The U.S. suffered 5 to 7 times more deaths due to COVID-19 per 100,000 people than did Taiwan, South Korea, and Japan. Why did so many more Americans die from the virus than people in these East Asian countries?

In a recent paper, an international team led by Stanford researchers proposed that “cultural defaults” – taken-for-granted habits of thinking, feeling, and acting in a particular society – played a significant role in how countries responded to the coronavirus pandemic, resulting in these national disparities.

The team’s analysis demonstrated that the defaults common in the U.S. reflect and foster individualism, or the prioritizing of the individual over the group. Contrastingly, the defaults common in East Asian countries reflect and foster collectivism, or the prioritizing of the group over the individual, which can be more effective in reducing mortality in a pandemic situation.

“We have introduced the concept of cultural defaults as a new and unexamined reason for the dramatic differences in life and death from COVID-19 in the United States and some East Asian countries,” said lead author Hazel Rose Markus, the Davis-Brack Professor in the Behavioral Sciences and professor of psychology in the Stanford School of Humanities and Sciences (H&S). “We found that many American defaults such as optimism and personal choice, which generally put us in good stead, did not serve us well during the pandemic.”

According to the researchers, cultural defaults are not inherent traits or fixed human tendencies, nor are they stereotypes. They are built into a national culture through institutions, media, and cultural products, as well as the practices and norms of social networks and daily interactions. Cultural defaults capture how the individualism of the U.S. and the collectivism of many parts of East Asia are experienced psychologically.

“By showcasing that cultural defaults are important for explaining behavior, we hope our paper can help policymakers and decision-makers learn from what happened during COVID-19 to better deal with current crises and plan for future challenges,” said co-author Jeanne L. Tsai, the Dunlevie Family Professor and professor of psychology in H&S.

The paper was published in a recent issue of the journal Psychological Science in the Public Interest. Other co-authors include Yukiko Uchida, professor of psychology at Kyoto University; Amrita Maitreyi, a research associate at Stanford SPARQ, a behavioral science “do tank” where Markus serves as faculty co-director; and Angela Yang, who earned a bachelor’s degree in psychology from Stanford in 2022.

Bridging empirical research and public policy

Over the course of their research, Markus, Tsai, and colleagues synthesized decades of studies in cultural psychology, which explores how culture affects people’s feelings and actions. The researchers then linked these empirical findings to statements made by high-level governmental and organizational decision-makers in the studied countries and to the different national responses during the pandemic.

The researchers identified six contrasting pairs of defaults (See Figure 1) that people and organizations in the U.S. and in some East Asian nations relied on when grappling with pandemic-related questions such as “How should I feel about this crisis?” and “Will it happen to me or us?”

For example, in U.S. cultural contexts, many people were initially optimistic that COVID-19 would not be much of a problem and that it wouldn’t happen to them. This is behavior related to what the researchers call the optimism-uniqueness default. In contrast, in some East Asian cultural contexts, the common response was more realistic, and people assumed that the crisis would affect them. This is in line with the realism-similarity default the researchers identified. These defaults were mirrored in the statements of high-level decision-makers.

For example, Anthony Fauci, former head of the National Institute of Allergy and Infectious Diseases in the U.S., initially said of the novel coronavirus that although “you need to take it seriously … this is not a major threat to the people of the United States.” Conversely, the prime minister of Japan at the time, Shinzo Abe, said, “Fighting an enemy that is hard to see and to understand is not easy” and “This is most certainly not someone else’s problem.”

Because of their respective cultural defaults, the highly individualistic U.S. handled some aspects of the pandemic much less effectively than collectivist East Asia. “An infectious disease violates the American assumptions that people are separate and independent,” Tsai said. East Asians tend to view themselves as connected and interdependent, are generally more cognizant of the impact their actions can have on others, and are more used to adjusting their behavior to fit with others, the paper authors explained.

Keeping culture in mind for public health

The journal invited thought leaders to comment on the paper. Ichiro Kawachi, the John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology at the Harvard T.H. Chan School of Public Health, praised the authors’ work, writing that their arguments “represent an important advance in our understanding of the public health response to the pandemic. Culture is frequently listed as a macro-level driver of population health … yet seldom analyzed in any depth.”

“As we are planning, we must also enlist the help of more social scientists who can help us navigate the culture and systems that we have built,” wrote Sara Cody, the director of the Santa Clara County (CA) Public Health Department and a second commenter on the paper. She added that U.S. defaults “all conspire to make the practice of public health, at times, a Sisyphean endeavor ... we need to make plans that embed and require interdependence.”