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Perceptions of the seriousness of major public health problems during the COVID-19 pandemic in seven middle-income countries

Peer Reviewed
20 December 2023

Richard T. Carson, Jie-Sheng Tan-Soo, Nnaemeka Andegbe Chukwuone, Martine Visser, Martin Julius Chegere, Shivani Wadehra, Simon Wagura Ndiritu, Pham Khanh Nam, Jorge A. Bonilla, Michael Hanemann, Marc Jeuland, Emily A. Khossravi, Francisco Alpizar, Franklin Amuakwa-Mensah, Thomas Sterner, Wiktor Adamowicz, Gunnar Köhlin, Dale Whittington


Public perception of the seriousness of the COVID-19 pandemic compared to six other major public health problems (alcoholism and drug use, HIV/AIDS, malaria, tuberculosis, lung cancer and respiratory diseases caused by air pollution and smoking, and water-borne diseases like diarrhea) is unclear. We designed a survey to examine this issue using YouGov’s internet panels in seven middle-income countries in Africa, Asia, and Latin America in early 2022.

Respondents rank-ordered the seriousness of the seven health problems using a repeated best-worst question format. Rank-ordered logit models allow comparisons within and across countries and assessment of covariates.

In six of the seven countries, respondents perceived other respiratory illnesses to be a more serious problem than COVID-19. Only in Vietnam was COVID-19 ranked above other respiratory illnesses. Alcoholism and drug use was ranked the second most serious problem in the African countries. HIV/AIDS ranked relatively high in all countries. Covariates, particularly a COVID-19 knowledge scale, explained differences within countries; statistics about the pandemic were highly correlated with differences in COVID-19’s perceived seriousness.

People in the seven middle-income countries perceived COVID-19 to be serious (on par with HIV/AIDS) but not as serious as other respiratory illnesses. In the African countries, respondents perceived alcoholism and drug use as more serious than COVID-19. Our survey-based approach can be used to quickly understand how the threat of a newly emergent disease, like COVID-19, fits into the larger context of public perceptions of the seriousness of health problems.


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Sustainable Development Goals
Publication reference
Carson, R. T., Hanemann, M., Köhlin, G., Adamowicz, W., Sterner, T., Amuakwa-Mensah, F., Alpizar, F., Khossravi, E. A., Jeuland, M., Bonilla, J. A., Tan-Soo, J.-S., Nam, P. K., Ndiritu, S. W., Wadehra, S., Chegere, M. J., Visser, M., Chukwuone, N. A., & Whittington, D. (2023). Perceptions of the seriousness of major public health problems during the COVID-19 pandemic in seven middle-income countries. Communications Medicine, 3(1).
Publication | 4 January 2024