A review identifies what most influences polarization on health issues

This article is a systematic review and, as such, is based on a solid and proven methodology for studying a specific aspect in scientific literature. In this case, it analyzes polarization in the field of health in relation to the COVID-19 pandemic and the factors that contribute to it. The authors deserve great credit, as they include articles with very diverse methodologies and are able to provide a clear summary of the main topics covered. Following their analysis, the factors identified are political ideology (and the underlying intrinsic polarization), misinformation, social media dynamics, trust in health institutions, perception of risks to individual health and that of loved ones, and socioeconomic factors.

For several years, various research studies have warned of the polarization of society, especially in relation to the pandemic. This study is novel because it synthesizes these studies and does a great job of summarizing the key factors that contribute to this polarization.

Perhaps one limitation to bear in mind, in terms of interpretation, is that this study may, ironically, contribute to polarization. Without questioning its scientific rigor, it presents certain social groups as “rational” compliers of health regulations, while the ideologically opposed group is portrayed as “emotional” non-compliers who rebel against the rules. Again, I do not question that this is the scientific reality pointed to by the results, but perhaps we should develop narratives that depolarize society, rather than widening the gap between the two ways of thinking.

On another note, when discussing the first factor (political ideology), it would have been interesting to discuss the results in terms of the political leanings of the countries' governments during the pandemic. Given the “partisanship” found by the authors, it is worth considering whether the reaction to government decisions would have been the opposite if they had been governed by those who were then in opposition.

In my opinion, this study is highly relevant to health policy in Spain. As the authors propose at the end of the discussion, an effort should be made to mitigate polarization and achieve greater cohesion, especially in times of crisis. Perhaps this will not be achieved until there is effective depoliticization of health and research, leading to consensus-based regulations and directives. Today, this is a dream, but works such as this are important in making our leaders aware that, if they truly want the common good, they must change their ways of acting.

Camacho-García et al. (2025) conduct a systematic literature review in accordance with PRISMA guidelines, integrating 90 studies selected from three databases (PubMed, Scopus, and Web of Science). In addition, the authors develop and use a tool for assessing the quality of scientific texts (QUEST) based on 20 indicators, which they make freely available.

This work has two main contributions. The first is the traceability and replicability of the review process. The second, no less important, is the identification of six major determinants of social polarization in health in the literature reviewed. These combine political, cognitive, technological, and social elements that explain how and why the population is divided on public health issues. This work therefore offers a useful interdisciplinary framework for future related research. Among the limitations to be taken into account, I would highlight the bias not only towards Western scenarios, as the authors warn, due to the languages read and the databases, but also towards the predominance of the US context, with very different characteristics in relation to the health system, which may condition the effect of the determinants identified.

The study published in Science Advances offers a broad and timely overview of how the COVID-19 pandemic affected not only physical health but also the communicative health of our societies. By analyzing the factors that fueled health polarization—from inequality and ideology to institutional trust and the circulation of misinformation—it confirms that public health management cannot be understood in isolation from the social processes of knowledge construction. Polarization around science does not arise from data, but from the meanings we attribute to it and the media and political dynamics that amplify it.

Various studies published in recent years agree that scientific literacy and familiarity with biological concepts have a moderating effect on ideological polarization. People with greater knowledge about the coronavirus and scientific processes were less vulnerable to extreme narratives and showed a more critical attitude towards the political management of the pandemic. These studies reinforce the idea that health polarization is not so much due to a lack of information as to the absence of dialogue and spaces for public deliberation around risk and evidence.

In the Spanish context, the conclusions of this study are particularly relevant: the response to future health crises cannot be limited to improving institutional communication, but must also reinforce critical and participatory scientific literacy in schools, the media, and social networks. Trust in science is built over the long term, in everyday life and through continuous learning. Fostering a pro-science culture, but also one that is critical and healthy skepticism—capable of distinguishing between uncertainty and manipulation—is one of the best tools for preventing polarization and strengthening democracy.