If you want to understand why America is faring so badly in the fight against Covid, it helps to understand deeper public attitudes toward health—and how they’re different around the world.
In 2009, you could immediately spot the cool kids at my middle school in Seoul based on a single item: face masks. The masks specifically had to be from Sakun, a Korean streetwear brand that became known for its black masks with teeth marks printed on the front. It was common all over Korea to see 15-year-olds with thick bangs and Sakun masks, only their eyes visible. The masks signaled that you were mysterious, trendy and a little intimidating—everything a middle-schooler wanted to be.
The trend first kicked off when a member of Big Bang, the most popular boy band in Korea at the time, wore a Sakun mask in a series of selfies in 2008. From there, ulzzangs—late 2000s influencers who built massive fan bases by posting flattering photos on social media—adopted the masks in their daily fashion. Until that point, face masks were occasionally worn by sick people in Korea, but now they started to go mainstream: as a way to cover pimples, block out air pollution and, eventually, protect wearers from getting or spreading airborne viruses.
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So, when the Covid-19 outbreak hit, it wasn’t surprising that Koreans reached for their masks en masse even before the government required them to, or that the government began producing some 186 million masks each week for a country of 51.6 million people. Masks are a completely normal part of Korean life. Growing up, it was not uncommon to walk down the street in Seoul on a spring day and see gaggles of people emerging from subway stations with masks on. Even after the Sakun trend petered out, many kids, me included, still kept some kind of mask buried in the corner of our wardrobes. When a new epidemic hit, we knew what to do.
The same simply cannot be said for the United States, where states are battling cities over local face-covering requirements; congressional staffers have reported getting berated for wearing masks at work; and no shortage of politicians, including, for several months, the president himself, have resisted mask-wearing. Despite the scientific evidence supporting the effectiveness of masks in minimizing viral transmission, the share of Americans who say they “always” wear a mask when they go out hovers around 50 percent in recent polls.
If you want to understand how the United States is faring so badly in the fight against Covid—even compared with denser countries that got hit earlier—it helps to understand Americans’ deeper public attitudes toward health, and why those attitudes are so different in other parts of the world.
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Part of the resistance to mask-wearing in the United States has to do with the fact that it’s become a partisan political issue. But what I saw growing up in South Korea is how cultural norms can play an important role in the way a country approaches a public health crisis like the coronavirus. I also saw how those norms can change over time, which means they might just change some day in America—too late for this pandemic, but maybe not for the next one.
There are numerous reasons Americans cite for not wanting to wear masks. Some see mask mandates as an attack against their freedom; some think masks make them look weak; some—incorrectly— believe masks will cut off their oxygen supply; and some simply find masks uncomfortable. Underlying these arguments is the strong sense of individualism that Americans trace to the country’s founding, says Josef Woodman, CEO of Patients Beyond Borders, a company that provides resources for people who seek medical treatment abroad. That same sense of individualism, he says, is part of the reason the United States is one of the few developed countries in the world without a universal health care system.
“That’s what worked in the United States: a ‘me’ culture and the rugged individualist heading West in their wagon trains. All that is still part of the iconic image of Americans, ” he says. “And it’s not working so well for us right now.”
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In Asian countries such as Japan and South Korea, people more commonly believe they have a civic obligation to take care of one another, says Somava Saha, who leads an organization called Well Being and Equity in the World and has worked on public health projects across the globe. There are words for this sense of responsibility. In Japan, it relates to the concept of giri, or duties toward others. Koreans refer to inhwa, a culture of harmony between people that is seen as a social value. Masks are common in these countries even in nonpandemic times, such as during the flu season. The idea is simple: Assume that anyone can be a carrier—even yourself—and protect others from yourself by wearing a mask.
The few Koreans who don’t wear masks are often met with glares and public shaming. When I was in Korea in April, a teenager without a mask sat next to me on the train and started talking on his phone. As I scooted away from him, he met with stares from the passengers until an elderly lady scolded him. He immediately hung up and got off at the next station.
“I’m furious when I see people not wearing a mask, ” says Seo-joo Kim, 19, a student at Dankook University. “Covid-19 is a virus that can only be stopped if everyone does their duty. You can’t expect yourself to be the only exception.”
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Trust in government is another factor that can affect compliance with public health measures like mask-wearing. In a study of the 2014-15 Ebola outbreak, researchers in Liberia found that the disease spread more widely and for a longer period of time because people’s faith in the government was low. Individuals with lower trust in the government were less likely to follow safety precautions such as implementing “safe burial” practices for infected bodies, keeping chlorinated water on hand at home and restricting travel.
This past January, before the coronavirus was known to be widespread, U.S. News & World Report conducted a survey in which it found that just 44 percent of Americans said they trusted their government to take care of their health. Italy also recorded a low rate, 52 percent. Meanwhile, 80 percent of Chinese respondents said they trusted the government, and 65 percent of Koreans felt the same way. In late March, the outlet published an article observing that countries with lower levels of trust generally were not responding as well to the virus.
In the United States, trust in government has been on a downward trend for two decades and is now near a historic low. To make matters worse, distrust in government is often paired with skepticism toward the health care system, says Carolyn Orbann, a University of Missouri anthropologist who studies how culture affects the spread of infectious diseases. “The trust issue is a problem because people have been feeling failure from the health care system for a while, ” Orbann says. “They’ve had lack of access. Our health care system is very expensive. Rural communities are being abandoned. Hospitals are closing, providers are leaving.”
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In mainland China, where citizens generally have a positive view of their government’s response to the coronavirus, they also have been willing to comply with intrusive surveillance policies, such as being required to scan QR codes when entering buildings in order to facilitate contact tracing.
In the United States, it doesn’t help that masks sometimes come with negative cultural connotations. Saha says masks in American pop culture are often linked to mischief and ill deeds. “If you ask the average American, [wearing masks] is associated with gang culture, and if you think about every Western you’ve ever seen, it’s the bad guys that are wearing the masks that are bandannas, ” she says. People who fear being targeted by law enforcement might determine that the risk of being mistaken for a criminal is worse than the risk the virus poses.
“I’ve heard, when we didn’t have enough of a supply of what looks like official-looking surgical masks and asked people to wear bandanas and cloth coverings, many communities of color immediately said, ‘I’m not wearing that. That’s like taking my life in my hands, ” she says. (Despite this risk, there is evidence that people of color in the United States are more likely to wear masks than their white peers.)
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The good news for the United States is that attitudes about masks and other health measures can change over time. I saw this in South Korea. Even when Korea was faced with the threat of SARS in 2003, masks weren’t widely used, partially because the government was able to keep the virus at bay. During the ensuing years, Koreans wore masks as fashion statements or to protect from dust particles, but they weren’t solidified as part of Korean culture until the swine flu outbreak in 2009 and MERS in 2015. Consistent messaging from experts on the benefits of mask-wearing
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