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Introduction
In December 2022, the AAMC Center for Health Justice conducted a nationally representative poll of 1,510 members of Generation Z (Gen Z), ages 18 to 24, with the purpose of learning more about their attitudes about some of the social factors that influence health and health equity. What does Gen Z value?
Gen Z comprises individuals born between 1997 and 2012, though our poll focused on adults (age 18+) from this generation. Overall, previous polls have suggested Gen Z is on track to have had more years of schooling and to be more politically progressive than both Generation X and the Baby Boomer Generation.
In terms of political ideology, 24% of individuals in our sample identified themselves as conservative, 50% of individuals identified themselves as liberal, and 26% of individuals identified themselves as moderate. These proportions are similar to other polls assessing ideology in this age span.
Concerning health and health equity, other recent polls suggest that Gen Z has developed a holistic understanding of these concepts. For example, a poll from the University of Michigan1 found that more than 80% of 14- to 24-year-olds indicated the importance of medical providers screening for health-related social needs such as housing and food security.
Why the vital conditions?
Source: Rippel Foundation. Vital Conditions for Health and Wellbeing.
The findings from this poll support and strengthen current research that demonstrates the key roles — and importance — of many social and economic factors that impact health. The Vital Conditions for Health and Well-Being framework is a helpful lens for understanding the complex interactions between the many social influences necessary to create healthy communities and, therefore, healthy people. The framework accounts for basic needs for health and safety, belonging and civic muscle, humane housing, meaningful work and wealth, and a thriving natural world.
Gen Z has matured to adulthood during years when there has been increasing awareness of the effects of social influences on individual and population health. Although there is generally a divide on social issues across political ideologies (i.e., liberal and conservative), there are many important areas of widespread agreement.2
More than half of Gen Z agreed that reproductive justice, racial justice, housing affordability, gun violence, and climate change should be a top priority for the federal government to address (Figure 1).
Basic Needs for Health and Safety
Basic needs for health and safety encompass access to clean air and water, nutritious food, quality health care, and a life free from violence, injury, and toxic stress.
Generation Z believes that access to health care is a basic human right…
Our poll found that 87% of Gen Z agreed with the statement “Access to health care is a basic human right,” including 77% of conservative Gen Z (Figure 2). Perhaps in contrast with this finding, more than two-thirds of Gen Z agreed with the statement “A person is ultimately responsible for his/her own health.” This is consistent with findings from a report by Fierce Healthcare3, which posits that Gen Z will be influential in shaping the future of the health care landscape — which, findings suggest, would be primarily due to an increasing focus on patient-centered holistic care.
Across key demographics such as race/ethnicity, political ideology, region, religion, sexuality, and metropolitan status, nearly three-quarters of Gen Z said access, affordability, and quality are essential elements in improving health care.
…and in the freedom to make their own reproductive choices.
Almost 8 in 10 of Gen Z (79%) agreed with the statement “People should have the right to decide if they want to continue a pregnancy.” Even among self-identified conservative Gen Z, more than half agreed with this statement. In addition, 61% of Gen Z categorized reproductive justice as a top priority for the federal government to address. Two-thirds (66%) of all Gen Z polled agreed with the statement “My generation is willing to fight for abortion access and can make a significant impact.” This broad agreement is especially salient given the wave of recent legislation that restricts abortion access.
Generation Z believes that gun violence is a public health issue...
Seven in ten (70%) of Gen Z respondents agreed that gun violence is a public health issue, with nearly half (49%) of conservative respondents endorsing the statement.
…and that cannabis legalization and research have potential benefits.
Seventy percent of Gen Z across all respondent demographics surveyed, including more than half of conservative Gen Z individuals, agreed that marijuana should be legalized for adults and that there should be more research on the effects of marijuana, psilocybin, and MDMA on people’s health.
Belonging and Civic Muscle
Belonging and civic muscle as a vital condition refers to “the need for individuals to have fulfilling relationships and social supports. Belonging and civic muscle also encompasses the freedom to thrive without being subjected to oppression and hate.”4
Generation Z believes that inequities are present in the U.S. health care system…
Two thirds (67%) of Gen Z agreed with the statements “Systemic racism is a public health crisis” and “Systemic racism makes it more difficult for people of color to get access to the health care they need" (Figure 3). Among individuals who reported having experienced discrimination within the past year, 77% believed that systemic racism is a public health crisis. Almost three-quarters (73%) of Gen Z across all respondent demographics believed that the COVID-19 pandemic highlighted inequities that were already present in the United States health care system; echoed by an even higher percentage (82%) of individuals who reported experiencing discrimination within the past year.
…but does not have consensus on why these inequities exist.
More than half (52%) of the conservative individuals in Gen Z agreed with the statement “Health differences observed between different racial groups are the result of the way people decide to live, not because of racism.”
Generation Z has little confidence in the criminal justice system.
Fifty-one percent of our overall sample reported having experienced discrimination of any type and 27% reported having experienced discrimination in the past year. In addition, the majority of Gen Z (60%) reported having little to no confidence in the U.S. criminal justice system to treat all individuals equally. Trust in police departments was especially low among individuals who had experienced discrimination.
Humane Housing
Humane housing as a vital condition means that “people are able to thrive with access to secure, consistent places to live, homes and neighborhoods that are safe from hazards, and neighborhoods that provide access to food and other basic needs, opportunity, and resources that promote healthy living.” Humane housing also means addressing housing affordability and the ways that the inaccessibility of homeownership can detract from building generational wealth, a key contributor to compounding inequities.
Generation Z is committed to fair housing policies...
More than three-quarters of Gen Z indicated that racial residential segregation and discrimination in housing (77%), and residential segregation and discrimination in housing including LGBTQ+ and disability discrimination (70%) should be a priority for the federal government to address.
…and agrees that affordability should be addressed.
Sixty percent of Gen Z agreed that housing affordability is a problem that should be addressed at both the local and federal levels. The majority of Gen Z thought the shortage of homes and apartments for rent (82%), the number of Americans experiencing homelessness (84%), and the poor quality of public housing (81%) are important for the federal government to address (Figure 4).
Meaningful Work and Wealth
Wealth includes personal, family, and community resources, bolstered by gainful careers that can provide financial security. Generational wealth is instrumental in building a successful future for individuals and families and in addressing the persistent wealth gaps experienced by many communities.
Generation Z believes that there is a wealth gap.
Across all demographics (including politically conservative), nearly three-quarters of Gen Z (73%) believed that federal government should pursue policies that try to reduce the gap in wealth between the richest and poorest Americans (Figure 5). Seventy-six percent of Gen Z agreed that the federal government should give economic support to those with lower incomes.
Thriving Natural World
A thriving natural world means clean air, clean water, clean land, and well-functioning ecosystems. A healthy environment is one that is free from environmental hazards, resilient to future changes and threats, and fulfills our need to connect with nature. Environmental justice “embraces the principle that all people and communities have a right to equal protection and equal enforcement of environmental laws and regulations.”
The majority of Generation Z is concerned about climate change…
More than 7 in 10 individuals we polled believed climate change is an immediate (73%) and long-term (79%) threat to the safety of the planet (Figure 6). Over half of Gen Z believed the health consequences of climate change will harm everyone in the United States equally (57%).
…and believes the issue is complex.
Eighty percent of Gen Z thought public health agencies should work with communities to improve the environment and 74% stated that the United States should commit to policies that target reducing CO2 emissions. Despite their concern, only half of Gen Z say they have been personally impacted by the effects of climate change — either because they disagreed with the statement or they were not sure.
Conclusion
Generation Z understands that population health is not based solely on clinical measures of health. As framed by the Vital Conditions for Health and Well-Being, well-being is a product of whether your basic needs are being met, your sense of belonging and civic engagement, what resources you have easy access to, and your physical environment.
The findings of this poll highlight that although ideological divisions persist among members of Gen Z, there is a sense of softening demarcation across topics that have previously been thought of as politically polarizing. The vital conditions are of great concern to many members of Gen Z. The general agreement across measures such as the right to health care, the importance of access to abortion, the need to reduce the wealth gap, and the threat climate change poses to the health of the planet — and the responsibility of the federal government to address all these issues — demonstrates that members of this generation have deep awareness of the factors impacting health. From forming active political movements5,6,7 and organizations to championing important social causes, Gen Z has already begun to make its voice heard about the health and well-being of the United States. Gen Z is a political and social force to be reckoned with and as the fastest growing portion of the electorate, policymakers will not be able to count them out.
