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From Cholera To Seat Belts: History Of Americans Reacting To Public Health Messages

AUDIE CORNISH, BYLINE: We've talked a lot on this program about the dangers of conspiracy theories and political resistance to the public health guidance on COVID-19.

DAVID ROSNER: This goes back to our very founding.

CORNISH: David Rosner should know. He's a medical historian and co-director at the Center for the History of Ethics of Public Health. That's at Columbia University.

ROSNER: There are moments when a kind of deep-seated American tradition of fearing government and fearing authorities and fearing professionals is brought to the fore.

CORNISH: Rosner says this was also coupled with our country's religiosity. Disease was considered God's judgment on society.

ROSNER: During the 1830s, we experienced one of our first national epidemics. The disease was cholera, and it swept into this country from Europe. We watched it with kind of our casualness because we believed that unlike Europeans, we in the United States were immune to the disease largely because we're a moral people. The idea that disease is a reflection of God's judgment of us individually and of us as a community is long-standing in American history.

CORNISH: And that meant even when it started to affect populations in the United States, the same kind of thinking prevailed, right?

ROSNER: Absolutely. There was barely a response on the part of the government to the disease other than to set up what they called temporary boards of health because they believed the disease was temporary. We told our population to go and pray, to go to church, to have a national day of prayer rather than actually to take strong preventive measures. We thought that it would pass because, obviously, we're a moral nation.

CORNISH: And that kind of thinking prevailed well into the early 1900s.


UNIDENTIFIED PERSON #1: One of the worst natural disasters in recorded history was caused by a virus. The influenza pandemic of 1918 struck every major U.S. city, dropping people where they stood.

UNIDENTIFIED PERSON #2: There were at least 20 million people killed worldwide.

ROSNER: In the 1918 pandemic, in the 1831 cholera epidemic and the smallpox epidemics, everyone feels that somehow, either they're personally immune because they're living a moral life or, secondly, they have no control over it, that it's something that's going to be decided by God. And that's a very dangerous combination when you have that kind of strong tradition that really counteracts all public health communal activity because public health is a communal act. I mean, it's an act on part of the public, of all of us.

CORNISH: But it's not something that can't be overcome. If the conditions are right, public health messages are embraced. One example - the smallpox outbreak in New York just after World War II.


UNIDENTIFIED PERSON #3: These pictures show a patient who had an onset of smallpox the day of arrival in New York from...

ROSNER: In 1947, hundreds of thousands of people lined up to get vaccinated without any fear, without any anxiety, with complete trust in the government. You have to remember this was coming after 10 years of economic depression in which the New Deal was understood as a major tool. You know, FDR was somebody you trusted. And it also came after World War II, when we had a tremendous faith in the ability of government to do things.

CORNISH: Trust in science, the government and other institutions. So it makes sense, Rosner says, that the next time that trust falters - the 1960s - we see another public health campaign struggle.

ROSNER: In the 1940s, it was discovered that if you added some fluoride to your water supply, you could actually reduce the cavities that kids had. In the 1950s and 1960s, however, it became a real political issue. Some towns throughout the country introduced fluoride into their water, and organizations like the John Birch Society, which was a right-wing group, used fluoride as a symbol of the intrusion of government into people's lives and the fear that somehow you're being poisoned by, in this case, communists. You know, if you remember in the 1960s, the film "Dr. Strangelove"...

CORNISH: Right. You had General Jack Ripper, right? It was part of his mad kind of ramblings in the film.


STERLING HAYDEN: (As Jack Ripper) You and I need fresh, pure water to replenish our precious bodily fluids.

ROSNER: That he was worried about his precious bodily fluids and their being invaded by the use of fluoride.


HAYDEN: (As Jack Ripper) Do you realize that fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face?

ROSNER: Fearing the elites who are going to take over our bodies or take over our souls or take over our government and take over our liberties - so that's always there, but it only comes out at moments when they're used by political leaders.

CORNISH: David Rosner, history professor at Columbia University. Rosner sees 2020 as another moment where distrust of professionals, institutions, et cetera is a vacuum for a certain kind of politics to fill. Heading into the election, despite the pleas of public health experts, COVID-19 became a political football. And to understand more about how that happened, we turn to Gaurav Suri. He's an experimental psychologist at San Francisco State University. He studies decision-making and motivation. Not surprisingly, he says words matter.

GAURAV SURI: For example, the word mandate is not a pleasant word for many people. When the same policy is framed as a mask mandate, Republicans are inclined to receive it a lot less favorably than they are when it is framed as a protection plan. But if any public policy is going to work, it's very important that it be compatible with people's communication preferences and styles and what they're going to be open to. Many people are just not open to the word mandate. Making big changes requires us to tailor and communicate public policy in a way that's going to be open for all segments of the population.

CORNISH: Given what you've learned, when you read news reports about people who claim they don't believe that the disease is real or that it's like the flu or even comments from the White House, how do you think about that in the context of your work?

SURI: I think it's a disaster. I think this is a existential threat to our culture. And I understand why it's happening. I think it's happening because we take belonging to social tribes very seriously. And the president has sent signals that, look; all this mask-wearing is not a very necessary thing to do. And so it's sort of become a symbol. And people who value their belonging to that social tribe are trying to reduce dissonance - right? - because on the one hand, they say, we're not wearing a mask. And on the other hand, there's all these news report about - reports about the severity of the pandemic.

So how do you reduce dissonance? You just deny off what's producing the dissonance. In this case, they deny that this is a serious disease. I think that's risky not just to themselves but to their loved ones, to their networks, to the entire country. We have to start communicating better about science than we have been. I think this pandemic has really exposed a lack of communication about what science is, what the scientific method is and how we should live.

CORNISH: Gaurav Suri of San Francisco State University. Suri is also a neuroscientist, and we'll hear more from him tomorrow on pandemic fatigue and why our brains have trouble understanding risk.

(SOUNDBITE OF D.P. KAUFMAN'S "BRAVERY") Transcript provided by NPR, Copyright NPR.