The health/wealth trade-off: Communication matters
The impact of communication on people’s preferences for the COVID-19 emergency management
The management of the Covid-19 health emergency has meant governments around the world are facing a challenging health/wealth trade-off. On one hand, the unconventional measures that have resulted in the total shutdown of all social and economic activities seem to have produced large health benefits (e.g. Friedson et al. 2020). On the other hand, they come at huge economic cost for national economies (Wren-Lewis 2020). McKibbin and Fernando (2020) simulate a global economic model to explore seven scenarios regarding the spread of COVID-19 and overall GDP loss for each country/region under the seven scenarios. Under the pessimistic scenario, the cost in lost economic output is estimated to be roughly $3 trillion globally.
During the initial phase of the pandemic, many countries clearly opted for health over wealth. However, after a period of almost total shutdown of non-essential economic activities, many countries have entered or are now entering ‘phase two’ of the pandemic emergency. While different approaches are possible, the second phase of the pandemic emergency typically combines a gradual restart of economic activities with precautionary individual behaviours (washing hands, avoiding touching the eyes, nose, mouth; staying at least two metres from other people, etc.) and on-the-job preventive measures (disinfection, staggered arrivals, etc.) to control the diffusion of the infection. During this phase, life gradually returns to the way it was before, but the health threat remains. This is perhaps the most complicated phase of the pandemic emergency, as it makes even more explicit the health/wealth trade-off and requires policymakers to choose where to position themselves on this trade-off. This is a big policy dilemma that will persist perhaps until a medical response becomes available.
A growing stream of Covid-19 economics literature is investigating this trade-off, and in particular how people perceive it. Indeed, when choosing how to balance the health/wealth trade-off and deciding policies aimed at managing the health emergency, policymakers have to take people’s perceptions into account. This is not only because these policies affect political consensus, but also because their efficacy is strictly related to compliance, which in turn depends on whether people agree with them (Hargreaves Heap et al. 2020). Self-isolation, social distancing and precautionary individual behaviours are extremely difficult to implement without individual collaboration.
A first element influencing people’s evaluation of the health-wealth trade-off is the information that they receive. Hargreaves Heap et al. (2020) randomised the provision of information on the economic and health costs of the pandemic to assess public preferences regarding the trade-off. They found that people’s relative valuation of health versus wealth seems to change in predictable ways as the experience of death and income loss unfolds. Importantly, they also find that those who choose the maximum valuation of health over wealth are more likely to comply with appropriate behaviours.
In this column, we focus on another aspect that may be important for people’s perception – namely, how the trade-off is communicated to the public. To investigate this issue, we performed a field experiment in the form of a randomised controlled trial (RCT) involving around 2,000 students enrolled in a big university in the south of Italy (Carrieri et al. 2020). Italy is an interesting case study, as it has been one of the countries most affected by the outbreak and is among those expecting very high economic losses (Barba Navaretti et al. 2020).
We start from the idea that how individuals evaluate health and wealth depends on the perceived value of these two dimensions, and that how each of these two dimensions is framed might turn out to be relevant. Since in our case policymakers have to decide on policies that entail costs in terms of health or wealth, we have compared different framings where the two dimensions of the trade-off are presented in a negative way (i.e. in terms of cost) or a positive way (i.e. in terms of protection). This allows us to test the language used by politicians and media during the lockdown in Italy, in which terms such as “health protection” or “health safeguard” were extremely common. For instance, on 26 February, during the initial phase of the epidemic, a government bill that included the closure of schools and many economic activities was presented by the Ministry of Health as “Actions for the protection of community health”.1
During the period 20-25 April, i.e. before the start of ‘phase 2’, we administered a survey that collected information on students’ wellbeing during the pandemic, individual characteristics (demographics and socioeconomic background variables), place of residence, self-reported measures of personality traits and intention to adhere to social distancing and precautionary behaviours. The key question of the survey, used to answer our research question, asked for preferences regarding health concerns versus economic concerns for the management of ‘phase two’. We varied both the introductory text of this question and the text of the four possible answers in order to investigate the impact of a positive versus a negative framing. As shown in Table 1, where we report responses given by students exposed to different framings, we find that under the treatment that frames the decisions in terms of protection of health and economic costs, 47.36% of students answered that they would prefer policies that consider “extremely” seriously or “very much” the protection of health, and the costs in terms of a worsening economic situation “not much” or only “a little bit”. Conversely, when the trade-off is framed in terms of the costs to health and the economy, 34.15% of students answered that they would prefer policies that consider “extremely” seriously or “very much” the costs for health, and the costs in terms of a worsening economic situation “not much” or only “a little bit”.
These results show that preferences over the health/wealth trade-off depend greatly on how the trade-off is communicated. Framing the two dimensions respectively in terms of health protection (i.e. a positive framing) and economic costs (i.e. a negative framing) induces a large majority of students to place a strong emphasis on health compared to when dimensions are framed in negative terms.
Similar to what is found by Hargreaves Heap et al. (2020), we find that students who position themselves more on the health side of the trade-off are more likely to show a stronger intention to comply with self-isolation and precautionary behaviours.
Table 1 Relative frequencies of responses by treatment
We also find that students’ preferences over the health/money trade-off are also highly influenced by a number of features. The field of study (i.e. studying economics) and a difficult household economic situation appear to be the main determinants of a higher weight being given to the economic dimension of the pandemic. Individuals who are worried for their personal health and stressed when going out, and those with altruistic feelings, seem to assign more weight to the health dimension.
Our finding that a positive framing on the health side of the trade-off induces people to worry and care more about health provides useful insights to public authorities on how to tailor the policy message during ‘phase two’. Framing the measures adopted in terms of “protecting” health would induce people to place more weight on health concerns and might increase their compliance with behaviours, helping to control and limit the spread of the virus. This in turn would allow policymakers to focus more on the economic consequences of the pandemic. Second, our paper shows a large degree of heterogeneity in preferences regarding the health-money trade-off during the pandemic. Some of these differences are related to personal attitudes and/or specific knowledge (i.e. field of study) or to state-dependent conditions (e.g. personal or familial experience with Covid-19). However, there are marked differences due to socioeconomic background that may pose important policy concerns. The political debate in many countries is dominated by very polarised positions over the priorities during the management of ‘phase two’. Our findings suggest that these differences might be explained by the asymmetric economic consequences of the pandemic. One implication of this result is that financial help for people who have faced large economic shocks may strength social cohesion and align preferences regarding the management of the pandemic.
Carrieri, V, M De Paola and F Gioia (2020), “The impact of communication on preferences for public policies: Evidence from a field experiment on the Covid-19 health-wealth trade-off”, Covid Economics: Vetted and Real-Time Papers 25, 3 June.
Friedson A I, D McNichols, J J Sabia and D Dave (2020), “Did California’s shelter-in-place order work? Early coronavirus-related public health effects”, NBER Working Paper No. 26992.