Experience of Pandemic Hardship and Attitudes Toward Health Disparities Submission

COVID-19 has had profound consequences for many Americans, but these effects are unevenly distributed. In this paper we ask whether personal experience of COVID-19-related hardships is associated with greater support for policies that aim to mitigate health disparities. We draw on data from the AmeRicans’ Conceptions of Health Equity Study (ARCHES), an interdisciplinary investigation of how Americans form and change their views about who deserves what in the health realm. Phase I, from 2018-2019, included 170 interviews in Greater Cleveland, Ohio. In Phase II, findings from these interviews were tested in a nationally representative survey. Phase I suggested that personal experience of hardship promotes receptivity to structural explanations for health disparities and a sense of solidarity with those who experience similar circumstances, resulting in greater support for policies that advance health equity. This paper tests these findings by examining how COVID-19-related hardships affect understandings of health disparities and related policy preferences. Drawing on a national survey of 3,300 Americans fielded in October 2020, it examines whether household exposure to COVID-19 hardships (defined through (1) a 9-item pandemic impacts inventory and (2) county-level exposure to cases and deaths) is tied to greater recognition of the social determinants of health, a stronger sense of health solidarity, and more support for policies that mitigate health disparities. We find that self-reported pandemic hardships are strongly and consistently associated with all of these outcomes, even when controlling for demographic and ideological characteristics. Geographic exposure to COVID is not associated with these outcomes. Previous studies examining how COVID experiences affect pandemic-related policy views have found limited effects because partisanship dominates views on the pandemic. Our findings suggest that even when holding constant party and ideology, personal experience of COVID-related hardship is shaping broader health policy attitudes in ways that warrant attention in advocacy and messaging.