Public health working to fight misinformation through trust, relationships: Facts not enough
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* Lindsey Wahowiak

Despite best public health efforts, misinformation about health can spread wildly — often faster than factual information. It is a problem public health both recognizes and is struggling near-constantly to combat.

In a study published March 9 in *Science*, researchers at the Massachusetts Institute of Technology found that, at least on Twitter, “Falsehood diffused significantly farther, faster, deeper and more broadly than the truth in all categories of information,” especially for stories that were political in nature.

It makes sense. People are more likely to trust a friend or family member who shares something on Facebook than a stranger. But there are no laws or regulations that require items posted online or on social media be true.

That is why the relationships health providers and community health workers have with individuals and communities have never been more important, said Barbara Glickstein, MPH, RN, MS, director of communications for media projects at the Center for Health Policy and Media Engagement at the George Washington University’s School of Nursing.

“Across the spectrum, we have multiple obstacles to get to what we know to be the current-day truth,” Glickstein told *The Nation’s Health.* “Our job is not only getting out the best information, (it’s) also countering the misinformation.”

Vaccination is a prime example of how misinformation can wreak havoc on public health. Public health practitioners share information about how vaccines protect children and adults from easily preventable but deadly disease.

Yet some parents still refuse to get their children vaccinated, stemming from the results of a single discredited 1997 study. Measles was declared eliminated in the U.S. in 2000, but in 2014, the Centers for Disease Control and Prevention reported that 667 people over several states contracted the disease, brought on by travelers and made worse by communities where vaccination was uncommon.

The science itself often does not win people over, said Genna Reed, MA, lead science and policy analyst at the Union of Concerned Scientists’ Center for Science and Democracy and former co-chair of APHA’s Food and Environment Working Group.

“The decisionmaking process for all of us involves a lot more than just science; it involves relationships and trust and values,” Reed told *The Nation’s Health.* “That has to play into the way we’re incorporating science and working within our communities to reach the public health goals that we want to reach. It’s important to remember you don’t win hearts and minds with science and facts. You win hearts and minds with relationships and trust.”

Public health leaders need to not only reach community members, they need to reach policymakers as well. But there are some who, despite advocates’ efforts to protect and share important health information, try to sway the public with bad information. And they are improving their misinformation campaigns.

Crisis pregnancy centers are an example. They are designed to look and sound like clinics that provide abortion care or options counseling. They bill themselves as local nonprofits that provide support for people with an unwanted pregnancy.

But they are designed to prevent people from seeking or obtaining a wanted abortion. They use deception to get their way, said Erin Matson, co-founder and co-director of Reproaction, a reproductive justice nonprofit.

Crisis pregnancy centers are often located near abortion providers. They may even have similar-sounding names. That is the point, Matson said: Crisis pregnancy center volunteers and staff — who are not medical providers — get people to walk in their door instead of a clinic’s to keep people from getting an abortion.

A 2015 report by the National Institute of Reproductive Health found that crisis pregnancy centers falsely tell people who come in that abortion is linked to breast cancer, infertility and mental health issues. A 2018 study in APHA’s *American Journal of Public Health* found that when women are prevented from getting a wanted abortion, they have worse health and economic outcomes.

But none of this information is on crisis pregnancy centers’ websites, which are modeled to look like an option for someone considering an abortion, and optimized to populate in Google searches related to finding abortion services. The deception is by design: “The abortion-determined woman will not walk into a pregnancy center voluntarily,” said Brian Fisher, president and co-founder of anti-abortion group the Human Coalition, in 2017.

“As a big data group, they’re constantly updating and optimizing,” Matson told *The Nation’s Health.* “They’re making it easier and quicker to reach the next person. The vast majority masquerade as legitimate clinics that are neutral on abortion.”

Matson noted the parellels between crisis pregnancy centers and other public health misinformation campaigns, such as anti-vaccination groups.

“It’s so similar: It relies on junk science, it peddles shaming,” she said. “This is about broader health care systems, and this is about access to care.”

## Public health finding solutions to problem

To fight misinformation, public health could turn to a long-trusted source: nurses. Nursing has been rated the most trusted profession for 16 years running, according to a December Gallup Poll. Public health could do more to make nurses the spokes people for campaigns. The Woodhull Study Revisited, published by GW’s Center for Health Policy and Media Engagement, found that nurses account for only 2 percent of quotes in media health coverage.

And public health could do well to diversify: Minority Nurse, a resource for nursing professionals, found that 75 percent of nurses self-report as white. A 2013 study in *Social Work Research* showed that patients have better outcomes and feel more trust in their providers when providers with shared backgrounds serve them.

Some communities, however, may balk at trusting health professionals. A long history of unethical research on and treatment of black Americans has led many to question medicine’s efforts to improve outreach and care to the black community. And in immigrant communities, there may be distrust of public health departments and other agents of the state, particularly among immigrants without legal permission to be in the U.S., who face higher health risks than other populations.

Rather than ignoring history, public health ought to acknowledge it, said Jeffrey Spike, PhD, a professor of bioethics at the University of Texas School of Public Health’s Department of Management, Policy and Community Health.

“When addressing a marginalized community, and especially a community that has suffered from discrimination and injustice at the hands of the medical and public health establishment in the past, the most important thing to do to establish trust is to let members of the community know you acknowledge what was done, and that it was wrong, and that you want to make sure it will not happen again and to do that you need their active and honest participation,” Spike, an APHA member, told *The Nation’s Health.* “Even if you weren’t part of what happened, or weren’t born yet, it can help to say you are sorry. If you expect them to trust you, they deserve to know how strongly you feel about the wrongs of the past.”

Public health is making inroads to share the best information with communities, and to bring people around to putting their health and the best science first. Glickstein pointed to successful public health campaigns, such as Text4Baby, which reaches new moms with infant care information via text messages.

She also noted that public health is elevating the work of advocates from Black Lives Matter and survivors of the Parkland, Florida, school shooting in February, supporting community voices with research, care and community action.

Centering community voices can lead to improved relationships and outcomes. The New York City Department of Health and Mental Hygiene’s Center for Health Equity does just that. In 2016, the center launched Race to Justice, an internal reform effort to address structural racism.

In June 2017, the department launched its Neighborhood Health Action Centers, located in the East Harlem, Brownsville and Tremont neighborhoods. Among other services, the centers build the neighborhoods’ capacity to work with other neighborhood stakeholders and residents. Each action center has a Family Wellness Suite, offering health education and peer interaction to residents.

Aletha Maybank, MD, MPH, deputy commissioner of the department and director of its Center for Health Equity, said public health institutions must demand a seat at the table to become essential voices to promote accuracy and steer policy toward health equity. But public health’s power is also rooted in listening to what communities are saying, she added.

“While we have public health expertise, and our colleagues from other institutions and agencies have their respective expertise, we are in large part not experts on the neighborhoods we often serve, or can account for the lived experiences there within and the contextual understanding that comes with it,” Maybank told *The Nation’s Health.* “And thus, we cannot always be the leaders and deciders, but far more often the followers and supporters. We have to find creative ways of amplifying the inherent power that exists in neighborhoods. That approach is central to rebuilding trust and working with local communities to support transformative change.”

For more information on the New York Neighborhood Health Action Centers, visit [www1.nyc.gov](http://www1.nyc.gov).

*   Copyright The Nation’s Health, American Public Health Association