Has COVID-19 changed how people think about the drivers of health? If so, does it matter?

Abstract

BackgroundCould the COVID-19 pandemic prompt shifts in Americans' basic views on health mindset and policy solutions to health crises?MethodsA sample of 1,637 individuals rated the extent to which items (e.g., the role of environmental vs. individual factors) “may affect people's health and wellbeing,” both before (2018) and during the pandemic. In summer 2020 and fall 2021 they responded to questions about vaccination status and perceptions of COVID-19 related policies. We assessed changes in health mindset using repeated measures logistic regression, and used cross-sectional logistic regressions to assess whether variations in mindset explain COVID-19 related attitudes and behavior.ResultsBetween 2018 and 2021 respondents gave increasing weight to where people live and genetic factors and less weight to the role of individual health choices. Views on the importance of access to healthcare did not change appreciably. Those who reported that health care and place have a strong effect on health and wellbeing were significantly more likely to get vaccinated. Moreover, those who strongly believed that place is important were significantly less likely to agree that their local government went too far in restricting their freedom and that the local economy should have been left alone.ConclusionRespondents were more likely in 2021 than in 2018 to recognize social determinants of health, and this is associated with a greater openness to pandemic-control measures. It remains to be seen, however, whether the changes in health mindset will persist over time and contribute to changes in policy and practice.

2023 National Survey of Health Attitudes: Description and Top-Line Summary Data

“…The 2023 survey included many of the same domains but had a stronger focus on health equity perspectives including views on race, structural racism, and health equity; and perspectives and experiences of community wellbeing. These were included for three reasons: 1) a stronger focus on these topics for RWJF (Besser, 2024); 2) insights gained from the 2018 NSHA (Towe et al, 2018) and the aforementioned COVID-19 surveys (Carman et al, 2020(Carman et al, -2021 on American views on structural racism and health (Nelson et al, 2022;Carman et al, 2021), which highlighted the challenges of Americans recognizing the impact of racism on health; and 3) themes that have emerged from the RWJF-RAND Sentinel Communities Project (Warren May et al, 2021;, which showcased how an orientation towards health and wellbeing can be advanced or impeded by community choices and public sentiment.…”