COVID-19, Mask Mandates, And The Case For Physician Political Engagement – healthaffairs.org

The COVID-19 pandemic has demonstrated in stark terms the importance of considering politics as a key determinant of not just how but whether the nation effectively responds to emergent threats endangering public health. Our checkered experience with mask mandates in the US is a prime example of this intersection between politics and public health. Despite clear evidence that government mask mandates would increase mask-wearing behavior and save lives, elected leaders in several states chose not to institute them. Their inaction, which jeopardized the health of thousands of Americans, underscores that public health is not immune from political tides; it is directly tied to them. Physicians, having taken an oath to serve patients, have a responsibility to confront this sobering reality; they must engage in the policy and political arena to prevent medical and public health science from being undermined and to safeguard the health of patients and communities.

Physicians are ideally suited to advocate for science and for their patients. Physicians train throughout their careers to solve problems by targeting root causes and to communicate accessibly with people of diverse backgrounds. These skills, combined with the public trust they command, provide physicians with a unique capacity to serve as effective political advocates for policies that put medical and public health science first. However, this potential remains largely untapped. Barriers such as the lack of prior experience with political organizing and policy advocacy among physicians and the absence of incentive structures to reward them for such engagements must be overcome. Avenues for addressing these barriers are beginning to emerge. Medical schools and academic medical centers should invest in these emerging efforts and commit to the goal of equipping the next generation of physicians with the mindset and skills to effectively engage in the political and policy arena on behalf of science, patients, and communities.  

Politics Of Public Health In The COVID-19 Era

Numerous studies published in 2020 concluded that mask mandates increased mask-wearing and that universal mask-wearing decreased COVID-19 transmission, infections, and deaths. By October 2020, Nature had released a model projecting thousands of US COVID-19 deaths could be averted if mask usage reached the 95 percent mark over the ensuing winter. The research definitively substantiated mask mandates as a low-cost, low-risk, high-yield population health intervention. Yet, elected leaders in 11 US states decided not to implement mask mandates at any point in the pandemic. In Florida, Texas, Arkansas, and Iowa, state leaders successfully passed legislation or signed executive orders prohibiting cities, counties, or school districts in their jurisdictions from issuing their own mask mandates. There is also evidence to suggest that messaging from elected leaders seeking to make mask-wearing a partisan issue undermined both mask-wearing and social-distancing behaviors of their constituents.

Implications For The Physician Workforce

Cynical political efforts to frame research-backed public health measures as a threat to freedom and to cast defenders of those measures as enemies are unfolding in the public square with lethal effects. Elected leaders’ failure to enact evidence-based measures to save lives and their undermining of confidence in public health expertise amidst a pandemic reveal a new landscape that public health stakeholders, including physicians, must confront. In such a climate, public health advocacy can no longer be viewed as an exclusively apolitical endeavor that can be furthered outside the political process, as is often erroneously assumed. Accordingly, physicians who view themselves as public health advocates now need to step into the political arena as professionals whose unique science-centric expertise and clinical experience caring for patients should be actively considered in policy making.

Historical aversion to public political engagement among physicians has stemmed from a fear of being painted as partisan or unprofessional and concerns that this label will erode the trust the public generally has for health care professionals. However, as evidenced by the mask example, physicians’ silence creates an expertise vacuum in the political arena that allows politicians to mislead patients and endanger the lives of the general public. In this environment, physicians becoming political without being blindly partisan may be one of the most professional acts of all. 

Potential Physician Contributions To Political Process And Policy Making

The physician workforce already has several assets that uniquely position it to help address the political determinants of health. These include a high level of public trust and training in both scientific problem-solving and effective communication.

Physicians have generally commanded a heightened level of public trust relative to other professions. A recent poll conducted by Pew Research found that while trust in other professions and institutions has declined during the COVID-19 pandemic, public confidence in the ethical standards of medical doctors has increased. This public trust means that physicians who make the case for policies that advance sound medical and public health science may have a greater chance than other advocates of generating the public and political will needed to make patient-centric policy ideas, from mask mandates to universal health care, a reality.

In addition, physicians are trained to be focused problem-solvers. Medical education prioritizes equipping trainees with the capacity to identify a problem, collect qualitative and quantitative data to characterize the problem, distinguish symptoms from the root cause, and work to treat the root cause. Such a systematic approach to addressing the policy failures that threaten the health of communities and that exacerbate existing inequities is sorely lacking and desperately needed among policy makers. 

Cultivating communication skills in physicians is another bedrock of medical education. Physician communication skills are known to correlate positively with health outcomes, incentivizing physicians in training and practice to hone their ability to meet patients where they are, elicit accurate information, gain patient trust, and partner with them to arrive at a shared plan of action. This skill is directly transferable to policy making. Tailoring messaging to the audience and relying on powerful storytelling are also keys to translating policy ideas into legislative action.

Path To Political Engagement

While these qualities give the profession considerable power to drive policy and political action, this potential remains largely untapped. There is less physician representation in Congress today than there was during the first century of US history. Physicians tend to vote at lower rates than the general population. Structural reform is needed within the profession to inculcate in physicians the mindset to recognize political engagement as an extension of their professional obligation and the skillset to be effective in this political engagement.

Some experts have suggested that there is a lack of direct exposure to politics and public policy in the training of future physicians. Aside from the absence of comprehensive health policy content in the curricula of most medical schools, there is limited infrastructure in medical schools to encourage student engagement with the political process through avenues such as policy internships with elected officials or political organizing around public health issues. Such practical, hands-on experiences are vital for equipping trainees with the confidence and competencies they need to pursue policy-influencing or policy-making roles and to excel in them.

Other barriers that have previously been identified include the fact that advancement in medicine is traditionally understood to rely on publications in peer-reviewed journals and grant funding. Physicians and future doctors are apprehensive about whether science-informed policy advocacy and involvement in political organizing will be recognized and rewarded by the institutions where they work.

Overcoming these barriers will require medical institutions, from medical schools to hospitals, to undertake important changes. Medical schools would be well-served to support emerging student-led efforts that are making the case for why physician political engagement is central to patient care and connecting students to opportunities for learning and pursuing impactful pro-science, patient-centric advocacy. Efforts in this arena include Future Doctors in Politics, a non-partisan organization that fellow medical students and I recently launched. Our goal is to build political and policy literacy through workshops and seminars and expose medical students to policy advocacy and political organizing through experiences such as meeting with elected officials, providing oral testimony in state legislatures, writing op-eds, and grassroots canvassing. Other student-influenced efforts such as GOTVax and We Got Us are deploying political canvassing techniques to increase COVID-19 vaccine uptake and education in marginalized communities while Vot-ER is mobilizing medical students, residents, and physicians to register voters in emergency departments across the country.

Aside from actively encouraging patient-centric political engagement, medical schools will need to further integrate both policy and political literacy into their curricula so that as students learn about what pills to prescribe to their patients, they are also learning about the bills that can impact patient health outcomes to an even greater degree. Experts have also recommended that academic medical centers should commit to rewarding trainees and physicians for choosing to pursue political and public policy-related paths by weighing these activities positively in residency applications and performance evaluations.

As we emerge from the ravages of the COVID-19 pandemic, we must reckon with how to confront the many societal vulnerabilities this public health travesty has laid bare. The pandemic has made unequivocally clear that politics and health are inextricably linked. Practicing and aspiring physicians alike must ask the question: What does honoring our oath mean when the health of our patients is most impacted not by the kind of care they receive from their doctors but by the political decisions being made by their elected leaders? As professionals charged with protecting the health of individuals and populations, we have an obligation to build the infrastructure that will motivate, educate, and train future and current physicians to pursue political and policy advocacy to ensure that our nation’s politics and policy making help rather than hurt our patients and communities.