Francesca Matthews Pillemer

Francesca Matthews Pillemer

formerly Senior Policy Analyst, RAND Corporation

Dissertation Title:"Responses to the Use of Public Health Authority"

The potential uses of public health authority are broad. They range from smaller powers, such as prohibiting smoking in the workplace, to greater powers, such as large scale quarantine or the forced institutional isolation of sick individuals. Across this spectrum of activity, public health officials and decision makers rely on the public to comply with public health recommendations and to maintain the political support necessary to achieve public health goals through the use of authority. This dissertation addresses the relationship between public support and public health authority on the issues of pandemic preparedness and sexual education policy. For pandemic preparedness, this dissertation also investigates the perspectives of decision makers on the uses of public health authority.

Section 1 uses public opinion data from 4 countries (United States, Hong Kong, Taiwan, Singapore) and regression techniques to explore the predictors of support for non-pharmaceutical interventions (NPIs), such as quarantine. We find that the predictors of NPI support vary widely by region. However, ethnic subgroups are generally less supportive of punishment for non-compliance. Prior exposure to face mask usage also results in increased support for future face mask usage, as well as other NPIs. Cultural issues and prior experiences may account for the variations in response to policies.

Section 2 analyzes national public opinion data with regression techniques to investigate predictors of both sexual education policy and political motivation (i.e. willingness to change a vote over this issue). Associations with political motivation are evaluated for both supporters of comprehensive sexual education and abstinence-only education. We conclude that the predictors of support for a particular type of sexual education are distinct from the predictors of political motivation at both the state and local level. Most notably, while religious affiliation and conservative ideology were both significant predictors of policy preference, religious affiliation was not a significant predictor of political motivation for abstinence-only supporters. This may reflect some form of political organization.

For section 3, I conducted interviews with 15 high-level decision makers for public health emergencies in Massachusetts on the subject of altered standards of care. This section focuses on interviewees’ perceptions about the likelihood of events, sources of advice and information, ethical preferences and the decision making process. Our results indicate a low-level of consensus for ethical preferences, which were often driven by varied principles (e.g.utility, fairness, etc…) Consensus for more extreme public health interventions was greater than consensus for less extreme interventions. Importantly, not all decision makers used an ethical framework in their approach to policy preferences, which is in contrast to the current focus of the literature.


Graduation Year


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