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.

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

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. 

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  8. The Wellcome Global Monitor Questionnaire Development Report references several studies on the subject and notes that regular public surveys have been conducted in the US (NSF, General Social Survey), Europe (Eurobarometer), the United Kingdom (Wellcome Trust, the UK government, as well as others) and a number of Latin American countries (Latin American Network for Science).
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  16. A detailed description of the cognitive and pilot interviews, as well as the main findings from the literature review, can be found in the Wellcome Global Monitor Questionnaire Development Report: https://wellcome.org/sites/default/files/wellcome-global-monitor-quest... [accessed 20 May 2019].
  17. For full details of the development of the survey questionnaire, please see the Wellcome Global Monitor Questionnaire Development Report, 2018 https://wellcome.org/sites/default/files/wellcome-global-monitor-quest... [accessed 20 May 2019].