Hildebrandt Timothy, Bode Leticia, Ng Jessica S C
Department of Social Policy, London School of Economics and Political Science, London, UK
Communication, Culture & Technology, Georgetown University, Washington, DC, USA.
BMJ Open. 2019 Aug 22;9(8):e029747. doi: 10.1136/bmjopen-2019-029747.
This study examines how the perceived role of poor lifestyle and irresponsible behaviour in contracting HIV, human papilloma virus (HPV) and diabetes affects public support for government-provisioned prevention efforts in Britain. It assesses whether public attitudes on healthcare spending are broadly sensitive to 'lifestyle stigmas'.
We conducted an online survey of 738 respondents in Britain and embedded three separate survey experiments to measure support for government-provisioned interventions for HIV, HPV and type 2 diabetes. In each experiment, we manipulated language used to describe the extent to which the diseases are caused by lifestyle choices. Most respondents participated in all three experiments, but assignment was randomised within each condition. Analysis compared support among respondents exposed to 'lifestyle' treatment (information emphasising the disease's lifestyle causes) versus control treatment. We estimated three separate t-tests in which support for government provision of interventions is the dependent variable.
Support for government-provisioned prevention was high for all three diseases. There was no statistical difference between treatment and control conditions for HIV (treatment mean=3.73, control mean=3.86, p=0.38). But in both HPV (treatment mean=3.96, control mean=4.43, p<0.01) and type 2 diabetes (treatment mean=3.53, control mean=4.03, p<0.01) experiments, support for government-provisioned interventions was significantly lower under lifestyle treatment conditions.
Public opinion on healthcare expenditures in Britain is unexpected and uneven. Consistent participant support for pre-exposure prophylaxis (PrEP) shows public attitudes are not always sensitive to lifestyle stigmas-but for other diseases, perceived relationships between individual behaviour and poor health can still shape public opinion about health expenditures. Policymakers and practitioners should remain attentive to how health problems are framed and discussed to ensure broad public support, and take advantage of policy windows like with PrEP as they may close.
本研究探讨了人们对不良生活方式和不负责任行为在感染艾滋病毒、人乳头瘤病毒（HPV）及糖尿病方面所起作用的认知如何影响英国公众对政府提供的预防措施的支持度。研究评估了公众对医疗保健支出的态度是否普遍对“生活方式污名化”敏感。
我们对738名英国受访者进行了一项在线调查，并嵌入了三个独立的调查实验，以衡量对政府为艾滋病毒、HPV和2型糖尿病提供干预措施的支持度。在每个实验中，我们操纵了用于描述疾病由生活方式选择导致的程度的语言。大多数受访者参与了所有三个实验，但在每个条件下分配是随机的。分析比较了接受“生活方式”处理（强调疾病生活方式成因的信息）的受访者与对照组之间的支持度。我们估计了三个独立的t检验，其中对政府提供干预措施的支持度为因变量。
对所有三种疾病，公众对政府提供预防措施的支持度都很高。艾滋病毒方面，处理组和对照组之间没有统计学差异（处理组均值 = 3.73，对照组均值 = 3.86，p = 0.38）。但在HPV（处理组均值 = 3.96，对照组均值 = 4.43，p < 0.01）和2型糖尿病（处理组均值 = 3.53，对照组均值 = 4.03，p < 0.01）实验中，在生活方式处理条件下，对政府提供干预措施的支持度显著较低。
英国公众对医疗保健支出的看法出人意料且不均衡。参与者对暴露前预防（PrEP）的持续支持表明，公众态度并不总是对生活方式污名化敏感——但对于其他疾病，个人行为与健康不佳之间的认知关系仍会影响公众对医疗保健支出的看法。政策制定者和从业者应持续关注健康问题的框架构建和讨论方式，以确保获得广泛的公众支持，并利用像PrEP这样的政策窗口，因为它们可能会关闭。
