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Q&A: How People Decide Whether to Comply with Public Health Orders

December 9, 2020
Professors Ketki Sheth and Greg Wright
UC Merced Professors Ketki Sheth and Greg Wright.

How do people decide whether to comply with public health directives around the COVID-19 pandemic, such as wearing masks, social distancing and staying at home?

Whether to take such preventative measures is a personal decision based on many factors. According to previous research, it would be expected that people would be more likely to take steps to protect themselves and others if they have existing health conditions (or live with people who do), if they are typically altruistic to others, or if they generally have a low tolerance for risk.

That does not appear to be the case, according to new research from UC Merced economists Ketki Sheth and Greg Wright. They recently answered a few questions regarding the implications of their work, which was published recently in the journal Review of Economics of the Household.

What factors in a person’s history would you expect to be predictive of whether they will comply with California’s COVID-19 orders, and why?

In general, those who are most likely to suffer serious consequences due to the illness or perceive the risk of illness to be high are more likely to adopt preventative measures. There’s also evidence that people who are less tolerant of risk — that is, less risk-loving — are more likely to adopt preventative health measures in general. And in the context of infectious diseases, we may expect that people who are more altruistic, or care for their community independent of the benefits to themselves, are more likely to comply. This is because their compliance will reduce transmission, therefore reduces the likelihood of others becoming infected.

These were the main characteristics we focused on in our research, because we expected that they would be predictive of compliance based on the academic literature in other health contexts, as well as from the theoretical foundations of infectious diseases and decision-making. They are also characteristics that we felt were commonly highlighted in conversations and public discourse on assumed motivations for the policy and expected compliance (or lack thereof).

What is your study’s design and what does the research show?

In our study, we surveyed undergraduate students at UC Merced in the initial days of California’s stay-at-home order issued in March 2020. Students were asked about their compliance with the order; that is, whether they interacted with members outside their household for non-essential purposes. We also measured each of our factors of interest:

  • whether they, or anyone they were living with, had characteristics associated with increased severity of a COVID-19 infection (e.g., moderate to severe asthma or 65 years or older);
  • their risk preference; and
  • their altruism.

We then estimated whether each of these factors was predictive of whether the student complied with the stay-at-home order. Surprisingly, we found that none of these factors were predictive of compliance.

For example, those who were living in households with elderly people or people who had other health conditions associated with an increased severity of a COVID-19 infection were no more likely to be in compliance with the order. This lack of relationship was also documented by a Kaiser Family Foundation poll around the same time as our study, which surveyed a broader population and found that for most preventative measures, there was no meaningful difference in compliance based on having an elderly person or someone with a chronic condition in the household.

With respect to risk tolerance, we did find it was predictive of compliance when individuals were considering activities that were permissible under the stay-at-home order at the time — such as the decision to socially interact for employment or essential services — just as you would expect. But in determining whether to comply with the guidelines in contexts other than work or essential services, such as purely social interactions, tolerance for risk was not relevant.

Finally, we found that those who were more altruistic — in other words, those who would typically care more for the health and safety of others — were no more likely to comply with the order than less altruistic people. There is survey evidence from Sweden that shows the converse of our finding in the COVID-19 context — that those who are more altruistic are more likely to comply with public health guidance. But we did not find support for this in our context.

If these traditional factors seem to have no bearing on these decisions, what else might be at play here?

There are other studies that have also tried to understand the adoption of preventative measures in the face of COVID-19, and two relationships that seem to be quite predictive of the decision to adopt preventative measures are political affiliation and media preferences.  

There continue to be misperceptions around the risks of COVID-19, and these misperceptions seem to align with political leanings. We generally do not want our political preferences to have an effect on our decisions around health care. And yet, in this context, we are seeing exactly that — not only our preference for adoption of preventative measures, but perhaps more worrisome, our beliefs about the effectiveness of those measures and our beliefs about the risk that COVID-19 poses.

Survey evidence has suggested that people are responding to their perceived risk from COVID-19, but that perceived risks may not be a good proxy for the true risk. This would suggest that if partisan leanings and news sources affect your perception of risk, then these will be important factors in the varying responses to public policy during the pandemic.

Do you expect that this phenomenon would also extend to something like annual flu shots, or is COVID-19 a special case?

COVID-19 seems like a special case, perhaps because it is so novel and because public policy is very publicized and invasive. Historically, studies do find that an individual’s risk aversion and whether they are elderly affects whether they get a flu shot. However, we are now seeing the flu shot being recommended to help reduce concerns for COVID-19. For example, students at UC Merced are required to get the flu shot this year. It is unclear if the special way that we are responding to COVID-19 will then seep into how we respond to these tangential public policy recommendations and requirements, such as with the flu shot.

How might this research help inform policymaking or future studies? What other questions has this raised for you?

I think our research offers cautions about public policies that rely on self-enforcement. First, we do find that a lot of the young people we surveyed — about 25 percent — were violating the order, even at the start. Typically, these policies allow for flexibility because they want to allow people to respond based on their personal risks and benefits. But if we are seeing that the response does not correspond to people’s true risks of COVID-19, then at a minimum, this suggests reviewing whether the response and outcomes of public policies are as expected.

As we think about employers and universities considering their own policies for allowing people back in person, the assumptions that underly efficiency of self-enforced policies should be reconsidered. Other research cautions that the partisan lens may be making it difficult for people to accurately understand their risks associated with COVID-19. This raises some concerns about reduced efficiency of low-monitored public policy recommendations or requirements.

Finally, our research speaks to some of the public discourse and debate we see around the response to the policy. Those who violate public health guidelines are often accused of being selfish. Likewise, those who argue against public policy orders or the need for preventative measures claim that people are being “too afraid” or “living in fear” and are overreacting to the pandemic. Our results suggest that these assumptions about people’s motivations may be misguided, which in turn undermines productive debate on the public policy response to the pandemic.