Issues Relevant to Population Health in Political Advertising in the United States, 2011-2012 and 2015-2016

Erika Franklin Fowler, Laura M. Baum, Emma Jesch, Dolly Haddad, Carolyn Reyes, Sarah E. Gollust, Jeff Niederdeppe

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Policy Points Political advertising can influence which issues are public policy priorities. Population health–relevant issues were frequently referenced in televised political advertising in the 2011-2012 and 2015-2016 US election cycles, with about one-fourth of all ads aired mentioning traditional public health and health policy topics and more than half referencing broader determinants of population health. The volume of population health–relevant issues referenced in political ads varied by geography, political office, political party, and election cycle. Ads referencing broader determinants of population health (such as employment, education, or gender equality) rarely tied these determinants directly to health outcomes. Context: Political discourse is one way that policymakers and candidates for public office discuss societal problems, propose solutions, and articulate actionable policies that might improve population health. Yet we know little about how politicians define and discuss issues relevant to population health in their major source of electoral communication, campaign advertisements. This study examined the prevalence of references to population health–relevant issues conveyed in campaign advertising for political office at all levels of government in the United States in 2011-2012 and 2015-2016. Understanding advertising as part of the political discourse on topics of relevance to population health yields insights about political agenda-setting and can inform efforts to shape opinion. Methods: We conducted a content analysis of all English-language, candidate-related campaign advertisements aired on local broadcast, national network, and national cable television in the 2011-2012 and 2015-2016 election cycles (3,980,457 and 3,767,477 airings, respectively). We analyzed the volume of coverage in these ads about issues relevant to population health, including narrowly defined public health issues as well as a broad range of other social, economic, and environmental factors that affect population health. Findings: Across both election cycles and all electoral races, 26% of campaign advertising discussed issues relevant for the narrowly defined conceptualization of public health and 57% discussed issues pertinent to topics within the more expansive population health conceptualization. There was substantial variation in population health–related content in ads across election cycles, by level of political office, political party, and geographic area. Geographic variation indicates that where a person lives affects their potential exposure to political communication about various health-related topics. Conclusions: Political campaign ads in the United States frequently referenced population health–relevant content at all levels of government, although the ads rarely connected population health–relevant issues to health. Variation in volume and content of these references likely shaped public opinion and the public will to address population health–related policy.

Original languageEnglish (US)
Pages (from-to)1062-1107
Number of pages46
JournalMilbank Quarterly
Issue number4
StatePublished - Dec 1 2019

Bibliographical note

Funding Information:
This research was supported by the Robert Wood Johnson Foundation (grant no. 73619) and Wesleyan University. Conflict of Interest Disclosures : All authors have completed the ICMJE form for disclosure of potential conflicts of interest. Franklin Fowler and Gollust reported that they were consultants to Cornell University on work related to, but not reported in this article. Niederdeppe was a consultant to the University of Minnesota and Wesleyan University for work related to, but not reported in the article. Data Availability Statement : The extensive data used in this analysis will be made available to academics in a method consistent with the contract from the underlying data provider (users must sign a contract stating they agree to use the data solely for noncommercial academic use and will not share or otherwise make disaggregated data available; a nominal fee of $20 per data set will be charged to cover associated administrative costs). Acknowledgments : We thank Travis N. Ridout, Michael M. Franz, Colleen L. Barry, and Rosemary Avery for their advice and support throughout the research process, Conner Sexton for his data visualization work, and the numerous student researchers at Wesleyan and Cornell Universities who made this project possible.


  • campaign advertising
  • media
  • politics
  • population health
  • public health
  • public opinion
  • social determinants of health

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