A health educator talks to women about mother and child healthcare in a village in Chad
Credit: Giacomo Pirozzi/Panos

Chapter 1: Introduction

This is chapter 1 of the Wellcome Global Monitor 2018

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  • Wellcome Global Monitor provides new insights and evidence into relationships between the public, science and scientists across the world.
  • It is the first study of public attitudes to science and health on a global scale, conducting nationally representative surveys of people aged 15 years or older in over 140 countries. 
  • It provides data on topics such as trust in science and scientists, trust in sources of information about health, public understanding of the word 'science', attitudes to vaccines, and the intersection between religious teachings and science. 
  • The results will help scientists, researchers, health professionals and science policy makers across the world better understand public perceptions of science; in turn, this should help to improve engagement between the scientific community and the public. 

Why study global public attitudes to science?

Science can lead to discoveries and new technologies that change people’s understanding of the world, influencing the way we live and how our communities and societies function. Active, transparent engagement between the scientific community and people from all parts of society increases mutual understanding, enabling people to communicate their support for – or concerns about – particular scientific applications. This idea of engagement is central to Wellcome’s support for scientific research that can lead to improvements in health. But evidence suggests that public access to and engagement with science are influenced by important disparities related to gender, income and educational attainment.1 

A number of social and technological trends may also influence someone’s attitudes to science and scientists. Those include declining trust in political and social institutions2,3 the association of scientific and technological progress with economic inequality (often through the impact on employment),4,5 and changes in the media environment and mass communication through more recent technologies (such as social media and the internet).6,7

Much of the research into what the public thinks and feels about science and its relation to health, however, has been disproportionately conducted in North America and Europe.8 There is limited understanding of how billions of people in other parts of the world perceive science and its relation to their health and their lives.9 Given how easily health benefits and health risks spread across the world today, this is a serious and fundamental lack of knowledge.

Wellcome Global Monitor explores inequalities in access to and engagement with science – and their relationships to inequalities in income and health outcomes – across different segments of the population and in all regions of the world. Improved understanding of how different people feel and think about science and its relation to health is essential to encourage debate, address disparities and foster greater public engagement, with the ultimate goal of improving health for everyone.

Box 1.1: Science’s social contract with the public

The relationship between science and society is sometimes discussed in terms of the social contract.

It is said that science 'is not an isolated enterprise' and that 'to keep its position in society requires legitimacy'.10 This legitimacy justifies important types of support to the scientific community, including financial resources, legal support and research autonomy. In return, the scientific community must meet certain public expectations, including maintaining high ethical standards, conducting rigorous and credible research that is socially relevant and beneficial to the public, and being aware of the various cultural contexts in which they operate. 

Some researchers believe a broader model is required to describe the modern relationship between science and society: 'Given the extraordinary effects of scientific discoveries and technological inventions during the 20th century, effects that will only increase throughout the 21st century, social contract theory cannot give a sufficiently comprehensive account of the science-society relationship.'11 Instead, the idea of scientific and political pursuit for the common good means that 'it is incumbent upon the scientist to preserve the integrity of science, treat all experimental subjects with respect, inform the community about research under consideration, provide ways for the community to help define the goals of scientific research, and report in a timely manner the results of the research in forums accessible to the non-specialist.'12

Either way, if the public comes to believe that a certain type of research is driven by motives that are not in the public good, or is harmful to people, this can lead to widespread distrust and resistance to acting on scientific health advice.13,14,15

What research questions are in the Wellcome Global Monitor?

Wellcome Global Monitor is the first survey conducted at such a scale. Research questions that Wellcome is looking to understand better include:

  1. To what extent are the concepts of 'science' and 'scientists' understood differently in different countries and cultures, and across different demographic groups (such as gender and age)? Are there any differences in understanding what those terms mean, or are they equally understood globally?
  2. Is there a difference in the way people interact with science across countries and different demographic groups (such as gender, age, education, etc)?
  3. To what extent do people seek information about science and about health (separately), and would they like to know more about science and about health-related matters?
  4. To what extent do people trust scientists and the work that scientists do? How does trust vary on a regional or country-by-country basis?

  5. What demographic characteristics (such as gender, age, education level, etc.) or other factors influence people’s trust in scientists?

  6. How does trust in scientists fare compared to trust in other societal institutions, such as government, the media, and the people who live in the same neighbourhood?

  7. What is the current state of trust in doctors and nurses in different parts of the world? Who would people trust the most to give them health and medical advice?

  8. How included do people feel in science and health research, and to what extent do people believe science benefits them personally as well as society as a whole?

  9. Are people concerned about the impact of science and technology on their economic wellbeing and employment opportunities, and do people believe that science and technology will benefit the next generation?

  10. For people for whom religion is an important part of their daily lives, to what extent do they believe that science and the teachings of their religion disagree, and in the case of disagreement, which information do they believe?

  11. How do people around the world feel about the safety, effectiveness and importance of vaccines, and how do these views vary by region and country, and by key demographics such as gender, age, education level, income level and urban/rural residence?

  12. How are attitudes to vaccines related to trust in science, in government and in health workers?

  13. Do positive or negative attitudes towards vaccines translate into practical outcomes such as non-vaccination?

As this is the first wave of the Wellcome Global Monitor, the survey results and analyses will be cautiously interpreted in the context of existing research. However, as it includes countries that have not been studied before, some results will be presented in a more descriptive manner.

The analysis of all research questions will be done mainly by gender, age groups, urban/rural residence, education and income levels. Health research can only benefit everyone in society when the full diversity of the people it is meant to serve have the opportunity to engage with it. That is why this report analyses how people’s relationship with science and health varies by these demographic and socio-economic groups. Therefore it will be an important way for the scientific community to understand how successfully it is engaging with all parts of society. Future waves of the survey will allow for more robust testing and analysis of the results presented in this report.

Please note, in tables throughout this report, percentage data will not always add up to 100% because of rounding.

How was the Wellcome Global Monitor survey developed?

As this is a large survey asked of people in different countries, different languages, and across different levels of education and socio-economic backgrounds, many of the questions had fewer response options than is often the case in smaller national and cross-national surveys. This was to ensure consistency of understanding across all those interviewed, and also because testing in many local languages had revealed that minimal or non-existent differences between response options such as 'strongly agree', 'somewhat agree', and 'agree' made questions more confusing for people to answer.

Questionnaire development started with a review of the research literature on public attitudes to science and previous surveys, followed by interviews with experts at Wellcome and various academic institutions and non-governmental organisations. Once a long list of potential survey items had been developed (see Box 1.3), questions were tested in cognitive interviews with 12 people in each of seven countries: Colombia, India, Kenya, Nigeria, South Africa, Thailand and Vietnam. This was to ensure that questionnaire items were clear, easy to understand and interpret, and focused on eliciting the desired information. Participants discussed their interpretation of survey items, the thought process by which they would arrive at an answer, and recommendations for improving or clarifying question wordings.

Questions that were cognitively challenging or easily misunderstood were deleted, while questions that were relatively well understood were reworded so they could be understood well and quickly by all demographic groups. 

Another round of pilot testing was conducted with 50 people in each of ten countries, in various languages. The countries were China, Colombia, Egypt, France, India, Kenya, Nigeria, South Africa, Thailand and Vietnam. Other aspects assessed in this round of testing included whether the planned process of administering the questionnaire was workable, timely and efficient. Further refinements were then made to arrive at the final survey instrument, which can be found in Appendix B: Questionnaire [PDF 2.13MB].16

Box 1.2: Theoretical approaches of research on public understanding of science

Social psychologist Martin Bauer has traced the evolution of theories on the public understanding of science from the 1960s to the present. He identifies three distinct paradigms:

1. Scientific literacy, 1960s–1980s 

This approach took a public deficit of scientific knowledge as the main problem, using quiz-like survey items to assess the extent of the deficit and calling for increased efforts in science education.

2. Public understanding, 1980s–1990s 

Here, the notion of a public deficit remained, but measures expanded beyond people’s knowledge of scientific facts to assessing positive attitudes towards science, with the assumption that the ultimate goal of raising public understanding is to generate higher levels of public support for science.

3. Science-in-society, 1990s–present 

This approach moved away from the public deficit idea, focusing instead on science and scientists’ relationship with the populations they served and assessing the health of the social contract between science and society. In this approach, public engagement with and trust in science and scientific institutions are key outcomes. 

Box 1.3: Topics in the Wellcome Global Monitor questionnaire 

Scientific understanding

The questionnaire included questions to assess respondents’ own knowledge of science, and at what stage in their education they learned about any type of science. Questions about a person’s factual understanding of science were kept at a general level, not about specific types of science (see 'Scientific knowledge' below). 

Interest in and engagement with science 

Some research suggests that a person’s general interest in science could, in some instances, help explain their attitude to and trust in science. The survey contains several questions to assess interest in seeking information about science and health, all of which proved relatively easy to understand by all people interviewed in the testing.

Direct measures of trust in science and scientists 

Several questions ask whether respondents have confidence or trust in scientific individuals or institutions, including scientists, doctors and nurses, hospitals and health clinics. All questions on this topic proved relatively easy to understand in testing.

Science and society 

Several survey items ask respondents to assess how they think science will affect important aspects of their lives and society, such as job availability and the lives of the next generation. Some people’s attitudes towards science and health research are affected by cultural forces and social norms that have greater influence on their lives, such as religion, traditional customs and traditional leaders or healers. The survey asked a few questions that explored this topic. All questions on this topic proved relatively easy to understand.

General levels of trust in other institutions in society

Some research has shown that levels of trust in different institutions and key groups can be important in understanding whether a person trusts science and scientists specifically. This survey asks several questions about levels of trust in different institutions and professions. All questions on this topic proved relatively easy to understand.

Vaccination questions

The survey contains a number of questions about issues related to vaccinations, a critical application of science to public health. 

Explored but not included in final questionnaire17

Scientific knowledge 

The first draft of the questionnaire included questions about a person’s factual understanding of different types of sciences, such as physics, chemistry and biology. These knowledge-related questions on the sciences were excluded from the final survey because of the difficulty many people had in understanding and answering them.

Drug-resistant infections 

A set of questions on drug-resistant infections (or antimicrobial resistance) was included in the cognitive testing. These questions were very difficult for most people to understand. Items were interpreted differently depending on people’s education and socio-economic backgrounds. Even the word ‘antibiotic’ caused confusion for many respondents. These questions were not included in the final draft.

What next?

Wellcome Global Monitor is the first ever global study of public attitudes to science, scientists and health. It builds on existing research and provides new insights into people’s attitudes to science and health, and specifically to vaccines, a subject of critical importance in all countries today.

Results from the first wave, presented in this report, provide a baseline of evidence to assess how attitudes change over time, and to help formulate effective and targeted policy interventions to improve public engagement with science and health.

It will also help researchers take account of the social and cultural contexts of their work, stimulate more localised research to understand public attitudes to science and, in doing so, make science research more relevant to more people.

Health research can only benefit everyone in society when the full diversity of the people it is meant to serve have the opportunity to engage with it. This report is an important resource for the scientific community to understand how successfully it is engaging with all parts of society.

Regional country groupings

In this report, Wellcome has largely followed the regional groupings of the United Nations Statistics Division (see Box 1.4) for the regional analysis of the survey results. However, the UNSD does not include a region known as the 'Middle East', and instead includes those countries in the category of 'West Asia'. As many readers may be more familiar with a 'Middle East' region rather than West Asia, Wellcome modified UNSD’s regional groupings to create a ‘Middle East’ region. 

The territories of Northern Cyprus and Kosovo, which were included in the study but not in UNSD’s regional definitions, are not included in the comparison of regional results. However, interviews conducted in these areas are included in any analysis of global results or when examining country-by-country results. 

Box 1.4: Regional groupings used in this report

Countries surveyed are grouped into 18 categories:

North Africa: Algeria, Egypt, Libya, Morocco, Tunisia
Eastern Africa: Burundi, Comoros, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe
Central Africa: Cameroon, Chad, Republic of the Congo, Gabon
Southern Africa: Botswana, Namibia, South Africa, eSwatini
Western Africa: Benin, Burkina Faso, Ghana, Guinea, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, The Gambia, Togo
Central America and Mexico: Costa Rica, Dominican Republic, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama
South America: Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay, Venezuela
Northern America: Canada, United States
Central Asia: Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Uzbekistan
East Asia: China, Japan, Mongolia, South Korea, Taiwan
Southeast Asia: Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam
South Asia: Afghanistan, Bangladesh, India, Iran, Nepal, Pakistan, Sri Lanka
Middle East: Iraq, Israel, Jordan, Kuwait, Lebanon, Palestine, Saudi Arabia, Turkey, United Arab Emirates, Yemen
Eastern Europe: Belarus, Bulgaria, Czech Republic, Hungary, Moldova, Poland, Romania, Russia, Slovakia, Ukraine
Northern Europe: Denmark, Estonia, Finland, Iceland, Ireland, Latvia, Lithuania, Norway, Sweden, United Kingdom
Southern Europe: Albania, Bosnia Herzegovina, Croatia, Cyprus, Greece, Italy, Malta, North Macedonia, Montenegro, Portugal, Serbia, Slovenia, Spain
Western Europe: Austria, Belgium, France, Germany, Luxembourg, Netherlands, Switzerland
Australia and New Zealand: Australia, New Zealand

Source: https://unstats.un.org/unsd/methodology/m49/

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