“If you tangle with culture, culture will always win.”
When it comes to COVID-19, global health leader Bill Foege’s words have never been more apt.
Culture is critical to understanding Americans’ divided response to COVID-19, but no one is talking about it.
Culture—a population’s distinct set of values, beliefs, customs, and norms—frames our way of living, thinking, and interacting. It’s also the single most important factor influencing health behaviors.
Yet the US medical and public health communities are focused more on the virus than on the culture that’s allowing it to thrive.
There’s one essential truth about US culture: It’s very individualistic, valuing individual interests over group interests, no matter the broader consequences. Collectivist cultures, in contrast, place group interests first.
Individualism, like all cultural characteristics, is not an inherently bad cultural trait. The protection of personal liberties is a uniquely defining American characteristic. However, confronting a common enemy like COVID-19 requires collective action.
Acting collectively is not entirely foreign to America. Throughout world wars, the Great Depression, and 9/11, Americans banded together with great success. There was nothing political about wanting to keep our citizens safe from senseless acts of terrorism after 9/11. Similarly, there is nothing political about wanting to keep our citizens safe from COVID.
So why have Americans remained divided in responding to COVID?
Collectivism is easy to encourage when the enemy is the visible “other”—a person or group of people perceived as not belonging. It is not uncommon for people to rally around each other to protect against a common, visible outsider. When the enemy is an invisible “insider,” such as a virus, acting collectively becomes more difficult.
It might be tempting to blame politics and partisanship for the public’s lack of compliance with public health measures—and to be fair, they do play a role. But they don’t tell the whole story. Culturally, Americans tend to mistrust the government; in fact, trust in the government is at an all-time low. There is also growing skepticism of experts; this was evident as many Americans grew weary of the changing messaging surrounding masks. As recently as 2019, a Pew Research Center survey showed that 35% of Americans believed that the scientific method can be used to produce “any result that the researcher wants.”
Given these American cultural traits, the difficulty in persuading people to comply with public health measures shouldn’t be surprising. But experts assumed people would listen to public health guidance, government leaders thought people would voluntarily comply, and public health professionals focused messages on conveying scientific information. None of these efforts took American culture into consideration. Had culture been considered, the response and messaging could have been more effective.
It’s why, for example, many states have resorted to mask mandates though many Americans see masks as an intrusion on their personal liberties. So, forced, rather than voluntary, compliance is necessary.
And trying to convince those who do not believe in science by sharing more science is futile at best. It is also shortsighted to cast blame and write people off as ignorant, as I have seen some public health and scientific professionals do. We wouldn’t hand out written pamphlets to a population that is largely illiterate. In the same way, we shouldn’t deliver blanket public health messages that strictly convey science in a country marked by growing skepticism of science and expert advice. And just as we wouldn’t blame a largely illiterate population in a low-income country for illiteracy, recognizing that there are many nuances that impact this outcome—a broken educational system, poverty, economic realities that force work over schooling, lack of infrastructure, etc.— multiple, synergistic realities shape peoples’ views, knowledge, and outlooks in the US as well.
Instead of perpetuating these failed approaches, the US public health community needs to adopt an inclusive and targeted messaging strategy that frames public health measures in ways that speak to US culture. For example, rather than continuing to use messaging that assumes science and expertise will invoke compliance, we need to insist, as the Surgeon General has, that wearing masks will help us regain our freedoms—to socialize, travel, send our children to school, and move about without restrictions.
One of the best ways that we engage communities globally is by using faith leaders as conduits for messaging. Knowing that more than 70% of Americans identify with a religion, we should work with our faith community leaders to persuade people to follow public health directives.
Similarly, we need to engage all local community leaders—beyond government—who have won the people’s trust.
Finally, the US is, culturally, a “melting pot”—sticking to uniform messaging will not ensure progress. Messages need to be tailored to the multiple US sub-cultures and avoid just translating one message into different languages. There is no “one size fits all” solution—we have to be creative in finding other ways to appeal to cultural traits.
As daily COVID cases rise to unfathomable levels, we simply cannot afford to ignore culture. It’s time to tailor our approach and encourage the collectivism needed to meet the pandemic’s challenge.
Failure to do so will almost surely result in our continued defeat against COVID-19.
Sarah McCool, PhD, MPH, is a clinical associate professor in Health Policy & Behavioral Sciences at the Georgia State University School of Public Health in Atlanta, Georgia. Follow her on Twitter or Instagram: @DrSarahMcCool
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