When I visited a rural dog park in Washington State recently, I was surprised to find my neighbors—who span the political spectrum from progressive to libertarian to MAGA Republican—joking about Tylenol. Typically, a neighborly peace at the park is sustained by avoiding politics altogether, or breaking into smaller, like-minded groups to talk furtively about current events. But on this morning, as our dogs tussled at our feet, we laughed in common at the absurdity of President Trump’s suggestion that acetaminophen causes autism. While sometimes crass or awkward, the jokes were made funnier by our collective surprise: were we actually agreeing about something political?
It's too early to say whether and to what extent Americans will follow Trump’s latest harmful health advice. Nor can we say what might motivate people to do so – whether it be political allegiance, falling prey to misinformation, or actual changes in health beliefs. What is clear, however, is that an increasing number of otherwise mundane domains of public health expertise are rapidly being polarized in the US. Health behaviors, beliefs, and rhetoric now feel as politically divisive as issues like taxation, immigration, and education.
The Trump administration has taken on the dismantling of core public health as a central pillar of its work, and what it hopes will be a mobilizing issue for its base. From COVID and vaccines to fluoride, Ivermectin, and even milk, public health is under constant assault in the US, with new fissures of polarization appearing all the time. Media and information environments further fuel this polarization, and powerful commercial actors profit from it.
Health polarization is not new, but the situation in the US poses urgent questions about how public health can approach and address such division: What drives people apart on health issues, and alternately, what brings them together? Why do certain health topics become highly polarized when others do not? And what can be done to build social support for core public health interventions once polarization has taken root? As an Andrew Carnegie Fellow over the next two years, my research will try to answer these questions in depth. In the meantime, however, I believe my neighbors’ conversation points to several important insights about polarization and health that can be mobilized now to limit harms and build solidarity around health, even when political polarization is at all-time highs.
Health polarization: perception vs. reality
With constant news cycles highlighting divisiveness around public health, it’s no wonder that polarization around health topics feels like it’s getting more acute and dangerous all the time. Events like the shooting at CDC headquarters indicate, as well, that polarized rhetoric around issues such as vaccines is capable of fueling politically-motivated violence. Nor is this an isolated incident – assaults on health workers account for 73% of all non-fatal injuries from violence in the US.
Researchers who study polarization, however, often find that what we feel about polarization is not always reflective of reality. As Rachel Kleinfeld notes for the Carnegie Endowment, “American voters are less ideologically polarized than they think they are, and that misperception is greatest for the most politically engaged people.” This perception gap often leads to what researchers call affective polarization, in which people on opposite sides tend to express greater dislike, disdain, and animosity for each other.
These insights are particularly important for understanding health polarization in the US. While issues such as vaccine mandates are seen as highly polarized, separate polls by both the de Beaumont Foundation and the Kaiser Family Foundation have shown that about 80% of Americans support childhood vaccine requirements. This includes three-quarters of Republican parents and even 73% of MAGA Republicans. Similarly, in recently highly polarized debates over Medicaid and Medicare coverage, Data for Progress found that only 8% of voters nationwide wanted to cut Medicaid funding. More strikingly given the US’ geopolitical polarization, no more than 15% of voters in any congressional district supported Medicaid cuts.
These polls show that the perception gap in polarization on health issues can be far wider than reality. There are a number of complex factors driving this effect, but it’s clear that public health has broad and strong support for even its most politicized areas of intervention, despite shockingly dangerous rhetoric at the national level.
What gets polarized?
Another under-recognized reality is that not all health issues are polarized at all times. In fact, most activities of public health – from cancer screenings to food safety measures – are not only largely unpoliticized, but go unnoticed by most citizens. And even as the Trump administration has assaulted public health science on many fronts, HHS administrators and congressional legislators have moved aggressively to address issues with fairness and safety in US organ donation and procurement, with an explicit goal of restoring trust in the system. Nor do Democrats have an unvarnished record of protecting public health: for example, President Biden flouted and undermined public health safety measures for COVID.
What becomes polarized in health often changes over time, between contexts, and across geopolitical environments. In highly polarized South Korea, for example, aggressive COVID mitigation strategies had broad public support, but efforts to increase the physician workforce have been highly politicized, even resulting in political and legal prosecution of physicians. Nor is anti-public health polarization necessarily permanent: I recall working in South Africa in the 2000s when AIDS denialism was rampant and deeply politically entrenched. Few would have predicted that within several short years the country would have embraced HIV treatment, and sustained its commitment to this crucial public health intervention even as political polarization has steadily worsened. While health polarization in the US seems extreme at the moment, other countries are not immune – and we need to learn from each other about both how to prevent such polarization and how to ameliorate it.
Reclaiming health solidarity
At its heart, effective public health policy often depends on mobilizing citizens to act in solidarity and shared community with others, including those across groups or political lines. Research shows that reminding citizens of their shared values and collective goals can help reduce affective polarization. As we know from the work of groups like Treatment Action Campaign in South Africa, broad citizen coalitions, deep organizing, and bringing science to the people can be highly effective in building solidarity around core public health initiatives. Yet we need more research about how to foster, build, and preserve such solidarity when it comes to health in highly polarized contexts.
This work matters not only for health policymakers, but for all of us. Research shows that as perceived and real polarization increases, support for public health does deteriorate. And health indicators are worse for those in more polarized societies and those who are at political extremes within their polities. This is, in part, why the work of groups like The Collective is so important.
Though public health may feel particularly attacked in the US right now, this story is far from over, and I see space to help solidarities grow and thrive. In pursuing work on this topic over the coming years, I hope to give people like my neighbors more opportunities to realize our shared beliefs and to care about each others’ health.
About the author
Nora Kenworthy is a writer, professor, and public health expert whose work examines how politics, technology, and inequality affect health. She is the author of Crowded Out: The True Costs of Crowdfunding Healthcare (MIT Press, 2024), and of the award-winning ethnography, Mistreated: The Political Consequences of the Fight Against AIDS in Lesotho (Vanderbilt University Press, 2017). She is the co-editor of two additional books, Case Studies on Corporations and Global Health Governance: Impacts, Influence and Accountability (Rowman & Littlefield, 2016), and HIV Scale-up and the Politics of Global Health (Routledge, 2015). Kenworthy's work has appeared in scholarly journals such as the American Journal of Public Health, Social Science and Medicine, PLOS One, and Medical Anthropology Quarterly as well as media outlets such as The Washington Post, Scientific American, and The Los Angeles Times. Currently, Kenworthy is a Professor of Health Studies at the University of Washington (UW) Bothell, and she also holds adjunct appointments in the Departments of Anthropology and Global Health at UW Seattle. She received a PhD and MA from Columbia University and a BA from Williams College.
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