The biggest challenge in the public health response to the coronavirus pandemic appears to be communication. Health policy has been inconsistent, suppressed or ignored, governors have rescinded mandates about masks, and health departments have faced resistance to policy, with individual health officials even suffering harrassment and death threats. We observe that public health messages meet resistance and are ineffective when issued as mandates. Health agencies and departments are limited in their legal authority and their power to enforce policy. The goals of public health are reduction of health problems and improvement of health, so if mandates don’t work we must consider why and enact alternatives.
Where regulation is established and enforceable, and a pattern of compliance exists (for example, with building codes and food service) a legislative approach to public health policy is functional and effective. Otherwise, the effectiveness of public health policy must rely on education, enabling a target population to make informed choices. For a successful outcome of a benefical public health intervention, the essential event which enables it is compliance, a decision made by an individual in their own best interest. In the rapidity of the onset of the coronavirus pandemic, public health forgot that and failed where it presumed to rule by edict.
We need compliance. Compliance must be a choice made freely by an informed community. Compliance rests on the credibility of the health organization. The backlash against masks is the consequence of a public health response gone wrong. The foundation of the public health response to our pandemic crisis must be persuasion, not compulsion. We must respect the individual within the target community, treating them as a partner in the educational process and acknowledging it is they who are free to choose. The public health organization is therefore an advocate for the community, helping the members of the community to be aware of a problem and helping them to understand the benefits of a particular policy response. We strive for the critical step, the exercise of a free, informed choice by individuals within the community. Policy messaging doesn’t work by simply telling people what they “have” to do.
The backlash we have seen against masks reveals insufficient consideration for enabling informed choices and including the community in decision making. This lack of consideration may be an honest oversight, if naive. Everyone is taught from an early age to cover the nose and mouth during a sneeze or a cough. Everyone is familiar with medical workers wearing masks to promote sanitary conditions. Who would have thought such simple and sensible guidance as a recommendation to wear a mask to mitigate the risk of viral transmission would provoke resistance, such intense resistence? It has been a great surprise to many and has even led to resignations by public health officials frustrated by the impotence of policy making.
Public health policy must develop another way to get the point across. The crisis of public health policy during the pandemic is a crisis of communication.
The context of public resistance to public health messaging suggests the need for educational outreach programs preceding or accompanying policy interventions. Furthermore, other preparation is necessary just to pave the way for education because we can observe other distal causes of resistance that can impede the reception of education. These include:
- Distrust of expertise.
- Distrust of science.
- Distrust of government.
- Overarching anti-intellectualism.
- Theorizing about conspiracies, especially on social media.
- Politicization of science.
- Politicization of health policy.
- Prominent unhealthy role models in government and society.
- Lack of expert consenus.
- Contradictory policy guidance.
It would be easy to list more examples. The point that should be clear is that there is a lot of other messaging to overcome first before a target community can even be ready to receive well-formulated and persuasive policy recommendations. It is advisable for us in public health to look to the capacities of public relations and advertising to influence public opinion in order to establish credibility and foster a receptive environment in order to achieve the desirable outcome of healthy choices made by informed communities.