The Impact of a Conservative Worldview on Women and Children’s Health

It has been proposed by George Lakoff [1] that politically liberal and conservative individuals possess very different worldviews. This is especially true around topics such as women’s rights, childrearing, gender equality, and healthcare. Lakoff explains these differences in the form of “family metaphors” where conservatives lean toward the model of the authoritarian Strict Father and liberals the model of the supportive Nurturing Parent. This paper reviews the research into the impact of a conservative worldview on public health. Although the purpose of this paper is not to determine which worldview is correct, it does show that conservative beliefs can have negative effects in various health related areas such as women’s health, reproductive rights, punishment, childrearing, healthcare, disease transmission, and domestic violence.


Introduction
, promotes the idea that contemporary American politics is about worldview; the way people see and understand the world. It encompasses one's beliefs and assumptions that describe reality, especially the way people view issues of politics, medicine, public health, religion, and morality. Political liberals and conservatives tend to have very different worldviews and applications of moral systems. This prompts them to resonate with specific political rhetoric and beliefs.
The paper will use the dictionary definitions of political liberals and conservatives [2]. A liberal is one who is open-minded and advocates for liberalism (a political philosophy based on belief in progress, the essential goodness of man and the autonomy of the individual and standing for the protection of political and civil liberties) in individual rights. A conservative is one that has a tendency or is disposed to maintain existing views. An adherent or advocate of political conservationism (a disposition in politics to preserve what is established. Based on tradition and social stability, stressing established institutions and preferring gradual development to abrupt change). Lakoff [1] argues that people relate to politics in terms of "family metaphors". He believes that at the center of the conservative worldview is the "Strict Father" model that supports the notion of a traditional, nuclear family with the father having responsibility for family support and protection. The father has the authority to set strict rules for the family and when disobeyed, he enforces them. On the other hand, liberals relate to the "Nurturing Parent" model that emphasizes love, caring, nurturing, and respect however, unlike the strict father they do not emphasize strict rules and punishment as a method of control. Importantly,McAdams,et al. [3] indicate that the differences in worldview between liberals and conservatives has been found to be deeply implicated in people's motivation and identity. It becomes the way they view their life and the lives of others. Therefore, political orientations reflect how a good family (or society) should be organized, how family (or society) members should behave, who the family (society) members obey, and how they (societal members) raise their children. Political identification has been shown to predict voting behavior.
According to Brown [4], conservatives see politics as "an instrumental activity aimed at preventing domination by establishing institutions and practices that facilitate the public contestation of government decisions". They are concerned with the way societies respond to ethical dilemmas associated with conservative ideals. Therefore, it is commonplace to see conservativism intruding the political arena to push for their notions of personal independence, Volume 3; Issue 02 J Community Med Public Health, an open access journal ISSN: 2577-2228 a nationalistic political economy, limited government, and safeguarding the traditional family. Liberalism, on the other hand, is aware of the persistence of power and conflict over these issues, but views politics in narrow terms of individual and group interest, not necessarily to push an ideology or belief system. It is important for the American public to understand that "when ideology--whether it is the ideology of scientists and clinicians or of politicians--distorts scientific findings and public health judgment, public welfare is endangered, potentially affecting every person in our nation [5]. With the 2016 election of conservative Donald Trump, many Americans and health professionals are in a state of high anxiety because of decreasing healthcare budgets, weakening environmental regulations, and the disappearance of access to reproductive health services. We have good reason to be very concerned.

Childhood Vaccination
The threats of many childhood diseases that were nearly eradicated in the Western Hemisphere by the late 1990's such as the measles, diphtheria, and the whooping cough, have now returned raising new health concerns. Estep [6] indicated that certain attitudes that are correlated with conservative political identity, e.g., commitment to parental rights, suspicion of government intrusion into personal choices, and distrust of science, foster opposition to many forms of healthcare.
Although the sample in their study was small Rabinowitz,et al. [7] found that the effect of ideology on whether or not to vaccinate children was significant. Results indicated that conservatives and moderates were less likely than liberals to vaccinate their children. In 2018, Estep [6] studied the rates of parents opting out of vaccinations by using Personal Belief Exemptions (PBE) in California. He found that PBE rates were higher in highly Republican/conservative neighborhoods and three times higher than Democratic/liberal neighborhoods.
Social media propagates false and misleading information regarding various issues including conspiracy theories about childhood vaccination. Featherstone,et al. [8] found that conservatives tend to believe Internet conspiracy theories in part because of their distrust of science, anti-intellectualism, and their reliance on social media for information.
Women's Healthcare Thompson [9] presents another example of politics interfering with public health concerns by discussing the conservative war against the "Affordable Care Act" (ACA) which provides most Americans with access to high quality, affordable health insurance. Since its inception, Congressional Republicans have vowed to fight the passing and implementation of the ACA. By fighting this initiative, conservatives are risking a higher incidence of death, disease, disability, addictions, and discomfort in the American public, especially among the poor, women, and children.
A key part of the ACA, Medicaid expansion, has been opposed by conservatives despite its public health benefits and fiscal advantages. Understanding that this expansion could help some of their constituents, some Republican politicians introduced modifications to the Medicaid expansion which are rooted in the conservative principles of personal responsibility, self-reliance, and accountability which may have made the expansion more politically viable in these states. These ideals promote the concept of individualism, where individual freedom and self-fulfillment are valued rather than a sense of duty or obligation. It is this thinking that promotes the idea that poor people must have not worked hard enough and therefore do not deserve social welfare benefits. This thinking represents a narrow understanding of the social, economic, and structural factors that may be underlying the plight of the poor and uneducated [10].
Women are at risk when healthcare services are restricted or made inaccessible especially during their reproductive years. In an article entitled the "The War on Women", Wesley [11] indicates that conservative opposition to many women's issues, including reproductive and preventive healthcare, birth control, unequal pay, and reproductive rights, undermines a woman's right to full citizenship as well as putting all women at risk by not allowing them to monitor and care for the health of themselves and their children. Further, these inequities in women's rights likely impose greater burdens on minority and financially challenged women as well as their children thus impacting their health and overall wellness.
Women's health and reproductive rights has been debated for years. Based upon Pew Research Center Polling [12], about six-inten U.S. adults (58%) said in a 2018 survey that abortion should be legal in all or most cases, compared with 37% who said it should be illegal. There is also a wide ideological gap on the public's view of abortion rights where 59% of Republicans indicated that abortion should be illegal in all/most cases contrasted to 21% of Democrats ( Figure 1 Although it is clear from polling statistics that most people in the U.S. support a woman's right to choose, abortion is an issue that conservatives use to galvanize the reassertion of traditional religious values. Republican politics have been unequivocal in their belief that abortion is murder and thus presenting a moral stance and far-right conservative approach to the issue [13].
Women's health can be enhanced if women are given the opportunity to make their own reproduction choices about sex, contraception, abortion and application of reproductive technologies. The discussion surrounding abortion usually centers on whether it should be legal or illegal. Access to safe abortion is critical to the health of women and to their autonomy. The development of new effective contraceptive methods has a profound impact on women's lives. By the use of contraception, it is possible to lessen maternal, infant and child mortality and to reduce the prevalence of sexually transmitted diseases. Dissemination of information about the safety and effectiveness of contraceptive methods is of great importance.
As conservative governments remove funding for organizations such as Planned Parenthood, many essential health services are made inaccessible by young, poor, migrant, and undereducated women. Without these organizations many women will have no access to affordable birth control, cancer screenings, health & wellness checks, pregnancy planning and services, prenatal care, and abortions.
Governments and society must ensure the women's equal rights to health care just as men have in the regulation of their fertility.

Punishment
Although self-reliance displayed by the child is the end goal of most parenting models, Lakoff's [1] "strict father" often accomplishes this through authoritarian methods. The strict father parenting, while being loving and caring, promotes the use of strict rules and punishment to discipline the children. Like operant conditioning in which behaviors are associated with consequences, the parents, especially the father, either reinforces behavior or punishes it. Punishment is most often physical for example, spanking, hitting, slapping. Strict father parenting encourages parents to leave their infants alone when they start to cry and typically requires that the infant sleep in a crib in a separate room so as not to coddle the child. Whereas, nurturing parents believe in an open, two-way, mutually respectful communication focused on the development and formation of a child that is also empathic, caring, and capable of fulfilling their inner potential.
Research shows that there are numerous problems with punishment, especially physical punishment (including spanking), is that it has been related to poor health outcomes for the child. Current research [WU1] by Afifi,et al. [14] reinforces the findings of previous studies that indicate a childhood history of spanking is associated with an increased likelihood of suicide attempts, moderate to heavy alcohol abuse, and street drug use in adulthood.
In contrast, the nurturing parent believes that children reach self-reliance through the nurturing love, care, and respect that their parents provide them. This ultimately promotes a secure childparent attachment, mastery of parental expectations, and moral empathy. They view the family as a community where children have responsibilities but also show empathy for others. Obedience to the nurturing parent does not come from fear of punishment. When children do wrong, nurturing parents favor restitution rather than retribution [1].
Social policy regarding punishment is also important for those leaning toward the conservative worldview. It has been shown by Okimoto and Gromet [15] that political differences in social policy support may be driven by the tendency for conservatives to show greater sensitivity to deviance than liberals and demonstrate a firm rebuke of deviant others. Conservatives prefer social policies that provide appropriate punishments for those who are wrongdoers or who deviate from the normal. This may be explained by an individual's motivation to protect and preserve their own selfimage, their in-group (a select group in which all members feel a strong sense of identity with the group) and out-group (those not a part of the in-group) goals, and their worldviews.
Conservative are often suspicious of other groups (outgroups) and desire clear moral and behavioral codes that also include the belief in the importance of punishing anyone who violates these codes [13]. Jost,et al. [16] indicates this desire to emulate the attitudes and behavior of typical in-group members produces group cohesion which makes it a key role in the formation and development of social identity and the emergence of group conformity. They tend to be more accepting of inequalities and more resistant to social change than liberals. Those who support conservative viewpoints tend to also score low on openness to experience, integrative complexity, and relatively high on death anxiety, dogmatism, and the need for social order and closure compared with more liberal individuals. These viewpoints may persist to as an effort for conservatives to feel safe, secure, and linked with other like-minded individuals.

Domestic Violence and Abuse
Cross discipline studies have confirmed that women are the main victims of domestic violence. Historically it has been legal for men to hit their wives and although today violence against women is illegal, it does not mean that violence does not occur in American families. Domestic abuse has been associated not only with physical injuries but also with psychological distress and anxiety [17].
Gender inequality promotes policies and social rules that allow men to play a dominate role in many cultures. These stigma systems grant permission for dominate status people to harass or subordinate lower status people. In gender-based violence assaults and threats are generally understood as based in male aggression or sexual needs and their behavior is regarded as understandable if not justified in terms of women's irrationality (she asked for it) [18].
Gender inequality and domestic abuse is found across all demographics, however, it clear that "strict father" conservatives [1] and those who hold for traditional male and female roles insist on consequences for those who disagree or deviate from their viewpoint [13].
In addition to gender equality there has been the misuse of biblical texts that perpetuate gender stereotypes and negative views on women, as well as religiously tinted discourse inspired by essentialist understandings of human nature, endorsing women's subordination and legitimizing domestic violence.
In a study by Robinett [19], the strongest predictor of political identity was participant level of religiosity. The higher the level of religiosity, the more conservative participants were. The Pew Research Center conducted a "Religious Landscape Study" in 2014. Self-report findings revealed that 55% of Evangelical Christians reported they were politically conservative. The same applied to 37% of Catholics, 60% of Mormons, and 34% Orthodox Christian [12].
According to Jost,et al. [18] religion provides an ideological justification for the existing social order. So, the prevailing institutions and arrangements are perceived as legitimate and just, therefore worth obeying and preserving. Religion also endorses the belief in a "just-world" (or "just societal order") in which people get what they deserve in life. For example ,Jost,et al. [18] point out that in the New Testament political authorities are legitimate and should be obeyed. That the political authority or leader is an agent of wrath to bring punishment to the wrongdoer. Therefore, it is important to submit to these authorities or be punished. If a person is a perceived wrongdoer according to the authorities, that person is to be punished because they must "get what they deserve".
In addition, some abusers use religion to legitimize their abusive behavior in order to deny responsibility and mitigate feelings of guilt following the abuse of their partner and/or children. Obviously, there are other factors that can initiate abuse such as personality disorders, mental illness, or the abusive history of the perpetrator, however conservatives' level of religiosity and beliefs about traditional gender roles and also play a part in violence toward women.
Being able to survive in an abusive environment may be a challenge for religious wives who desire to end oppression but remain true to their religion. Conservative wives who maintain a hard line connection to husband domination may feel obliged by biblical authority to remain in an abusive relationship [20].

Discussion
This paper connects an individual's political affiliation to Lakoff's [1] "strict father" or "nurturing parent" worldview. If Lakoff's family metaphors apply to society in general, it is understandable why conservatives hold certain political beliefs, for example, punishing those who enter the country illegally (immigration); punishment for doctors performing abortion as well as the women seeking an abortion; gender inequality in traditional family roles; a belief in the "just world" hypothesis where people are responsible for their own life circumstances; the use of religion to justify violence and restriction of women's rights; and support for strong authoritarian leaders that create policy in accordance with conservative views. In addition, because of the conservative belief in a family-based moral system that is of utmost importance social safety net programs, and women's reproductive rights.
This polarization between liberal and conservative worldviews is causing anxiety, anger, and rage across our nation. Liberal and conservative political worldviews are resistant to argument, logic, or facts according to Cahn,et al. [13]. In fact, cultural research suggests that when facts or empirical evidence conflict with individuals' viewpoints, they reinterpret or deny the information rather than change their beliefs. Many areas of public and women's health have been impacted by the conservative worldviews including childhood vaccinations where conservatives who hold the worldview that government and science cannot be trusted, may be more inclined to withhold vaccinations for their children. These individuals are also more likely to believe in conspiracy theories regarding the effects of vaccinations. Withholding vaccinations from children can cause the transmission of diseases to other children as well as the family.
The accessibility of health services for women are also negatively impacted by the loss of support and funding for organizations such as Planned Parenthood that not only provides abortions but also provides affordable reproductive healthcare, cancer screenings, STD diagnosis and treatment, prenatal care, and birth control. Access to safe abortion and birth control are critical to the health of women and to their autonomy.
A belief in the "strict father" worldview, while being loving and caring, promotes the use of strict rules and punishment to discipline the children. This punishment is most often physical for example, spanking, hitting, and slapping. Research indicates a childhood history of spanking is associated with an increased likelihood of suicide attempts, moderate to heavy alcohol abuse, and street drug use in adulthood.
Violence and punishment are also seen in domestic abuse cases where the dominate male in the family believes that it is their duty to insist on punitive consequences for those who disagree or deviate from their viewpoint, including their wives. In addition, some abusers use religion to legitimize their abusive behavior in order to deny responsibility and mitigate feelings of guilt following the abuse of their partner and/or children [13].
It is important for the general public to be aware of these different worldviews and to understand the implications of allowing the conservative worldview to permeate our government, laws, and policies. It is up to all of us to promote scientific knowledge, gender equality, the separation of religion and government, healthcare for all, becoming media savvy to avoid believing conspiracies and false information, and sharing health-related resources for the public.