Generating opposition to universal health care policies in the United States: An analysis of private health industry advertising on Meta platforms

In 2019, the Partnership for America's Health Care Future (PAHCF), a private health industry lobby group, launched a campaign across Meta platforms (Facebook, Instagram) to generate opposition to universal health care policies in the United States. This study investigates the content and themes prevalent in PAHCF's campaign and how these might shape public discourse and perceptions around universal health care policies. Using qualitative content analysis, 1675 advertisements were examined on Meta platforms within PAHCF's campaign. Inductive methodology was applied to develop a coding framework. Details of campaign spend and number of impressions advertisements received were also collected. The qualitative coding strategies identified three overarching campaign foci: policy targets, claims and themes, and targeted appeal groups. These elements were found to strategically and mutually reinforce one another to generate the narrative that proposed universal health care policies will be detrimental to public health, the economy, and society. Analysis identified that PAHCF engages in strategies common among unhealthy commodity industries. Social media in this instance powerfully perpetuated PAHCF messages that undermined universal health care efforts and contributed to the commercial determinants of health impacts of this industry. These findings indicate that the private health care industry is participating in wider commercial determinants of health activities, acting to protect their profits to the detriment of public health. Like other campaigns by unhealthy commodity industries, PAHCF's campaign is designed to increase doubt in the benefits of health policies, undermine public trust in government and evidence, and promote public alignment with their own messaging and preferred solutions. To counter such tactics, public health professionals need to gain a better understanding of the strategies unhealthy commodity industries utilize to deflect attention from their underlying health-harming intentions, especially through more novel platforms like social media.