When Republicans were told, as part of a recent study, that diabetes results from social factors that mitigate personal responsibility, like a lack of neighborhood grocery stores or government-funded places to exercise, they were not inclined to want to enact legislation to rectify that - but Democrats reacted better to a government approach when culture was to blame rather than individuals.

Both were equally supportive when diabetes was presented in terms of genetic factors.

Was the lesson that framing is bad and science is good?  Well, no, though personally I am inclined to think that way.

The lesson for proponents of legislation like health care reform is that things that appeal strongly to their active political base may hurt their credibility in the mainstream.  But are health care opinions polarized by political affiliation or is the debate changing political affiliations?   Senior citizens are in open revolt against Democrats, who ordinarily rely on them, as beneficiaries of government programs, to support Democratic candidates, for example.

It's just partisan politics, say the authors of the study in the American Journal of Public Health.

In their study, participants viewed news articles about type 2 diabetes on the Internet and then answered questions about their opinions on health policy and their attitudes about people with diabetes.   When each viewed an article on the links between social and neighborhood factors and diabetes, 32 percent of Democrats agreed with social factors' role on health compared to 16 percent of Republicans.

"If you are more liberally minded the 'neighborhood explanation' can be motivating, but for people who are more conservative politically, that message can backfire and make them even less interested," says Peter A. Ubel, M.D., professor of internal medicine at the University of Michigan. "The same information can polarize people." 

Ubel designed the study with Paula Lantz, Ph.D., a social epidemiologist (???) at the University of Michigan and Sarah E. Gollust, Ph.D., a Robert Wood Johnson Foundation Health and Society Scholar at the University of Pennsylvania.

Type 2 diabetes is associated with health behaviors, such as poor diet, lack of physical activity and obesity but some also contend these behavioral factors can be influenced by social and economic factors such as living in an unhealthy neighborhood. Scientists have also identified numerous genetic variants that increase susceptibility to type 2 diabetes.

So why focus on the social factors if it may backfire?    Well, it's popular this decade because it worked in the past and the goal of framing health matters according to social factors is to shift attention to non-medical strategies to improve health. The media also commonly discuss the prevalence of social factors when describing health issues because it provides a people perspective and never blames anyone.

"The problem is these messages aren't going to have the same effect on all people," Ubel says. 

That doesn't mean the news media should avoid reporting on social factors - the UK had a science relations disaster and resulting backlash when heavy-handed activists in the science community tried to cajole newspapers into not printing any quotes or articles from researchers who disputed a CO2 basis for global warming. Instead, advocates who want to mobilize public support for broader government health policies should disseminate information to the media using both social factors and individual behavioral causes. 

In other words, data first and agenda second.   That's a lesson for all of us.

"Advocacy groups need to be very careful in thinking about who their audience is and what framing will work best for that audience," Ubel says. "Media should do a richer job of helping people understand each of these different causes." 

Article: Sarah E. Gollust, Ph.D., Paula M. Lantz, Ph.D., and Peter A. Ubel, M.D.,  American Journal of Public Health, Vol. 99, No. 12, December 2009

Funding: Robert Wood Johnson Foundation Health and Society Scholars Program at the University of Michigan and at the University of Pennsylvania, the U-M Center for Behavioral and Decision Sciences in Medicine, and the University of Michigan Rackham Predoctoral Fellowship.