How U.S. ‘cultural defaults’ challenge American public health and what public health officers can do about it

As practitioners and scientists reflect on what can be learned from COVID, we argue that cultural defaults—commonsense, rational, and taken-for-granted ways of thinking, feeling, and acting —played an important role in how countries responded to the pandemic, and help explain why the United States suffered 4-6 times more deaths per 100,000 people compared to the East Asian countries of Japan, Taiwan, and South Korea. Drawing on a recent review and theoretical integration, we describe six pairs of contrasting cultural defaults that were common in how the U.S. and some East Asian nations responded to the pandemic: (1) optimism-uniqueness vs. realism-similarity, (2) single vs. multiple causes, (3) expression of high vs. low arousal emotions, (4) influence-control vs. wait-adjust, (5) personal choice-self-regulation vs. social choice-social regulation, and (6) promotion vs. prevention. These historically-derived defaults are often outside of individual awareness, but are reflected in and reinforced by institutional practices and policies, the media, and everyday interactions. They are infused with cultural values, understood as the “right way” to be or behave, and are adaptive in their respective contexts. Importantly, both constellations of cultural defaults are viable depending on the problem to be solved. We then provide six specific ways in which public health officers might productively consider these and other cultural defaults when preparing for the next crisis and planning how to effectively motivate people to protect their own and others’ health. Our hope is to facilitate efforts to include a focus on culture within the scope of the social determinants of health and to encourage more partnerships between behavioral scientists and public health practitioners. Recognizing the cultural defaults of the various “publics” they seek to protect is critical as U.S. public health officers aim to promote health for all, a significant and complex challenge in the increasingly individualistic U.S.