The next two months will be filled with harsh and divisive campaigning, deepening the ideological divide that characterizes our politics these days. Both conventions seemed primarily designed to energize their bases, by emphasizing the sharpest differences between the political “tribes.” Perhaps this is necessary in today’s politics, but it doesn’t bode well for population health policy over the coming decade. Improving population health will require cutting health care costs while preserving access and quality, enabling better health behaviors, improving education, economic growth, and the physical environment while also increasing social support and social capital. These are decisions that will require careful, nuanced decisions that go far beyond simplified political exchanges.
Last Labor Day I blogged on my summer read of Friedman and Mandelbaum’s book That Used To Be Us: How America Fell Behind in the World It Invented and How We Can Come Back, and their call for third party movement or even a new party which seeks to find common ground on such major challenges facing the country. This summer, I continued in this genre with Jonathan Haidt’s The Righteous Mind: Why Good People are Divided by Politics and Religion. Haidt is a social/moral psychologist, now at the NYU Stern School of Business. The book is a breathtaking synthesis of psychology, philosophy, evolutionary theory, anthropology, genetics, and political science. The book jacket poses these two questions: “Why can’t our political leaders work together as threats loom and problems mount? Why do people so readily assume the worst about the motives of their fellow citizens?”
Haidt sets out to answer these questions by dissecting what he calls our “moral intuition” (essentially our instantaneous perceptions of the world around us), arguing that our moral intuition operates much more quickly and strongly than rational thought processes. Through exhaustive psychological research, he identifies six moral foundations that he suggests characterize, in different proportions, global cultural and political “moral maps.” These include Care/Harm, Liberty/Oppression, Fairness/Cheating, Loyalty/Betrayal, Authority/Subversion, and Sanctity/Degradation. (NOTE: for those interested in his ideas, these terms require a fuller elaboration than I have space for here because they are more nuanced than they appear at first glance).
He argues that these different foundations have a partial genetic basis, which can be modified by early development and later life experience. In addition, he asserts they have evolved in different societies and cultures to define a dominant moral intuition that he believes plays a powerful role in explaining our beliefs and ideologies. One prominent strand of argument is that while we are basically selfish, evolution does promote group interests to some extent.
With respect to American political culture, Haidt cites evidence, mostly from studying twins, that 30-50% of political attitudes have a genetic basis, with most differences between liberal and conservatives relating to sensitivity to threats and openness to new experience. His most relevant finding is that liberals bind together and primarily operate from the first three foundations above, while conservatives have a more balanced moral map or intuition across all six foundations. He argues that this produces a conservative advantage and explains why rural and working class voters often vote Republican: they are voting their moral interests which do not only focus on “the care of victims and the pursuit of social justice” as Democrats tend to but also include attention to Authority and Sanctity as well.
So what does this have to do with improving our health? If Haidt is fundamentally correct in his assertion that our political and ideological affiliations have a substantial genetic and evolutionary basis, and that liberals and conservatives differ in some of the dominant moral foundations from which they inherently operate, we had better understand those differences more fully if we are going to find ways to work together to address our nation’s challenges, including the many policies relevant to population health improvement. Does the goal of better health only address liberal moral foundations like Care and Fairness, or are there elements of conservative moral intuition that can help in finding common ground? I don’t yet have answers to these important questions, but look forward to others joining me in pondering this provocative area.
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.