Health Hardship, COVID, and Attitudes toward Health Equity

Does experience of health hardship shape understandings of health equity and related policy preferences? Research has produced conflicting findings. Some scholars find that the experience of health hardship increases support for policies that promote health equity, while others argue that health hardship prompts an individualized focus that reduces support for these policies. Still others find that amid intense political polarization, partisan identity drives attitudes, drowning out any effect of health hardship. To examine this question, we draw on 170 interviews and two national surveys conducted in 2020 and 2024 through the AmeRicans’ Conceptions of Health Equity Study (ARCHES), an interdisciplinary investigation of how Americans form and change their views about whose health deserves investment. Interviews conducted in 2018-2019 in Greater Cleveland, Ohio suggest that personal experience of health hardship promotes awareness of structural explanations for health disparities, empathy for those who experience similar circumstances, and, in turn, greater support for policies that aim to mitigate health disparities. Similarly, findings from a preregistered October 2020 national probability survey of 3,320 Americans found that both generalized health hardship and COVID-19 hardship are associated with greater recognition of social determinants of health, broader assessments of who deserves assistance with healthcare costs, and more support for policies that aim to mitigate health disparities. Indeed, holding constant partisanship and ideology, those who experienced generalized or COVID hardship were more likely to express willingness to sign a petition to the next president advocating closing the health-wealth gap. In October 2024, we replicated this survey including a survey experiment that prompted some respondents to reflect on experience of health hardship in general or during the COVID-19 pandemic. This paper will evaluate whether the association between health hardship and support for policies that promote health equity – identified in pre-pandemic interviews and tested at the height of the COVID pandemic – extends to the present. In addition, analysis of the survey experiment will assess whether cuing respondents to reflect on health hardship shapes subsequent responses. If experience of health hardship prompts shared understandings and views, these findings suggests new avenues for coalition-building and messaging in support of policies that promote health equity.