Now that the world is officially in the midst of another public health emergency, this time prompted by an epidemic of clade 1b mpox in several African nations and the subsequent discovery of an imported case in Sweden, public health organizations at all levels are once again faced with the task of communicating health risks to their respective publics.
For many years, public health in the U.S. has operated under a paradigm known in the risk communication field as the deficit model. In the deficit model, experts see themselves as having the task of educating the general public, using their knowledge to inform lay people of the nature of the health risk and how to respond to it. In other words, the lay person is effectively a blank slate and only needs the right information and to be told what to do about it, thereby remedying the information deficit. Any resistance to this form of communication is perceived as a result of the public’s continued ignorance. Further education should, in theory, close these knowledge gaps.
This top-down approach leaves little room for the thoughts, feelings, and lived experiences of the audiences that scientists and public health officials seek to reach. There is no need for discussion or negotiation because the “expert” controls the flow of information. This is problematic for a number of reasons, not least because it sets up a communication dynamic that is at best ineffective and out of touch and at worst counterproductive.
Today, the deficit model is regarded as outdated and ineffective. The field of risk communications has since advocated replacing the deficit model with dialogue-based models in which information flows both ways. However, despite these positive developments, most public health and science communication still follows the deficit framework. This is a problem, because as we saw during the COVID-19 pandemic, more information does not always translate into the public taking the desired actions.
One only has to consider the complete failure of the deficit model to counteract the anti-vaccination movement, which has grown in strength over the course of the past decade. And while it is easy to blame the failing public education system in the U.S. for declining science literacy and general mistrust of scientific institutions, the story is more complicated and requires a deeper dive than is possible in this post. But one major takeaway is that people’s beliefs are motivated by many factors, and simply offering more information is usually not a sufficient incentive to change them.
The mpox epidemic of 2022 once again revealed the weaknesses of public health communication about risk, but the fact that the virus was most prevalent in a community already well-versed in responding effectively to health threats meant that there was a high degree of cooperation with health authorities. However, the LGBTQ+ community has been critical of the U.S. government’s response to mpox, citing the fact that they felt further stigmatized by its messaging. Some public health experts were additionally critical of the choice to label mpox as a sexually transmitted infection (STI), fearing that the added stigma would discourage patients from seeking health care. For example, the authors of this article point out that “far from the global, societal threat that characterizes COVID-19, considering mpox to be an STI may cause it to be perceived as a problem only for certain individuals. In the case of HIV, the advent of effective medications in the Global North contributed to policy shifting from seeing the virus as a societal issue to seeing it as an individual health condition, thwarting social action and deepening inequalities.”
And now we find ourselves in the worst-case scenario–clade 1b mpox, which is the strain that health authorities are currently trying to contain, does not behave like clade 2 mpox, which was predominantly diagnosed in men who have sex with men (MSM). This strain of mpox seems to be more transmissible through casual household contact, although it can be transmitted through sexual contact as well, and poses the greatest threat to young children. This requires a coordinated global response that involves everyone, not just a specific subculture. Yet the messaging around the 2022 outbreak has arguably done more harm than good, as health authorities will now have to revise their approach to communicating risk, undoing the previous messaging and starting over at square one.
It could be argued that the ineffectiveness of the communication campaigns from public health authorities has led to an insufficient global response that has left the hardest hit parts of Africa, particularly the epicenter of the current outbreak in the Democratic Republic of the Congo, without adequate vaccines to stop the spread of mpox. Without global investment in vaccine development and the health care workforce to deliver them, the spread of mpox threatens to overwhelm the continent and will undoubtedly spread beyond its borders.
Health authorities need to start applying the lessons learned during the COVID-19 pandemic when developing communications strategies to address public health emergencies. Top-down approaches are counterproductive, and emphasizing personal responsibility and individual risk leads to the perception that public health is an individual choice instead of a community responsibility that requires real, tangible economic and social investment. While communicating risk and uncertainty is inherently uncomfortable, it is profoundly necessary. Instead of emphasizing those populations who are most vulnerable, we should adopt language that emphasizes the shared public good that is health and well-being, while listening and responding to the concerns of those whose interests we serve.
Comments