Have perceptions of health changed post-pandemic?

“This must be having some effect on how people think about health, right?”

It was spring of 2020, and the “this” in question was a rampant pandemic, lockdowns, and more intensive public health interventions and messaging than many of us had ever lived through. FrameWorks had transitioned to a virtual workplace, and I vividly remember sitting in my makeshift home office and discussing this question again and again with my colleagues and our partners. Cultural mindsets run deep and are hard to change, but surely this was a moment when they might be more flexible. Could we be at a turning point? Could the scale of the pandemic and the government’s response shift how we as a culture think about health? Might people start seeing how systems affect our health, and not just how our own choices do?

It was questions like this that led us to launch the Culture Change Project a few months later. We were keenly interested in following how mindsets might change in response to the massive upheaval we were all experiencing—and I thought changes in thinking about health might be the first and most obvious ones we saw.

In a large, nationally-representative tracking survey we began asking participants whether they believed health was determined by diet and exercise (a health individualism mindset) or whether it was determined by context and environment (a systemic understanding of health mindset). We asked this as an either/or question, understanding that most people were likely to hold both mindsets but that one would be more immediately salient in their minds. From the beginning of our research in 2020, health individualism was overwhelmingly dominant, with around 80% of participants endorsing it compared to 20% of participants who endorsed the more systemic view.. There was a small increase in systemic thinking that peaked in the winter of 2021-2022 (and even then, the vast majority of people chose the individualistic view of health over the more systemic one). Since then, systemic thinking has only continued to weaken.

Individualistic understandings of health are now more dominant than they have been in the history of the Culture Change Project. We don’t have an easy answer for why this is the case, but we have a few theories. One is that our response to and discourse around the pandemic centered individual behaviors—like mask-wearing and vaccination. While there were some discussions of “protecting those around us” and “herd immunity,” much of the focus was on what individuals could do to protect themselves and others. Meanwhile, the backlash against those measures was similarly framed in individualistic terms as being about personal choice. Ultimately, the public conversation around COVID was largely around what actions individuals should take or be asked to take, which reinforced the idea that it’s our personal choices that matter.

We might have hoped that our experiences of the COVID-19 pandemic would have helped us see the extent to which context affects our health, but that doesn’t seem to have been the case. Instead, we must work harder than ever to combat the idea that our health is simply a product of personal choices and behaviors. There are other mindsets available to us to think about health—we just need to actively cue those mindsets, consistently, through our framing choices.

Our research on framing health over the past 20+ years has shown how critical it is for communicators to push back on health individualism by showing that health is a collective issue that requires a collective response. To see what that can look like in practice, check out Explain the Frame: Widening the Lens on Health. In this video, my colleague Dr. Julie Sweetland walks through how to cultivate systemic thinking about health and build support for the programs and policies we need for health equity:

For more resources on how to frame health as a systemic issue, check out:

• Reframing Health Disparities in Rural America: A Communications Toolkit
• Explain the Frame: Expand on health
• Explaining the Social Determinants of Health
• Changing the Narrative Together: Three Effective Strategies for Talking about Youth Mental Health
• Excessive Alcohol Use and Health Equity
• Framing the Foundation of Community Health