Historical Border Changes and Contemporary Public Health Outcomes

Abstract

Trust in government is a key predictor of adherence to government recommendations and accordingly plays a central role in compliance with public health policies. The COVID-19 pandemic underlined the importance of voluntary adherence to government public health recommendations. How trust deficits might be overcome to increase public health compliance depends crucially on its sources. We argue that the legacies of state-building and international politics in Europe are a significant source of variation in contemporary local adherence with public health recommendations. Building on research that links historical border changes to trust deficits in Europe, we show that more border changes in a locality relative to neighboring units affects two public health outcomes in Europe: COVID-19 vaccine hesitancy during the 2021 vaccine rollout and uptake of three established vaccines prior to the pandemic. We show that trust in government mediates the relationship between border instability and uptake of these established vaccines at the local level.