When talk is not cheap: What factors predict political campaign messaging on social determinants of health issues?

Political candidates use campaign communication to signal to the public which policy issues they consider important. However, the factors that shape political discourse related to the social determinants of health have not been adequately studied. We examined the volume and predictors of attention to three issues—jobs, income inequality, and early childhood education—among campaign ads in 2011–2012 (N = 10,467 ads, aired 4,025,771 times) and in 2015–2016 (N = 9926 ads, aired 3,809,887 times). While attention to jobs was common in campaign ads (41% and 21% of ads in 2011–2012 and 2015–2016), attention to economic inequality (11% and 4%) and early childhood education (0.4% and 0.9%) was much less common. Campaign-related factors (especially partisanship) explain much of the variation, as compared to community demographic conditions, although campaign ads referenced jobs more often in areas with higher unemployment in 2015–2016. Future research should explore political responsiveness to the factors that shape health in communities.