Study findings that identified non-COVID respiratory illness as the most serious health issue among members of low- and middle-income countries provide policymakers with a valuable lens through which to understand and address public health concerns.
Even in the middle of the COVID-19 pandemic, people in low- and middle-income countries considered COVID-19 to be less serious than other health issues, according to findings from a new study published in Communications Medicine.1
The COVID-19 pandemic has had a vast and lasting impact on the world, bringing about what some describe as a “new normal.” Despite this, members of several low- and middle-income countries considered non-COVID respiratory illness to be more serious than the novel virus. Results of the study, which illustrate a disconnect between global headlines and local concerns, offer critical insight into how public health policymakers can best serve the public.
“Our results show that respondents have different assessments of the relative importance of health problems than some experts believe,” investigators wrote. “While the whole world focused almost exclusively on COVID-19, many respondents saw other respiratory problems and alcohol and drugs as the most important health problems.”
Although only few cross-country comparisons have been made between people in low- and middle-income countries regarding health issue perceptions, available evidence suggests that people from either income class assess the seriousness of health problems differently than experts think they should. In conducting their study, investigators sought to assess whether COVID-19, which affected the countries studied and was heavily publicized by the media, overshadowed respondents’ rankings of other public health concerns.
Beginning in January 2022 and ending in February 2022, investigators surveyed 7 countries on the perceived seriousness of 7 health problems. Out of the 7, Colombia and South Africa accounted for 2 upper-middle-income countries, and India, Kenya, Nigeria, Tanzania, and Vietnam accounted for the remaining 5 lower-middle-income countries.
In each country, 1200 members were randomly selected from the YouGov internet panel, a web survey site, to rank the list of health problems in a series of best-worst tasks. Study participants represented an internet-connected population rather than the overall population, and as such underrepresented participants from rural, poorer, households.
Investigators noted that the 7 health problems studied—alcoholism and drugs, HIV/AIDS, malaria, tuberculosis, respiratory illness like lung cancer caused by air pollution and smoking, water-borne diseases like diarrhea, and COVID-19—were deliberately selected based on several factors. Namely, investigators wanted to include issues believed to be responsive to public health interventions.
To the investigators’ surprise, respiratory illness beat COVID-19 as the top-ranked health issue in every country except Vietnam, which placed respiratory illness second to COVID-19. The countries ranked alcohol and drugs, and HIV/AIDS as other notably serious health issues.
“We expected that COVID-19 would be the respondents’ top concern due to availability bias, ie, that information about COVID-19 was widely available in the media and a topic of discussion in most households at the time of the survey,” wrote study authors. “However, this was not the case. Instead, COVID-19 occupied an effective three-way tie for the second-highest ranking health problem, along with alcohol/drugs and HIV/AIDS.”
Study findings that identified non-COVID respiratory illness as the most serious health issue among members of low- and middle-income countries provide policymakers with a valuable lens through which to understand and address public health concerns. By aligning policies with public assessments, policymakers provide “peace of mind” to individuals whose concerns are being addressed, make decisions that are more likely to receive support, and home in on the local context surrounding health issues.
Further, study findings offer new insight into how media shapes perceptions of health issues, contradicting hypotheses from investigators that extensive media coverage might contribute to worse rankings of COVID-19.
“[Our findings] clearly suggests that the COVID-19 pandemic has not completely crowded out concern about other serious health problems,” said the study authors. “To the contrary, knowledge of COVID-19 increases concern about other respiratory diseases.”