Ann Arbor, MI, USA. Democrats and Republicans disagree on the recognition and management of medical conditions, with each group placing a different emphasis on the existence and/or importance of physical causes and the influence of societal factors. But what is the irreducible basis for agreement and what factors set them apart?

Increasing the public's awareness of social factors that impact health may not uniformly increase public support for action because some groups simply do not believe the types of information given are credible, according to the authors of a new study.

The results show that when given information on the genetic factors that cause a health condition (e.g., diabetes), both parties equally supported public health policies designed for prevention. But Republicans were less supportive of such policies after reading news reports that people with diabetes got their illness because of social or economic factors in which they live, such as lack of neighborhood grocery stores or safe places to exercise. It was different for Democrats: knowledge of the social factors actually increased their support.

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"When people are given the same information they can come away with very different opinions," says Sarah E. Gollust, Ph.D., a Robert Wood Johnson Foundation Health and Society Scholar at the University of Pennsylvania who worked on the study during her doctoral work at U-M School of Public Health.

Framing health problems in terms of the social determinants of health shifts policy attention to nonmedical strategies, opening the door to arguments about values that may have little to do with the scientific and medical basis for the health claims.

"Policymakers and journalists should be aware that social values influence people's opinions about health policy, and certain messages in the media might trigger these values," says Gollust.

Gollust designed the study with Paula Lantz, Ph.D., a social epidemiologist and chair of the Department of Health Management and Policy at the U-M School of Public Health and Peter A. Ubel, M.D., professor of internal medicine at the University of Michigan and director of the U-M Center for Behavioral and Decision Sciences in Medicine.

Study participants viewed news articles about type 2 diabetes on the Internet and then answered questions about their opinions on health policy and their attitudes about people with diabetes.

When each viewed an article on the links between social and neighborhood factors and diabetes, 32 percent of Democrats agreed with the impact of social factors on health, as compared to 16 percent of Republicans.

"If you are more liberally minded, the neighborhood explanation can be motivating, but for people who are more conservative politically, that message can backfire and make them even less interested," says Ubel. "The same information can polarize people."

Diabetes was merely used as an example of a common health issue.

Scientists have identified genetic variants that increase susceptibility to type 2 diabetes. However, type 2 also is associated with health behaviors (e.g., poor diet, physical inactivity and obesity), which can be influenced by social and economic factors (such as living in an unhealthy neighborhood).

So why focus on social factors?

The goal of framing health matters according to social factors is increasingly used to shift attention to non-medical strategies to improve health. "The problem is these messages aren't going to have the same effect on all people," Ubel says. Groups can place their emphasis on social factors to avoid discussion of medical science where they may be less secure in their positions; likewise, avoiding discussion of social factors tends to minimize the importance of science and medicine.

The media also commonly discuss the prevalence of social factors when describing health issues, but few studies have been devoted to whether it shifts public opinion. The authors do not suggest that news media avoid reporting on social factors. Rather, advocates who want to mobilize the public to support public health policies might consider disseminating information to the media about both social factors and individual behavioral causes to avoid triggering resistance.

"Advocacy groups need to be very careful in thinking about who their audience is and what framing will work best for that audience," Ubel says. "Media should do a richer job of helping people understand each of these different causes."

The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. Sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates. We welcome your comments. Use the form below to leave a public comment or send private correspondence via the TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.


TS-Si is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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