Preferences for Shared Language for Health Equity Across the Political Spectrum

Importance: The language used to describe health equity efforts has become increasingly contested. Understanding how language influences public attitudes is essential to effectively communicate equity-focused concepts across ideological groups. Objective: To assess the association of language and framing with public receptiveness to health equity concepts, including alignment of definitions with shared values, reactions to common terms, and preferences for public health framing statements. Design, Setting, and Participants: This cross-sectional online survey of 1000 US adults was conducted between April 9 and April 25, 2025, using an international public opinion research firm that recruited from a nonprobability-based online panel with matching and weighting to national benchmarks. Participants were stratified by age, sex, race and ethnicity, self-reported political ideology, and geographic region to approximate national demographics. Exposures: The survey included 3 modules: (1) random assignment to a definition of health equity or health equality with values-alignment questions; (2) evaluative reactions to 10 common health equity terms; and (3) preferences for 4 pairs of equivalent public health statements differing only in framing. Main Outcomes and Measures: Primary outcomes included participant ratings of values alignment (including personal values and values core to national identity, the latter of which were termed American values in the survey), evaluative reactions to equity-related terms (negative to nonnegative), and framing preferences across ideology groups. Descriptive statistics assessed values alignment, reactions to terms, and framing preferences. Results: Among 1000 US adults (weighted number, 513.2 [51.3%] female; 105.8 [10.6%] very liberal, 164.0 [16.4%] liberal, 344.0 [34.4%] moderate, 205.9 [20.6%] conservative, 98.7 [9.9%] very conservative, and 81.5 [8.2%] not sure), respondents represented a broad range of ages, racial and ethnic backgrounds, and educational attainment. Respondents assigned to the health equity definition reported higher alignment with personal values (42.9%-87.4% across groups) than those assigned to health equality (28.5%-79.0% across groups), with endorsement of either concept increasing progressively from very conservative to very liberal respondents (P < .001 in both cases). When assessing perceived core American values, health equity (47.0% [95% CI, 33.1%-60.8%]) was more frequently endorsed than health equality (21.1% [95% CI, 9.6%-32.5%]) among those identifying as very conservative. Four terms-accessible health care, health care investment, population health, and community health-were broadly well received (