Polarization is bad for our health. Could RFK help?

Americans have never been more polarized, and we dislike each other on partisan grounds now more than ever. Perhaps that’s not shocking, but what may come as a surprise is the way it’s hurting our health.

“Political polarization is harming our health in just about every way,” says Matthew Motta, a political scientist and health law scholar who studies anti-science attitudes at Boston University — and “pretty much all aspects of health have become politicized.” That leads elected officials and other authority figures to make bad health policy decisions and communicate with the public in ways that link health behavior with partisan ideology. A public that sees everything through a red-or-blue lens is more likely to distrust experts, dislike policies with clear health benefits, embrace policies with clear health risks, and make self-destructive choices.

These dynamics aren’t exclusive to a single party, says Jay Van Bavel, a psychologist at New York University who studies social identity and morality: Nobody is immune from the tricks polarization plays on the brain.

That makes this a particularly interesting time to be thinking about how polarization affects the decisions we make about our health. Robert F. Kennedy Jr., President-elect Donald Trump’s pick to lead the Department of Health and Human Services (HHS) — one of the US’s most influential leadership roles in health — isn’t just an anti-vaccine advocate with a shaky grasp on science. He’s also a partisan shapeshifter: A scion of one of America’s most consequential Democratic dynasties, he ran for president as a Democrat, only to endorse Trump as the Republican candidate later in the campaign.

Furthermore, his distrust of institutions is something Americans across the political spectrum share, and his concern about chronic diseases and the deleterious influences of the agriculture and pharmaceutical industries on health is something many health authorities agree with.

Experts say elevating Kennedy’s platform lifts up his worst ideas, and that may prove to be true. But given polarization’s threats, it’s worth considering whether his nomination could also depolarize public health — for good and for ill.

Jonathan Oberlander, a political scientist and health policy scholar at the University of North Carolina, recently published an essay explaining how political polarization degrades people’s health through its effects on both individuals and elected officials.

Political polarization shapes how people interpret risk and who they trust and listen to, which shapes what health services they access and what behaviors they partake in or don’t. This dynamic was a big reason Covid death rates so dramatically diverged between Republicans and Democrats: Party affiliation determined people’s willingness to get vaccinated, wear masks, social distance, and take other preventive measures, says Oberlander. Republicans were less likely to take these measures, and more likely to die of Covid as a consequence.

Highly polarized individuals are more likely to make self-sabotaging health choices just because “their guy” tells them to. This was true when right-leaning Americans embraced taking the antiparasite drugs ivermectin and hydrochloroquine for Covid (despite their adverse effects and cost) and refused Covid vaccines (despite evidence they were safe and saved lives), and when left-of-center Americans leaned into social distancing (despite concerns it was harmful to mental health).

Polarized people are also more likely to reject policies that they feel might help people on the opposing side. The rise in what Motta calls “partisan schadenfreude” means that people are increasingly taking pleasure in the suffering of people in other parties. During Covid, he explains, “Republicans took joy in Democrats losing their jobs as a result of stay-at-home orders, whereas Democrats take joy in Republicans getting sick as a result of being infected.”

Although left-wing Americans were more likely to take Covid’s risks seriously, Van Bavel notes Republicans outpaced Democrats on Ebola fears throughout the 2014 outbreak, during Barack Obama’s presidency. “It’s not that Democrats in America have a unique capacity to be attuned to the science and the risks of epidemics and pandemics,” he says; it’s that polarized people on the left and the right distrust the other party’s ability to handle any health threat.

Polarization is also creeping into our relationships with health care providers. A recent survey by communications firm Edelman found people feared the politicization of medical science as much as they feared the cost of medical care; 41 percent of respondents aged 18 to 34 said they wouldn’t trust medical advice from a provider who had a different political persuasion than they did, or would stop seeing them entirely.

Health care workers — nurses in particular, as well as dentists, doctors, and pharmacists — have historically been among the most trusted sources of health information for Americans. What happens when politics disrupts that bond, especially when health care workers are in short supply?

On the most essential level, polarization just makes people feel sick. Whether people are conservative or liberal, the mere perception of being politically distant from the average voter in their state raises their risk of developing depression and anxiety disorders, sleep problems, and poor physical health.

We’re trapped in a perilous feedback loop with our elected officials that only amplifies our polarization. When politicians espouse views on the extreme ends of their party’s platforms, it helps the public figure out their own stances on the issues, Motta says, “because they know which party they like, they know which candidates they like, and they take up their positions on the issues.” If a politician you like favors an extreme approach to policing, to firearms regulation, to health insurance, you might too without even knowing why.

Our tendency to take up the most radical opinions of popular elected officials has an enhancing effect. “Very perniciously and kind of paradoxically, once the public starts to polarize, that then creates an incentive for elites to polarize even further,” Motta says. That’s how we get into the kind of runaway polarization cycle we’re in right now.

One of the most powerful ways elected officials could reduce polarization is to publicly change their minds on high-profile health issues, Motta says. “If you can get partisan elites who normally hold positions at odds with the science to admit they’re wrong, to change their minds,” he says, people depolarize, “but it’s so hard to do because our elected officials never want to admit that they’re wrong.”

People often can’t agree on which messengers they trust to communicate that it’s possible to change your mind, but that’s a barrier that can be overcome with some creativity. In a 2022 working paper published by the National Bureau of Economic Research, political scientists attempting to convince right-leaning Americans to take Covid vaccines compiled a 27-second video of Trump’s positive comments about the vaccine and circulated it as a YouTube ad in low-vaccination counties. Vaccination in those counties increased.

The example shows “there’s no one-size-fits-all” when it comes to public health messaging, says Tim Callaghan, a political scientist who studies health policy at Boston University with a focus on overcoming vaccine hesitancy. Public health authorities need to use different health communications — and different trusted messengers — to target Democrats and Republicans.

And then there’s Robert F. Kennedy Jr.

Yes, he has leaned heavily into deeply unscientific takes on vaccines, fluoride, and the causes of gender dysphoria, mass shootings, and AIDS. However, his Make America Healthy Again (MAHA) platform also correctly calls out the US’s terrible record on preventing diabetes, heart disease, and unhealthy weight.

Much as nutritional experts do, he blames these problems on too-cozy relationships between the agriculture sector and the federal government, resulting in permissive policies and dietary guidelines that promote easy access to lots of ultra-processed foods.

A recovering addict himself — Kennedy used heroin for 14 years and says he attends a 12-step meeting daily — he also speaks credibly about the challenges of substance use disorders and has advocated for increasing Medicaid funding for rehabilitation programs, much as the Biden-Harris administration did. He is also in favor of abortion rights.

Although people who work in public health might see their goals as nonpartisan, the general public correctly perceives public health as an exercise in progressive politics. Since rolling out his MAHA platform in September, Kennedy has been trying to position himself as a true independent: An early graphic on his now-revamped website read, “Left isn’t better. Right isn’t better. Better is better.” Now that Trump has anointed him, Kennedy’s nomination could present an opportunity to de-link public health from any one political party’s identity.

That could be a good thing if he advocates for changes that benefit the public’s health but that have historically had more support from the mainstream left than the right, like increasing access to health care and decreasing environmental contamination. However, it could be a bad thing if his support for anti-vaccination and anti-fluoridation, associated with both far-right and far-left ideology, legitimizes those causes in the eyes of more moderate members of the public.

Health communicators have a role to play in that, whatever their politics, says Heather Lanthorn of the Council for Quality Health Communications, a nonprofit advocacy group. “On the numerous points where we disagree with MAHA, we need to do a better job of leveraging scientific evidence and addressing their specific concerns honestly, openly, and head-on,” she wrote in an email to Vox.

Jared Polis, the Democratic governor of Colorado, may have had bridge-building in mind when he praised Trump’s choice of Kennedy last week, applauding Kennedy’s activism against vaccine mandates and, in particular, his willingness to take on the pharmaceutical and agricultural industries.

Not everyone is as optimistic. Seeing Kennedy’s selection as an “olive branch” suggests a complete misunderstanding of his value to Trump, says Motta.

“Kennedy is in Trump’s orbit,” he says, “because they speak the same anti-intellectual language.” Some Democrats may fantasize that Kennedy’s presence at HHS would raise trust in science and government among Republicans.

However, there’s at least as big a risk his leadership would instead affirm conservatives’ misgivings while also seeding new distrust among Democrats and centrists who typically have higher levels of confidence in these institutions — just furthering the polarization health doom loop.