When talk is not cheap: What factors predict political campaign messaging on social determinants of health issues?

• Published date: 01 September 2022
• Author: Sarah E. Gollust,Chris Frenier,Margaret Tait,Laura L. Baum,Alene Kennedy‐Hendricks,Jeff Niederdeppe,Erika Franklin Fowler
• Date: 01 September 2022
• DOI: http://doi.org/10.1002/wmh3.470

World Med. & Health Policy. 2022;14:464–489.464

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wileyonlinelibrary.com/journal/wmh3

Received: 22 February 2021

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Revised: 24 May 2021

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Accepted: 4 July 2021

DOI: 10.1002/wmh3.470

ORIGINAL ARTICLE

When talk is not cheap: What factors predict

political campaign messaging on social

determinants of health issues?

Sarah E. Gollust

1

|Chris Frenier

1

|Margaret Tait

1

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Laura L. Baum

2

|Alene Kennedy‐Hendricks

3

|

Jeff Niederdeppe

4

|Erika Franklin Fowler

2

1

Division of Health Policy and Management,

University of Minnesota School of Public

Health, Minneapolis, Minnesota, USA

2

Department of Government, Wesleyan

University, Middletown, Connecticut, USA

3

Department of Health Policy and

Management, Johns Hopkins Bloomberg

School of Public Health, Baltimore,

Maryland, USA

4

Department of Communication, Cornell

University, Ithaca, New York, USA

Correspondence

Sarah E. Gollust, Division of Health Policy

and Management, University of Minnesota

School of Public Health, 420 Delaware St SE,

MMC 729, Minneapolis, MN 55455, USA.

Email: sgollust@umn.edu

Funding information

Robert Wood Johnson Foundation,

Grant/Award Number: 73619

Abstract

Political candidates use campaign communication to

signal to the public which policy issues they consider

important. However, the factors that shape political

discourse related to the social determinants of health

have not been adequately studied. We examined

the volume and predictors of attention to three

issues—jobs, income inequality, and early childhood

education—among campaign ads in 2011–2012

(N= 10,467 ads, aired 4,025,771 times) and in

2015–2016 (N= 9926 ads, aired 3,809,887 times).

While attention to jobs was common in campaign ads

(41% and 21% of ads in 2011–2012 and 2015–2016),

attention to economic inequality (11% and 4%)

and early childhood education (0.4% and 0.9%)

was much less common. Campaign‐related factors

(especially partisanship) explain much of the varia-

tion, as compared to community demographic condi-

tions, although campaign ads referenced jobs

more often in areas with higher unemployment in

2015–2016. Future research should explore political

responsiveness to the factors that shape health in

communities.

KEYWORDS

advertising, communication, health policy, politics, social determinants

of health

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which

permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no

modifications or adaptations are made.

© 2021 The Authors. World Medical & Health Policy published by Wiley Periodicals LLC on behalf of Policy Studies Organization.

Key points

•Attention to employment in campaign ads aired in the

2012 and 2016 election cycles is high.

•Attention to economic inequality and early childhood

education in campaign ads is much lower.

•Campaign‐related factors, especially partisanship, explain

much of the geographic variation in volume.

•Besides community unemployment rates, demo-

graphic conditions explain little of the variation in at-

tention to social determinants of health.

INTRODUCTION

A large body of research confirms that media discourse can both reflect and shape public

views about health and health policy. Scholars across multiple disciplines have demon-

strated relationships between the media environment and the public's attitudes, beliefs,

health behaviors, and their support for policy (Abroms & Maibach, 2008; Druckman, 2005;

Gollust et al., 2019; Iyengar, 1991). These studies found that the volume and content of

media coverage can influence various public health‐relevant outcomes by providing edu-

cational information, setting the agenda for what issues the public perceives to be the

important issues of the day, and framing issues to emphasize a particular set of causes,

solutions, and key groups affected (Gollust et al., 2019). Most research in this space has

focused on the relationship of news media (and, to a lesser extent, entertainment media) in

shaping these outcomes and perceptions (Gollust et al., 2019), but advertising also affects

the public's health and their understanding of health issues and priorities (Fowler et al.,

2017; Harris et al., 2009).

While health communication campaigns that are explicitly designed to shape public

health outcomes have been a major focus of research attention (Randolph & Viswanath,

2004), advertising that is not intentionally designed by public health stakeholders also has

an important contribution to the media ecology. It is well established, for instance, that

advertisements (ads) for unhealthy products (like soda, processed food, or alcohol) shape

public norms and consumption of these products (Grier & Kumanyika, 2008; Niederdeppe

et al., 2020; Tye et al., 1987). Less studied in the public health context, however, are political

campaign ads: the strategic messaging efforts during elections by political campaigns for

elected officials by candidates themselves, political parties, and powerful interest groups.

These messages appear frequently—particularly on television—and often discuss public

health‐relevant topics (Fowler et al., 2019).

Campaign advertising and the factors that shape it

Political communication conducted through campaign advertising generates a sizeable

source of health‐relevant information in the media ecosystem. Candidates invest heavily in

advertising; researchers estimate that one‐third of political candidates' overall budgets are

for advertising, and television is the largest expense within this budget category (and these

figures do not even include additional money for TV advertising spent by political parties and

interest groups) (Fowler et al., 2016). Campaign ads air frequently, and their volume has

increased over time. The Wesleyan Media Project estimates a 60% increase in the volume

of televised campaign ads between 2014 and 2018 (Fowler et al., 2020), and the 2020 cycle

CAMPAIGN ADS ON SOCIAL DETERMINANTS OF HEALTH

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