A Measure of Hope: New Questions for Postpandemic Rebuilding

As the United States continues to grapple with the trauma COVID-19 has inflicted, how has the pandemic affected Americans’ outlook on the future? Furthermore, with the nation at a critical juncture of social and economic recovery, how can public health address population-level hope and despair moving forward? In this issue of AJPH, Riley et al. (p. 509) begin to address these questions using a novel measure of the difference between anticipated life satisfaction (ALS) and current life satisfaction (CLS) to examine trends in hope across the nation and within US counties. This new way of tracking people’s outlook on their lives may help with the development of programs and policies aimed at bolstering hope to support well-being. However, this novel measure also raises several questions about the public health implications of population-level hope.

This population-level measure of hope contributes to the literature an aspect of the social environment not previously captured in the effort to theorize and test the associations between societal attitudes and health. Riley et al. aggregate individual responses to the Gallup National Health and Well-Being Index to summarize changes in hope at the county and national levels. Although theories about how social environments and individuals interrelate have existed for decades, measuring the social environment based on aggregating individual attitudes is relatively rare in the literature. Most commonly, such measures have captured social capital: the resources that are rooted in social networks such as social connectedness, civic engagement, norms of reciprocity, and trust in others that facilitate cooperation for mutual benefit.¹ Recently, health scholars have aggregated individual responses to national survey data to capture area-level attitudes of anti-Black racism, xenophobia, and homophobia to examine their associations with mortality.^2–4 Other studies have used aggregate individual data from Google searches and tweets as indicators of prejudicial social environments.^5,6

Questions remain about what a population-level measure of hope captures and how it should be applied in the future. How do other aspects of the social environment—such as income inequality, structural racism, and age distribution—influence and interact with population hope? Could aggregate measures of hope miss or underrepresent subpopulations who are marginalized in society? Do increases or decreases in hope predict future morbidity and mortality? Importantly, do all declines in hope warrant public health attention and resources equally? Answers to these questions will help to determine whether interventions to address declines in hope are warranted and, if so, in which circumstances.

IMPLICATIONS FOR TRACKING HOPE

Riley et al. found that despite the remarkable hardships that people have endured during the COVID-19 pandemic, Americans remained optimistic about their futures. In fact, hope significantly increased in 2020. This finding highlights the ability of the nation’s people to maintain a hopeful attitude about the future, even during a crisis never before experienced by anyone in this generation. This is a population strength that should be celebrated and activated as we rebuild US society. And yet, a maintenance in ALS drove this increase in hope, whereas CLS dropped considerably. What remains to be seen is whether ALS will continue to remain stable and whether CLS will improve with postpandemic recovery efforts.

According to Riley et al., even before the pandemic levels of hope varied across the country, with some parts of the country experiencing declines in hope. In the past few years, the phrase “deaths of despair” has been used to describe the declines in US life expectancy and increases in deaths from suicide, drug overdose, and alcohol use.⁷ Despair—the absence of hope—has been linked to numerous poor health outcomes and increased mortality. Therefore, tracking despair has emerged as a barometer of risk of poor mental health, unhealthy behaviors, and preventable mortality. The unique metric Riley et al. propose may help with forecasting increases in these public health problems for areas experiencing declines in hope.

However, conversations about despair have focused primarily on White Americans, and much less attention has been paid to Americans who experience long-standing marginalization, including Black, Indigenous, Filipinx, Latinx, and Pacific Islander communities and other communities of color, which have been hit hardest during the pandemic.^8,9 Using a population-level measure of hope might hide or miss subpopulations experiencing despair because of their minoritized status in the United States at the intersections of poverty, race/ethnicity, immigration status, sexual orientation, gender identity, and disability. More work is needed to examine what changing hope means, especially for groups that have had reasons to despair long before the pandemic.

Not all increases and decreases in hope are equivalent or necessarily require public health intervention. For example, a decline in hope over time that is driven primarily by an increase in CLS with a simultaneous maintenance of ALS probably does not meet criteria necessary for intervention, especially when experienced by people already enjoying societal privilege. At the same time, an increase in hope that is driven by a decline in CLS and a maintenance of ALS may require our attention. Through an equity lens, interventions may be seen as more relevant when declines in CLS, ALS, or both are detected among populations who are already socially disadvantaged because of low education, poverty, sexism, heteronormativity, racism, xenophobia, segregation, disability, and more. These socially constructed factors are likely to influence and interact with levels of hope.

Furthermore, it is important to keep in mind that CLS and ALS are subjective measures based on individual responses. Although subjectivity is not inherently problematic, we must consider whether historically oppressed groups, especially communities of color, have been socially conditioned to accept lower objective standards of living. This may enable them to maintain life satisfaction and hope even when their socioeconomic status is comparatively lower. Maintenance or even increase in hope may be a sign of resilience, but it also does not address the underlying structural inequality that contributes to health inequities in these populations.

Although measures of the social context based on aggregated individual data may be extremely useful for research and policy, they must be applied carefully and with awareness of their limitations. Research finds that aggregate neighborhood indices may underrepresent the needs of those most vulnerable to experiencing health inequities in a geographic area (https://bit.ly/3oYf6sA; Morey et al.¹⁰). Future studies should consider who is represented (and underrepresented) in aggregate measures of hope and who stands to benefit most from interventions into societal hope. These issues highlight the complexity of examining changing hope over time and possible equity issues with using increases and decreases in hope as an indicator of a broader public health problem.

CONCLUSIONS

This measure of changes in hope that Riley et al. provide opens new doors for public health intervention and research. As knowledge emerges on how hope affects morbidity and mortality over time, major questions remain about which segments of the population are likely to be affected and in which cases declines in hope warrant public health intervention. As the nation recovers from a pandemic, our attention should turn to how to build hope into the fabric of society. This will best be achieved by taking this opportunity that a pandemic has produced to build a more equitable society that will be more resilient and hopeful in the face of future national crises.