New figures on Polarized U.S. Public Opinion About Public Health During the COVID-19 Pandemic

Public Opinion on Public Health During the Pandemic This Viewpoint examines the stark differences in how Democrats and Republicans viewed the role of public health during the COVID-19 pandemic to understand the implications for the future of public health. JAMAHealthForum

In recent years, political polarization in the US has grown, and this polarization is being reflected in the public’s attitudes toward the field of public health, which was traditionally considered to be science-based and nonpartisan. Understanding the extent of polarization in public opinion is crucial to guide public health and policy leaders. We reviewed the results of 6 nationally representative polls of US adults (≥18 years old) conducted during the COVID-19 pandemic (2020 and 2021) on the US public health system^1-6 as well as a comparable poll conducted in 2009.⁷ We examined the gaps between Democrats’ and Republicans’ views and found stark differences in several areas with major implications for the future of public health.

In the midst of the COVID-19 pandemic, Democrats were generally trusting of recommendations made by key public health institutions, whereas Republicans generally were not. Polling in 2021 found large gaps (>20 percentage points) between Democrats and Republicans for their degree of trust in the Centers for Disease Control and Prevention (CDC; 76% vs 27%), the National Institutes of Health (NIH; 61% vs 21%), Food and Drug Administration (FDA; 47% vs 26%), and state health departments (59% vs 22%),¹ indicating that the public health establishment is not a well-trusted source of information for substantial majority of Republicans. This finding reflects broader trends of growing political divides over public trust in science and differences in public opinion regarding the role of scientific experts in making policy decisions.

When rating the performance of public health departments and agencies in 2021 during the COVID-19 pandemic, Democrats gave much higher ratings than Republicans across the board, with remarkably wide differences in positive ratings of the CDC (74% vs 32%), NIH (66% vs 28%), the FDA (58% vs 34%), and local (64% vs 40%) and state (56% vs 39%) health departments.¹ These findings were a marked change from 2009 when Democrats and Republicans gave generally similar ratings of the CDC, the NIH, the FDA, and state health departments⁷; and more than half of Republicans (56%) gave positive ratings to the nation’s public health system, compared with only 39% of Democrats. While Democrats’ views on the nation’s public health system have remained roughly stable (40% positive ratings in 2021), only 30% of Republicans gave positive ratings to the nation’s public health system in 2021, a 26 percentage-point decline from 2009.^1,7

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Political polarization is generally a reflection of differences in core values held by partisans, more so than disagreements over facts. Thus, educating partisans about evidence on public health issues is unlikely to change the current divisions.

Barring substantial shifts in the values held by the public, public health and policy leaders must either communicate public health issues in ways that reflect the differences in these underlying belief systems or work to bridge the public’s core principles and values. A hopeful possibility exists with both Democrats and Republicans largely trusting their own physicians and nurses for health guidance and recommendations. In the future, these health care professionals could play a broader and more sustained role in discussing public health issues with patients.