groups defined by age, partisanship, or within geographically defined communities, as well as strategies that boost overall public support for public health priorities, are important needs for the future.

Acknowledgments

This article is a product of the Collaborative on Media and Messaging for Health and Social Policy (COMM HSP). We would like to acknowledge the contributions of Jeff Niederdeppe, Neil Lewis Jr., and Jamila Michener to the interpretation of the findings along with the full COMM HSP team. This work was funded by the Robert Wood Johnson Foundation (grant #79754). The views expressed here do not necessarily reflect the views of the Robert Wood Johnson Foundation.

Notes

1.

Data are weighted to the US Census Bureau's Current Population Survey benchmarks by gender, age, education, race/ethnicity, and region.

2.

The phrase “complications from COVID-19” was most often used to describe those dying from COVID-19 in 2020. Although the language has shifted since then to the more simple “dying from COVID-19,” we kept the language in the items constant across all four waves.

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This open access article is distributed under the terms of the CC-BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0) and is freely available online at: https://doi.org/10.1215/03616878-11066304

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