By Peter Boyes
Strategic communications adviser specialising in healthcare and public policy
• 6 min read
One of the enduring puzzles of modern politics is why intelligent people continue to support politicians whose policies appear, at least to outside observers, to conflict with their own interests.
The question is repeatedly asked about Donald Trump and his remarkably loyal support base. Similar questions have been posed about political movements across Europe and elsewhere. Why do facts and evidence sometimes appear to have so little influence on public opinion?
Psychologists have spent decades exploring this question. Their conclusions suggest the explanation has less to do with intelligence than with human nature itself.
One concept that has attracted increasing attention is identity-protective cognition. It proposes that people are often inclined to interpret information in ways that protect the values and beliefs of the groups they identify with. Evidence may not be weighed on its own merits. It may first pass through an identity filter.
Healthcare aspires to be an evidence-driven field. Research is conducted, hypotheses are tested, findings are challenged, and over time, scientific understanding evolves. The process is often slow and untidy, but it is designed to allow knowledge to improve as better evidence emerges.
Yet some healthcare debates appear to mirror the patterns of political debate.
Questions about vaccination, nutrition, fluoridation, pharmaceutical funding, complementary medicine and public health interventions can quickly become markers of identity rather than topics for discussion. Positions are sometimes adopted with a certainty that leaves little room for doubt or nuance.
This isn’t surprising. Health is deeply personal. Most of us have experienced serious illness or watched someone we love navigate it. Our beliefs about healthcare are shaped not only by research papers and policy documents, but also by fear, hope, trust, disappointment and lived experience. Evidence is important, but it rarely arrives in an emotional vacuum.
In recent years, we have seen those who are sceptical of established medical institutions often become resistant to evidence that challenges their beliefs.
And those who trust established institutions can become dismissive of ideas simply because they originate outside the mainstream.
Neither response is confined to the political left or the political right. They are simply different expressions of the same human tendency.
Science itself offers an interesting contrast. One of the defining characteristics of science is not certainty but revision. Scientific understanding evolves as new evidence emerges. Treatments once considered effective are sometimes abandoned. Ideas initially regarded with scepticism occasionally become accepted as evidence accumulates.
This willingness to revise conclusions is not a weakness of science. It is one of its defining strengths.
Politics operates rather differently. Political movements often depend on consistency, conviction and loyalty. Changing one’s position can be portrayed as weakness or inconsistency. Certainty is often rewarded more than nuance.
Healthcare occupies an uncomfortable space between science and politics. Governments cannot wait for perfect evidence before making policy decisions. They must make choices based on the best available information at the time, while recognising that future research may alter today’s understanding.
As New Zealand approaches another election, health policy will once again be a hotly contested political football. That is healthy in a functioning democracy. Differing perspectives help test ideas and expose weaknesses in policy.
As the election campaign gets noisier, it may be worth asking not whether particular proposals are right or wrong, but how we assess them.
Do we begin with the evidence and see where it leads us? Or do we begin with our existing beliefs and seek evidence that supports them?
That is unlikely to be confined to a single political movement, profession or area of healthcare.
Perhaps that question is worth asking before we decide that the evidence is on our side.
References
Kahan DM. Misconceptions, Misinformation, and the Logic of Identity-Protective Cognition. Yale Law School/Public Law Research Paper No. 605, 2017.
Kunda Z. The Case for Motivated Reasoning. Psychological Bulletin. 1990;108(3):480-498.
Lord CG, Ross L, Lepper MR. Biased Assimilation and Attitude Polarization: The Effects of Prior Theories on Subsequently Considered Evidence. Journal of Personality and Social Psychology. 1979;37(11):2098-2109.
Van Bavel JJ, et al. Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behaviour. 2020;4:460-471.
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