Issues Relevant to Population Health in Political Advertising in the United States, 2011‐2012 and 2015‐2016

Abstract

Political advertising can influence which issues are public policy priorities. Population health–relevant issues were frequently referenced in televised political advertising in the 2011‐2012 and 2015‐2016 US election cycles, with about one‐fourth of all ads aired mentioning traditional public health and health policy topics and more than half referencing broader determinants of population health. The volume of population health–relevant issues referenced in political ads varied by geography, political office, political party, and election cycle. Ads referencing broader determinants of population health (such as employment, education, or gender equality) rarely tied these determinants directly to health outcomes. Context Political discourse is one way that policymakers and candidates for public office discuss societal problems, propose solutions, and articulate actionable policies that might improve population health. Yet we know little about how politicians define and discuss issues relevant to population health in their major source of electoral communication, campaign advertisements. This study examined the prevalence of references to population health–relevant issues conveyed in campaign advertising for political office at all levels of government in the United States in 2011‐2012 and 2015‐2016. Understanding advertising as part of the political discourse on topics of relevance to population health yields insights about political agenda‐setting and can inform efforts to shape opinion. Methods We conducted a content analysis of all English‐language, candidate‐related campaign advertisements aired on local broadcast, national network, and national cable television in the 2011‐2012 and 2015‐2016 election cycles (3,980,457 and 3,767,477 airings, respectively). We analyzed the volume of coverage in these ads about issues relevant to population health, including narrowly defined public health issues as well as a broad range of other social, economic, and environmental factors that affect population health. Findings Across both election cycles and all electoral races, 26% of campaign advertising discussed issues relevant for the narrowly defined conceptualization of public health and 57% discussed issues pertinent to topics within the more expansive population health conceptualization. There was substantial variation in population health–related content in ads across election cycles, by level of political office, political party, and geographic area. Geographic variation indicates that where a person lives affects their potential exposure to political communication about various health‐related topics. Conclusions Political campaign ads in the United States frequently referenced population health–relevant content at all levels of government, although the ads rarely connected population health–relevant issues to health. Variation in volume and content of these references likely shaped public opinion and the public will to address population health–related policy.

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

“…Taking a more expansive and "upstream" conceptualization of the determinants of population health that encompassed issues like socioeconomic status, power, and marginalization, education, housing, and economic inequality (Braveman et al, 2011), the analysis revealed that 57% of all ads aired referenced at least one population health-related topic, including the traditional public health topics. While campaigns rarely connected the upstream set of issues to health explicitly (Fowler et al, 2019), the prevalence of references to these issues signals their importance to the public and conveys politicians' potential interest in addressing these issues through federal, state, and/or local policymaking.…”

“…The prevalence and frequency of references to population health-related topics varied widely across different geographic locations in the United States (Fowler et al, 2019). This variation in political messaging about population health-related topics could reflect actual differences in the underlying social conditions in communities, with more attention to poverty, for example, in areas with higher poverty.…”

“…The outcome measures for this study were derived from a large-scale content analysis carried out in two stages (Fowler et al, 2019). In Stage 1, the coding team identified population health relevant topics in advertisements, while in Stage 2 the team identified detailed policy mentions (coded as present or absent in each ad) based on an inductive process of identifying the scope of policy and health-relevant content in ads under each topic area.…”

“…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).…”

Competing Public and Private Television Advertising Campaigns and Marketplace Enrollment for 2015 to 2018

“…We observe changes in health insurance advertising by varied sponsors and enrollment over time at the county level, identifying which types of advertising are associated with enrollment. We also assess the extent to which health-care-related political advertising plays a role, given that perceptions can be shaped by politicians responding to local preferences (Fowler, Baum, Jesch, et al 2019;Fording and Patton 2020;Pacheco, Haselswerdt, and Michener 2020), distinguishing between likely pro-ACA (pro-Democrat) and anti-ACA (pro-Republican) messages. Our study relies on a panel of counties and applies county fixed effects, exploiting variation in advertising and health insurance market environment within counties over time to assess the association of advertising with Marketplace enrollment.…”