The Protestant Work Ethic could explain a liking for 'natural' health care, research suggests

A strong belief in the Protestant Work Ethic might underpin the decision-making of many people choosing "natural" approaches to health care, new research suggests.

Academics say their paper, published in the Journal of Consumer Research, identifies the role of psychological factors in health choices ranging from a preference for vaginal birth—over cesarean sections—to "natural" cold and flu remedies. In the latter case, the preference holds even if the chemical composition of natural remedies may be identical to compounds synthesized in the laboratory.

Their work has implications for governments, global health organizations and clinicians around birth choices, the academics say. It could also reshape the marketing strategies and approaches of health care product manufacturers.

Anirban Mukhopadhyay, Professor of Marketing and Behavioural Science at Bayes Business School (formerly Cass), City, University of London, and Dr. Yimin Cheng, Associate Professor of Marketing at Melbourne's Monash University, analyzed country level data for cesarean sections across 41 nations and conducted five lab-based and online studies.

They identified a link between a strong belief in the Protestant Work Ethic and a preference for vaginal birth and natural over synthetic medicines.

Living their values

German sociologist Max Weber developed the influential concept of the Protestant Work Ethic (PWE) to explain the rise of modern capitalism, suggesting that the belief system instills virtues of hard work, self-reliance, frugality and asceticism. Later research from psychology suggests that these values may be held independent of religious beliefs, retaining their power in diverse communities and nations. Indeed, the latest studies found no link between belief in PWE values and religious belief.

The researchers assessed the strength of participants' PWE beliefs by using 13 questions from the World Values Survey and European Values Study, including a belief that success comes from hard work and that society would have fewer problems if people had less leisure time.

Professor Mukhopadhyay and Dr. Cheng tested whether some of those values—particularly self-reliance and hard work—embed a suspicion of external intervention and therefore a preference for "natural" health products and services.

Key findings include:

• Cesarean section rates across the 41 countries varied from less than 10% to over 40%—with a strong correlation between low rates of cesareans and high PWE scores, even after accounting for factors such as GDP per capita and access to medical facilities.
• Similarly, a study of 80 American women who had recently given birth vaginally and 80 who had chosen elective cesarean sections revealed that the former group were much more likely to strongly accept the values embodied in the PWE.
• Two online studies each involving 400 Americans found that an antipathy to external interference meant those with higher PWE scores were more likely to prefer natural medicine. They were more reluctant to embrace synthetic medicines—ranging from stomach flu to cancer drugs—even where the treatments' molecular structures are identical and they are equally effective.

Professor Mukhopadhyay said, "Medical experts caution about the rising prevalence of cesarean sections. Our finding around birthing choices raises the question of whether a short PWE assessment should be part of maternal health screening to help identify and caution low-PWE mothers about the potential risks of elective C-sections, where not medically necessary.

"It also suggests that at a global level, governments and international health care organizations could invest more effort in promoting natural deliveries in low-PWE countries. In the business sector, pharmaceutical companies and other health product suppliers could redirect and reshape their marketing to different population groups depending on how 'natural' the drug or other treatment is."

A market worth trillions

Dr. Cheng said, "Health care spending in the US alone passed $4 trillion in 2020 and is projected to grow at more than 5% annually. Consumers have been empowered to make their own health care decisions by the availability of over-the-counter drugs and private health care providers.

"Often that choice includes the option of a more 'natural' treatment. Our work suggests that even when there is no chemical difference between treatments, such decisions may be influenced by complex belief systems—including the pervasive impact of what Weber called the Protestant Work Ethic, even in secular societies."

In a final online study, 601 Americans were asked to imagine they had stomach flu. The researchers tested whether it was the extent of external intervention (e.g. adapting a wild plant for human use) or the intrusiveness of the intervention (e.g. gene editing), that drove people with high PWE scores to choose the most "natural" over-the-counter treatment option.

Those who identified strongly with PWE values were less likely to choose the option involving intrusive synthesis, such as gene editing. They appeared more willing to trust treatments which involved more visible but less intrusive human intervention—such as extensive processing of a wild plant for human consumption.

This suggests, the authors say, that the preference for "natural" treatments and approaches is not simply linked to a conservative world view expressed through respect for tradition. If such a yearning was in play, they suggest, the participants with high PWE scores would not differentiate between the two "unnatural" products.