Public Health in the Mind: The Psychology Behind Health Behaviors and Denial
PsyberSpace Podcast Episode Script: "Public Health in the Mind: The Psychology Behind Health Behaviors and Denial"
Introduction
Welcome back to PsyberSpace, the podcast where we dive deep into psychology, culture, media, and technology. I'm your host, Leslie Poston, a strategy consultant and research psychologist. My research touches on issues of power dynamics, resistance, adaptation, identity, and the evolution of communication in the digital age.
Today, we're exploring a topic that sits at the intersection of psychology and public health: the complex interplay between personal health choices and societal well-being. As we navigate the aftermath of the COVID-19 pandemic and face new health challenges in 2024, understanding the psychology behind our health behaviors has never been more essential.
We'll be asking some thought-provoking questions: Why do some people choose to work or socialize while sick? What drives the persistent denial about ongoing health issues? And how can we use psychological insights to promote better public health outcomes?
So, fasten your seatbelts, listeners. We're about to go through the human mind and its impact on public health.
Segment 1: The Psychology of Presenteeism
Let's kick things off by exploring a phenomenon that many of us have experienced or witnessed: presenteeism. That's the act of showing up to work while sick. Now, you might think, "Isn't it obvious that staying home when you're ill is the right thing to do?" Well, the psychology behind this behavior is more complex than you might imagine.
Dr. Gary Johns has done extensive research on presenteeism. In one study Johns found that presenteeism isn't just about being a workaholic or trying to impress the boss. Often, it's driven by a concept called loss aversion.
Loss aversion is a psychological principle first described by Nobel laureate Daniel Kahneman and his colleague Amos Tversky. It suggests that we feel the pain of losing something more intensely than the pleasure of gaining something of equal value. In the context of work, this means the fear of losing out on pay, missing important meetings, or potentially jeopardizing job security, or losing our perceived place in the organizational pecking order often outweighs health concerns.
But it's not just about individual psychology. Workplace culture plays a huge role too. A 2015 study by Dr. Mariella Miraglia and Dr. Gary Johns found that high job demands, job insecurity, and lack of backup options all contribute to higher rates of presenteeism.
Dr. Miraglia's research, which analyzed 61 previous studies involving more than 175,000 participants, revealed some intriguing insights. She found that presenteeism was more likely in organizations with a culture of long working hours. Employees who felt a strong connection to their job or a sense of job satisfaction were also more likely to work while sick, possibly due to a misplaced sense of loyalty or dedication.
And let's not forget the economic pressures. In countries without guaranteed sick leave, many workers simply can't afford to take time off. A 2020 study by Dr. LeaAnne DeRigne and colleagues found that workers without paid sick leave were 1.5 times more likely to go to work with a contagious illness.
This creates a perfect storm where individual fears, workplace expectations, and economic realities all push people to work while sick, potentially spreading illnesses to colleagues and customers.
But the impacts of presenteeism go beyond just the spread of illness. One 2018 study estimated that presenteeism costs the U.S. economy over $150 billion annually in lost productivity. Ironically, by trying to avoid short-term productivity losses, both individuals and organizations often end up with larger, long-term losses.
So, what can be done about presenteeism? Dr. Johns suggests that organizations need to create cultures that genuinely support employee health. This might involve providing adequate sick leave, ensuring staffing levels that allow for absences, encouraging remote work, and training managers to recognize and address presenteeism.
On an individual level, understanding the psychology behind presenteeism can help us make better decisions. By recognizing our tendency towards loss aversion, we can consciously weigh the short-term "gains" of going to work sick against the potential long-term costs to our health and the health of others.
Segment 2: Social Norms and Health Decisions
Now, let's zoom out a bit and look at how social norms shape our health behaviors, particularly when it comes to things like wearing masks or following health advisories.
We humans are inherently social creatures, and we're constantly looking to others for cues on how to behave. This phenomenon, known as social proof, can have a powerful impact on our health decisions.
Dr. Robert Cialdini, a renowned psychologist and author of "Influence: The Psychology of Persuasion," has shown how social proof can lead people to conform to the behaviors they see around them, sometimes even at the cost of their own health.
In a classic study from 1968, Dr. Stanley Milgram and colleagues demonstrated the power of social proof in a simple but revealing experiment. They had a confederate stand on a busy New York City street and look up at the sky. When it was just one person looking up, only a small percentage of passersby stopped to look up as well. But when the researchers increased the number of confederates to five, the number of people who stopped to look up more than quadrupled.
While this experiment might seem far removed from public health behaviors, the principle it demonstrates is directly applicable. During the COVID-19 pandemic, researchers observed similar effects with mask-wearing rates in communities.
A 2023 study by Dr. Marzieh Korzebor and Dr. Nahavandi found that perceived local norms significantly influenced COVID-19 prevention behaviors, including mask-wearing. If people believed others in their area were following preventive measures, they were more likely to do so themselves.
But here's where it gets tricky: our perception of these norms isn't always accurate. We might overestimate how many people are ignoring health guidelines based on a vocal minority or media coverage, leading to a self-fulfilling prophecy where more people start to disregard these measures.
This is why clear, consistent messaging from health authorities and community leaders is so vital. When we see respected figures and a majority of our peers following health guidelines, it creates a powerful social norm that can drive widespread compliance.
Dr. Cialdini's more recent work has expanded on this idea. In a 2021 paper he and his colleagues proposed a framework for using social norms to promote pro-environmental behavior. Many of these principles can be applied to public health behaviors as well.
One key insight from this work is the importance of making the desired behavior visible. For instance, during the pandemic, some communities used lawn signs or window stickers to indicate households that were following health guidelines. This made the "good" behavior more visible, potentially influencing others to follow suit.
Another important factor is the source of the social norm information. A 2020 study by Dr. Cristina Bicchieri and colleagues found that people were more likely to follow COVID-19 prevention measures when they believed that others in their immediate social circle were doing so, compared to when they were told that a majority of people in their country were following the measures.
This highlights the importance of local, community-based approaches to promoting public health behaviors. It's not enough to say "most people are doing this." Instead, we need to show that people's friends, neighbors, and respected community members are engaging in the desired behaviors.
But social norms aren't just about what others are doing - they're also about what others approve or disapprove of. This is what social psychologists call injunctive norms. A 2008 study by Dr. Allison Earl and Dr. Penny Visser found that both descriptive norms (what others are doing) and injunctive norms (what others approve of) influenced people's attitudes and behaviors.
This research underscores the complexity of social influence on health behaviors. It's not just about what people see others doing, but also about what they believe others think they should be doing. Effective public health campaigns need to address both of these aspects of social norms.
Segment 3: Cognitive Dissonance in Health Choices
Alright, let's dive into a fascinating psychological concept that plays a huge role in our health behaviors: cognitive dissonance. This term, coined by psychologist Leon Festinger in the 1950s, describes the mental discomfort we feel when our beliefs, attitudes, or behaviors contradict each other.
In the context of public health, cognitive dissonance often occurs when we understand the risks of certain behaviors but engage in them anyway. For example, we might know that going to a crowded indoor event during a pandemic is risky, but we really want to attend our friend's birthday party.
This conflict creates psychological discomfort, and our brains work hard to resolve it. Often, we do this by changing our beliefs rather than our behavior. We might tell ourselves, "I'm young and healthy, so I'm not at risk," or "The pandemic is basically over anyway."
Dr. Elliot Aronson, a pioneer in cognitive dissonance research, has shown that the more important the conflicting cognitions are to us, the more discomfort we feel and the harder we work to resolve it. In a classic study in 1959, Aronson and colleagues demonstrated how people would change their attitudes to justify their behavior, even when that behavior was relatively trivial.
This explains why people might go to great lengths to justify risky health behaviors, especially when those behaviors are tied to important aspects of their lives or identities. For instance, someone who prides themselves on being a social butterfly might find it particularly difficult to reconcile that self-image with the need for social distancing during a pandemic.
A more recent study by Dr. Cindy Jardine and colleagues examined how cognitive dissonance affects people's perceptions of health risks. They found that when people engaged in behaviors they knew were risky (like smoking or not wearing a seatbelt), they tended to downplay the risks associated with those behaviors.
This tendency to reduce dissonance by changing our beliefs rather than our behaviors can have serious implications for public health. It can lead to a kind of willful ignorance, where people avoid or dismiss information that might increase their dissonance.
Interestingly, research by Dr. Claude Mason Steele suggests that we often resolve dissonance by affirming other, unrelated positive aspects of ourselves. In a series of studies Steele found that people were more likely to accept threatening health information if they had first been given an opportunity to affirm their self-worth in an unrelated domain.
This insight has important implications for health communication. It suggests that messages that make people feel threatened or guilty about their health behaviors might backfire, causing people to double down on their existing beliefs to protect their self-esteem. Instead, approaches that allow people to maintain a positive self-image while still encouraging behavior change might be more effective.
One 2021 study applied these principles to promoting COVID-19 preventive behaviors among college students. They found that interventions that allowed students to affirm their values before receiving health information were more effective in promoting preventive behaviors than those that simply provided information.
Understanding cognitive dissonance can help us be more compassionate towards ourselves and others when we notice inconsistencies in health behaviors. It also points to the importance of making health-protective behaviors as easy and socially acceptable as possible, to reduce the dissonance people might feel when following guidelines.
For public health communicators, research suggests several strategies:
1. Frame health messages in ways that don't threaten people's self-image or core values.
2. Provide opportunities for people to affirm their self-worth before presenting challenging health information.
3. Make the desired health behaviors as easy and socially acceptable as possible to reduce the potential for dissonance.
4. Acknowledge the difficulty of behavior change and provide support for the process, rather than simply telling people what they should do.
By understanding and working with our tendency towards cognitive dissonance, rather than against it, we can develop more effective strategies for promoting public health.
Segment 4: Denialism and Information Avoidance
Let’s tackle a thorny issue that's become increasingly prominent in recent years: health denialism. Why do some people choose to ignore or deny health crises like the ongoing impacts of COVID-19, even in the face of overwhelming evidence?
Dr. Sara Gorman and Dr. Jack Gorman, authors of "Denying to the Grave: Why We Ignore the Facts That Will Save Us," have done fascinating work on this topic. They argue that denialism often stems from a complex interplay of cognitive biases, emotional needs, and social influences.
One key factor is information avoidance. This is the tendency to avoid information that might be unpleasant or require us to change our behavior.
Dr. Russell Golman and his colleagues at Carnegie Mellon University have shown that people often prefer to remain ignorant about health risks if knowing would cause anxiety or require lifestyle changes.
In a 2017 paper Golman and his team reviewed decades of research on information avoidance. They found that people are more likely to avoid information when they believe it will cause unpleasant emotions or when it might require them to take undesired actions.
This avoidance can be especially strong when the information challenges our worldview or identity. For instance, someone who values personal freedom might be more likely to avoid or deny information about the need for public health restrictions.
A 2021 study by Dr. Dolores Albarracín and colleagues examined how political ideology influenced reactions to COVID-19 information. They found that conservatives were more likely than liberals to avoid information about the pandemic, particularly when that information came from sources they perceived as ideologically opposed to them.
Denialism can also be a coping mechanism. In the face of a scary and uncertain situation like a pandemic, denial can provide a sense of control and reduce anxiety in the short term. Of course, this comes at the cost of taking appropriate precautions and potentially putting oneself and others at risk.
Dr. La Caille and colleagues explored this in a 2020 study. They found that during the early stages of the COVID-19 pandemic, some individuals used denial as a coping strategy to manage their anxiety. However, those who used denial were less likely to engage in preventive health behaviors.
It's important to note that denialism isn't just an individual phenomenon – it can spread through communities and even become institutionalized. This is where the impact of echo chambers and filter bubbles comes into play, reinforcing denial and resistance to health guidelines.
A 2016 study by Dr. Walter Quattrociocchi and colleagues examined how misinformation spreads on social media. They found that users tend to cluster in communities of interest, which causes reinforcement and fosters confirmation bias, segregation, and polarization. This can create echo chambers where denialism is reinforced and amplified.
Understanding the psychology of denialism is necessary for public health officials and communicators. It suggests that simply providing more facts often isn't enough to change minds. Instead, strategies that address underlying fears, respect people's values, and provide a sense of control may be more effective in combating denial and promoting health-protective behaviors.
Dr. Philipp Schmid and Dr. Cornelia Betsch found that simply debunking vaccine myths wasn't effective in changing the minds of vaccine-hesitant individuals. Instead, techniques that addressed the underlying motivations for vaccine hesitancy, such as acknowledging concerns and emphasizing the benefits of vaccination, were more successful.
So, what can be done to combat denialism and information avoidance in public health?
1. Acknowledge uncertainties: Being transparent about what is and isn't known can build trust and reduce the tendency to avoid information.
2. Frame information positively: Instead of focusing on risks and threats, emphasize the benefits of health-protective
behaviors. This can reduce the emotional threat that often leads to avoidance.
3. Provide a sense of control: When people feel overwhelmed by health information, they're more likely to resort to denial. Offering concrete, achievable steps can help combat this.
4. Address underlying values: Understanding and acknowledging the values that might be driving denial can help in crafting more effective messages.
5. Foster critical thinking: Education on media literacy and scientific reasoning can help people navigate complex health information and resist misinformation.
6. Use narrative approaches: Stories can be more engaging and less threatening than dry facts, potentially reducing information avoidance.
By understanding the psychological roots of denialism and information avoidance, we can develop more effective strategies for communicating critical health information and promoting protective behaviors.
Segment 5: Impact of Media and Misinformation
In our hyper-connected world, the media plays a huge role in shaping our perceptions and behaviors around health issues. But with the rise of social media and the fragmentation of traditional news sources, the impact of media on public health has become increasingly complex.
Dr. Sander van der Linden, a social psychologist at the University of Cambridge, has done groundbreaking work on how misinformation spreads online. In a 2017 study van der Linden and his colleagues found that exposure to misinformation about climate change had a significant impact on people's attitudes, even in the face of correct information.
This phenomenon, which they dubbed the "misinformation effect," is particularly dangerous in the context of public health. A single viral post claiming that masks are ineffective or that vaccines are dangerous can undermine months of careful public health messaging.
But it's not just about blatant misinformation. Even well-intentioned media coverage can sometimes have negative effects. Dr. Karin Wahl-Jorgensen at Cardiff University conducted a content analysis of media coverage during the early stages of the COVID-19 pandemic. Her research, published in The Conversation, found that media coverage emphasizing conflict and politicization around public health measures could reduce compliance with those measures.
The phenomenon of echo chambers and filter bubbles, where we're mainly exposed to information that confirms our existing beliefs, can further entrench denial and resistance to health guidelines. One study by Dr. Michela Del Vicario and colleagues showed how social media platforms can facilitate the formation of echo chambers, particularly around controversial topics.
Social media algorithms that prioritize engagement can inadvertently amplify misinformation and extreme views. Dr. Sinan Aral from MIT has studied this phenomenon extensively. In his 2020 book "The Hype Machine," Aral presents evidence that false news spreads faster and further than true news on social media platforms, largely due to its novelty and emotional impact.
So, what can be done? Dr. Brendan Nyhan has studied various strategies for combating misinformation. In one study Nyhan and his colleagues found that simply debunking false claims often isn't enough and can sometimes backfire. Instead, they suggest that "prebunking" – inoculating people against misinformation before they encounter it – can be more effective.
Information literacy education is also needed. A 2021 study by Dr. S. Mo Jones-Jang and colleagues found that while general media literacy didn't significantly help in identifying fake news, information literacy - the ability to locate, evaluate, and use information effectively - did improve people's ability to spot misinformation.
For health communicators, this research underscores the importance of crafting clear, consistent messages that resonate emotionally as well as factually. It also highlights the need to work with trusted community leaders and influencers who can help spread accurate health information through existing social networks.
Dr. Emily Vraga has explored how social correction - where social media users correct misinformation in their networks - can be an effective tool. Her study found that corrections from both experts and peers can be effective in reducing misperceptions.
As we navigate this complex media landscape, we must develop strategies to combat misinformation and promote accurate health information. This isn't just about individual responsibility - it requires coordinated efforts from researchers, policymakers, tech companies, and community leaders.
Segment 6: Strategies for Enhancing Public Health Compliance
So far, we've explored many of the psychological factors that can hinder public health efforts. But let's end on a more optimistic note by looking at strategies that health organizations, policymakers, and individuals can use to improve compliance with health guidelines.
One key insight comes from the work of Dr. Katy Milkman at the University of Pennsylvania. Her research on behavior change suggests that timing is important. In one study Milkman and her colleagues found that prompts to form implementation intentions increased influenza vaccination rates. This study demonstrates how simple interventions, timed appropriately, can significantly impact health behaviors.
Clear communication is also vital. Dr. Baruch Fischhoff, a decision scientist at Carnegie Mellon University, has spent decades studying risk communication. In his 2012 guide published by the US Department of Health and Human Services, Fischhoff emphasized the importance of communicating both what is known and what is uncertain about health risks. This transparency can build trust and help people make informed decisions.
The framing of health messages matters too. A 2007 meta-analysis by Dr. Daniel O'Keefe and Dr. Jakob Jensen found that gain-framed messages (emphasizing the benefits of following guidelines) are often more effective than loss-framed messages (emphasizing the risks of not following them) for preventive behaviors.
Community engagement is another powerful tool. Dr. Nina Wallerstein's work on community-based participatory research shows that involving community members in the design and implementation of health initiatives can dramatically improve their effectiveness. Her 2017 book on community-based participatory research for health demonstrates how this approach can lead to more culturally appropriate and sustainable health interventions.
We also shouldn't underestimate the power of social norms, which we discussed earlier. Dr. Robert Cialdini's work suggests that highlighting positive health behaviors as the norm can encourage more people to adopt them. A 2020 study by Dr. Jillian Jordan and colleagues, published as a preprint on PsyArXiv, found that people significantly underestimated how much others cared about COVID-19 prevention behaviors. Correcting these misperceptions increased people's willingness to engage in preventive behaviors.
Finally, making healthy choices easier can have a big impact. Dr. Theresa Marteau and colleagues at the University of Cambridge have shown that environmental changes that make healthy options more accessible and convenient can be more effective than education alone in changing behavior. Their 2012 study in Science demonstrated how targeting automatic processes can be important for changing human behavior to prevent disease.
By leveraging these psychological insights, we can create more effective public health strategies that not only inform people but also motivate and enable them to make healthier choices.
Conclusion
As we wrap up today's episode, it's clear that the psychology behind public health behaviors is complex and multifaceted. From the individual factors that drive presenteeism to the societal forces that shape our response to health crises, understanding these psychological dynamics is essential for effective public health strategies.
We've seen how cognitive biases, social norms, media influences, and environmental factors all play a role in shaping our health behaviors. But we've also explored promising strategies for leveraging these psychological insights to promote better public health outcomes.
As we continue to face ongoing and future health challenges, from the lingering effects of COVID-19 to the threat of new pandemics and the growing impact of climate change on health, these psychological insights will be more important than ever.
Remember, public health is not just about individual choices – it's about our collective responsibility to each other. By understanding the psychology behind our health behaviors, we can work together to create healthier communities and a more resilient society.
A bit of housekeeping – by popular request, we’re adjusting the drop time of our Monday episodes. Going forward we’ll drop at 8 AM Pacific / 11 AM Eastern.
Thank you for tuning in to PsyberSpace. This is your host Leslie Poston, signing off. Until next time, stay informed, stay healthy, and – as always - stay curious.
[Outro music plays]
