Why Public Health Matters to Private Lives with Emily Howell and Todd Newman
About This Episode
“COVID-19 is not just a medical issue. It is also a social justice, economic, and political issue. That makes it hard to figure out how best to share information about it, especially since messages come from a range of communicators—including elected officials, journalists, scientists, physicians, and community leaders—and are delivered to diverse audiences.”
Such is the foundational position in a recent piece published in Fast Company. Our guests this week, authors Todd Newman and Emily Howell (together with Dominique Broussard), present their insights into the messengers and their messages that constellate to keep us unhealthy.
This is a conversation about trust, and it brings with it some extraordinarily difficult questions. Does the public understand the role of public health? Has our model of health broken its promise of healthy communities across racial and economic boundaries? Has the media lived up to its obligation to truth in a public health crisis?
Objectively, the answer has to be a resounding no to these and so many more. Which opens to the door to our conversation this week in which we examine the opportunities before us to build trust, to cement community, to broaden the reach of our most critical messages, and to do so clearly. As Natalie so aptly says, “to engage in the production of the public’s health is actually a patriotic act.” So how do we make it clear that public health truly matters to private lives?
Our deep thanks to Todd and Emily for joining us this week. Please visit the link below to read the original article. Thank you for listening, and for sharing with your communities, too.
Links & Notes
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Carrie Fox: Welcome to the Mission Forward Podcast, where each week, we bring you a thought-provoking and perspective-shifting conversation on the world around us. I’m Carrie Fox, your host and CEO of Mission Partners, a social impact communications firm, and certified B Corporation. When Natalie Burke and I set out to create this season of the podcast, we wanted to dig into the many layered effects that COVID-19 had on our communities, from our connections to one another, our beliefs in people and systems, our understanding of power, and our trust in science and news, and it’s that last item, trust, that we’re going to look at this week. As you likely remember, the medical understanding of COVID was an ever-moving target, which made it hard for public health officials to figure out how best to share information about it, especially since messages were coming from a range of communicators, including elected officials, journalists, scientists, physicians, and community leaders, and all were being delivered to diverse audiences. So this week, we connect with two academic researchers from the University of Wisconsin-Madison, Todd Newman, and Emily Howell, put together with their colleague, Dominique Brossard, present their insights into the messengers and the messages that constellate, to keep us unhealthy. This is a conversation about trust, and it brings with it some extraordinarily difficult questions. Does the public understand the role of public health? Has our model of health broken its promise of healthy communities across racial and economic boundaries? Has the media lived up to its obligation to truth in a public health crisis? And most importantly, how do we make it clear that public health truly matters to private lives? Stay tuned for this conversation, and I’ll see you on the other side. Todd Newman and Emily Howell, thanks again so much for being with us, and I want to acknowledge that you had a third author or have a third author on your paper, your colleague, Dominique Brossard, who’s not with us today, but I want to acknowledge that the three of you recently wrote a piece that I read in Fast Company that just stopped me and said, "I need to reach out to the three of you, and see if we could talk more about not just that article, but the bigger picture story behind what is in that article, because it is so relevant to the time that we’re living in today." And for folks who are listening, you wrote an article focused on how the COVID-19 public health messages have been all over the place, and that the public health field needs to do better. And so, I’m going to ask you two, maybe to get us started today, why did you write this? What was on your mind specifically that pushed you forward to put this down on paper and to publish it?
Todd Newman: This article, I mean, started from conversations as the Department of Life Sciences Communication, we think about science communication issues broadly, and when the pandemic happened, and especially paying attention to the messaging that’s been going on, and in our point of view, mixed messaging, we felt the need to write something, and it just so happened that our coauthor, Dominique Brossard, Professor at the Department of Life Sciences Communication at UWA Madison, recently commissioned a report for the National Academies of Sciences on promoting behavior change, in regards to COVID-19. With that context, we really tried to put together a framework for what we saw as basically a lack of social science and communication research specifically, in a lot of the strategies going into messaging, and as we outlined in the article, a lot of this has to do with the fact that all science issues cut across different sectors, whether it’s politics, whether it’s the economy, the social justice issues, which we talk about, and that makes messaging really complex, very difficult. And so, we laid forward a framework to think about what are some strategies that could be used by anyone doing communicating, be it at the federal level, at the state level, community leaders, talking to your friend or your partner? And so, that was the context that set that forward.
Carrie Fox: Natalie, you and I have talked for a long time about public health’s communications problem, right? And that their inability, I say their, but the public health field, the inability to communicate clearly keeps people unhealthy. And I think it might be good, actually, if you unpacked that a little bit, as we get into this episode today, let’s talk about that, so that our listeners are all on the same page as we dig more into this really important, critical issue that you just mentioned, Todd, which is mixed messaging from public health,
Natalie Burke: From my perspective, public health suffers from a type of toxic humility, this whole thing that when public health is working, no one knows. And so, there is an inclination to undercommunicate about public health outside of times of crisis. And so, we have really failed to prepare the public for times when we are in crisis. The fact that people fail to understand what public health is as a larger discipline, as a system, the role that it plays in how we are interconnected as human beings, around even how it connects to housing, education, transportation, employment, structural racism, issues of equity, means that at times when we need to activate the public, to engage the public, to support those efforts that would protect and support and promote the public’s health, they’re ill prepared. And so, we’re trying to do that in a time of crisis, where people are having a very emotional response to being asked to change their lives, change their behaviors, and when they are feeling most vulnerable in a number of different ways, in terms of their own health, as well as economically, and in a host of other ways. So I am curious about what you think needs to happen outside of this crisis to lay the groundwork moving forward, so that public health is not new to people, and that people are connected to it in some way, shape, or form. And I’ll say this before I turn it back over to you, in my mind, this idea that to engage in the production of the public’s health is actually a patriotic act, is crystal clear. I get it, I see it, I’ve worked in communities, and we’ve actually talked about it, even though we may not say it in that way. What do you think is necessary for people to believe it’s true for them to engage in the production of health meaningfully, outside of times of crisis, and in times of crisis? What’s the message, what’s the narrative, and how do we deliver it?
Emily Howell: Yeah, I think that phrase, "toxic humility" is so helpful. I want to keep sharing that, if that’s okay. And I think this kind of ties into something we touched on in the article, which is there’s just underreporting of benefits, generally. And part of that is just the way the media systems work, we have this idea that that news is what makes the news, and so even just in the way that news is portrayed, it’s sort of always a crisis system. And then I was just listening to an interview recently, I wish I could remember the person, but they were talking about how our healthcare system is generally, even outside of a pandemic, set up as a crisis system. And so, we really, we’re not building in the structures that we need to be healthy, and public health is such an important piece of that. And so, I think it would be really great to be able to see that we highlight, what are the successes that we’ve seen from public health? And it’s difficult, because a lot of it is these longer term trends, but those are still stories we can tell, and that comes both from the health officials themselves of really… I know it’s not their job, their official job to communicate, but really, it is, in a lot of ways, if they want to be effective in their work. And then also on the journalism side, of really highlighting what were these success stories? What did we avoid, or what successes have we had because we invested in public health, in these different areas? And this idea of seeing that as something patriotic, I think is something else that we tend to not do maybe as much as we should in communication, which is showing the overlap between health and these other areas. So I think early on, we saw that a lot of the debate of how to respond to the pandemic fell into, "Oh, health versus the economy," and really, health is the economy. If people aren’t feeling well, they can’t go to work, there’s tremendous economic loss and costs from always being in this crisis mode. And so, I would like to see more conversations where we acknowledge that these things have a lot of overlap and really depend on each other.
Todd Newman: The communication ecosystem that we live in, that we’re embedded within, is something that needs to be nurtured, needs to be cultivated. And I think with that and going on, what you brought up, Natalie, with this idea of kind of cultivating this continued engagement with and understanding of public health, and how it integrates into so much of our life, is really thinking about consistent messages coming about this, from trusted communicators that are connected to the communities involved, right? So much of effective communication is about context, it’s about you can’t just give people information and they’ll just take that information. You have to place context around that, about what that values are, why it matters for them, why it matters for the larger society. And I think that is really where when you think of a lot of the success stories of public communication campaigns, it’s about having trusted messengers communicating a consistent message through trusted channels.
Carrie Fox: There was some research that came out not too long ago from the FrameWorks Institute about communicating about public health, I am certain you all saw it, but that in that research, they talked about how public health leaders lacked the relationships needed to engender familiarity and trust from leaders of key sectors. And so, they get into a situation and the trust isn’t there, and so the content is being pushed out, but to your point, Todd, the context nor are the relationships there to be able to receive and understand that information. And I’d love to get your take on that, how you’ve heard that about that research, and how you understand that issue to be playing out.
Todd Newman: Trust is a complicated construct. There’s many dimensions to it. I mean, you can trust someone, regardless of the information that’s coming from them, and if you have trust in them, we often say it’s not the message, it’s the messenger. And I think when you think about trust and when you think about how that is built up in a society, especially when it comes to public health, I think, again, it goes to this point, it’s people that look like me, that share the same values as me, that see the world as I see it. I mean, when you think about the divisions that have come where we say like, "Oh, we trust science, we trust scientists," well, we trust the science and the scientists that aligns with what we believe, and oftentimes, that is part of the issue. And I think it really gets down to thinking about ways to A, better understand these trust dynamics, figuring out infrastructure which can support this at the community level. I mean, again, it goes to this idea that communication is something that needs to be nurtured, that needs to be sustained, and it is a system in and of itself. How that plays out over time is about how situations like this are managed, and other crises that come up, and to Natalie’s point, the idea that, well, it shouldn’t be when these crises come up that you see these spikes in differences. So, I mean, I think those are some of the key takeaways that come to mind when I think about kind of trust in this context.
Natalie Burke: I’m wondering, one of the things that stands out for me has been the public’s response and frustration to how messaging related to the virus has changed over time. And it’s funny, because I feel as though the concept of it being a novel virus got dropped like four weeks into this, and with that, we lost an opportunity in the communication to say, "We are learning on an ongoing basis," right? So I think that that was a critical piece that got lost along the way. And in fact, the idea that you’re learning and can be trusted at the same time, those two things can actually happen, but I don’t feel as though the scientists and the other folks who had been coming out to communicate about that, recognized that those two things can hold space at the same time, and those things are very much connected to the need, to foster a collective consciousness. So the fact that we were going through such a politically divisive time, I think made that harder, and I want to make sure that I acknowledge that the polarization through media, and media sources, and how people really are sort of ensconced in their echo chambers, and stuck in the algorithms of their social media, absolutely factored into this. But what do you think could have been done differently in messaging and communicating about this idea that, "I’m asking you to engage in behavior, to trust me, because this thing is novel, and we’re going through it together?" What could’ve been done differently to help communicate that?
Emily Howell: The idea of consistency is also sort of repeating the same messages, because as you say, Natalie, I noticed that as well, that some of the messages that we were getting early on that were super helpful for giving this context and to why things were so uncertain, or even why a lockdown was necessary, or the flatten the curve, you can think back a year. But then that sort of disappeared, and I think that a loss, because the pandemic only became more relevant to people, and so that information would only become more sticky, and we all sort of got it at the stage where for most of us, it was still pretty abstract, and so it didn’t really connect in a meaningful way. And then it’s all conjecture, but then how that played out is we started having arguments about the value of masks, about lockdowns, we sort of lost that basic core of sort, "Why are we doing this?", I think, and some of the messaging around that. So some of it is just that, I know that in the news cycle, you want to keep going with new novel information, but some of that repeat messaging I think would’ve been really helpful throughout the whole year, really, as it becomes relevant to different people at different times.
Carrie Fox: And I want to take that same question but flip it and think, can either of you think of any examples of what was working or what worked through the pandemic, when, Todd, you mentioned earlier, it’s not always the message, it’s the messenger? Who were the messengers that really did help to communicate effectively through this process?
Todd Newman: I mean, I think one of the examples that comes to mind, and when you think about vaccine hesitancy, for example, historically, African Americans had more hesitancy for vaccines, for reasons historically that came up, with Tuskegee, et cetera. But over time, we saw that the African American community actually became one of the most highly adoptive of vaccines, partially because there was trusted communicators, medical practitioners within the field coming out and communicating and engaging, right? And then you saw conservatives primarily as the group that became the most dismissive, most unlikely to get vaccines, unlikely to follow, right? Again, because there’s a lot of mixed messaging, there’s not a consistent messenger. And I think when you look back too, historically to campaigns, you think of seatbelt laws, you think of smoking, you think of any of these other public health campaigns, what mattered for that was having leaders to come out that were from either the ideological party, the political party that they agreed with, that came from the same community, et cetera, and were able to push that message and have that engagement with their community. So I think that’s part of it, and the other thing too, is with the media system and the way in which this COVID is covered, so much of the messaging that we get, and Emily touched upon this, has been framed in the negative. It’s been the scare, it’s been the [inaudible 00:17:31], right? It grabs attention, that’s how the system is built. But we know that focusing on the benefits, focusing on the small business or the small salon that’s able to reopen because they followed protocols better, rather than the crowded beaches in Florida or something like that, where people think that this is getting out of hand, when in reality, it’s not necessarily the case. So these mixed messages from the media, I think play a problem in that, and in addition to that, and I think this goes off of what Natalie, you were talking about earlier about just covering this issue regardless, is we talk about this in the article, about science being a moving target. It’s very difficult to cover science in general. There are great science journalists out there. There are a lot of really bad attempts at covering this, because it is difficult, right? Science is science. It’s an evolving process, it’s not settled, it continues to evolve. And the public, especially those that don’t have a background in science, and for the majority, that’s just not top of mind for them, the process of science and understanding uncertainty and understanding parameters, is something that is really complicated to communicate, and is something really complicated for the vast public to wrap their heads around about, "What does this mean for me?" And I think that, coupled with the fragmented media system, makes this very complex.
Natalie Burke: Well, I think that speaks to the reality that public health is about relationships, relationships between and amongst systems, institutions, communities, individuals, resources, it’s about how we are all interconnected, which there’s an inherent tension between that and American individualism, and it’s part of why I think the American public has struggled to understand that your health is a production of society that is above and beyond personal responsibility and choice, access to healthcare and health insurance, right? That your health is about so much more than that. And I think this idea about trusted messenger is absolutely a critical component of this. And I can tell you, I was frustrated with the narrative about the mistrust based on Tuskegee coming out of the African American community, because I knew what I was hearing was quite different than that. The fact that people were not having access to vaccinations played a critical role, the fact that we had places like in Michigan, where they chose not to collect data in terms of racial data on who was being vaccinated, means then we didn’t have an idea of who was and who wasn’t being vaccinated, and where resources actually needed to be put. So this narrative was then being crafted while black people are not getting vaccinated because they don’t want to get vaccinated, and dismissed these other factors that were important. So I think it’s interesting, I went to the grocery store, and everywhere I go, I ask people, "So, getting vaccinated? Did you get vaccinated yet? You didn’t? Want to talk about it, want a resource?" I’m constantly doing that, and for me, I can tell you the tool in my toolkit, the arrow in my quiver was Dr. Kizzmekia Corbett. And I could pull my phone out and show a picture and say, "Here is someone who helped to develop the vaccine. And yep, she’s a black woman. She’s a young black woman, she’s vaccinated, and she’s getting her family vaccinated too. So what are you going to do?" I cannot tell you how many people said, "Oh, all right. They’re going to be here on Wednesday, I’m going to get vaccinated." And that was it, it didn’t require anything else. So I’m wondering, is it that we need to position the experts, the scientists, to deliver the messages, or is it that we need to equip messengers who function outside of the science to deliver the messages? Are we asking scientists to do too much with this?
Emily Howell: Yeah. Yeah, I think that is definitely a bigger conversation going on in communication fields too, is for so long it was like, "Oh, scientists need to communicate better," but that’s not what they’re trained to do. And some scientists, they’re really good at science because that’s just what they do and what they focus on, and they don’t want to think about or have time to think about how to fit it into these other contexts or communicate it to people. So I think definitely having more people who are able to sort of cross these different disciplines, these different communities, and communicate across, and then also hearing your examples, Natalie, it also reminds me that so often in communication research, we’re focusing on these big media systems, and structures, and algorithms and things, but really, interpersonal communication is so huge and so much more impactful, and we just don’t have good ways to study it, but we know that it matters. And so, really to have good communication, you need good human connections, really in that sense, and that’s also where you need more people represented in these expert communities, in these journalism communities. So for example, I’m in Montana, and so most of the difficulty in vaccination and masks coming from more rural areas, which also are underserved. And so, they just don’t have people who can represent them in these public health communities or in these media systems. And so, a lot of it is also just that, and making sure that we get better representation in the fields themselves.
Todd Newman: Not all scientists should be communicators, not all scientists because they have a PhD should be talking about COVID, if they’re not studying public health or they’re studying the disease clearly. But so, the interpersonal side of this, and I think this is something that science is recognizing, and I think the different ways in which science is represented, is making steps to get better at is, is who are these experts? And part of that is giving them platforms, and pedestals, and opportunities to be in positions of communicating. And also, as a science communication researcher, thinking about diversity, equity, and inclusion in part of the research process, and I think that’s something that is becoming more and more part of the discipline, we call it the science of science communication, is putting these questions into the design of the research, and having it be community centered, because we can’t think of the public, right? There is no public, there’s publics. And I think a lot of these factors combined present opportunities and also challenges that require systemic changes in science, and I think there are efforts at this, but clearly needs to be more going on. But I think it’s a really powerful point about who should be communicating and when, and I think that needs to be addressed.
Carrie Fox: Yeah, that resonates a lot with me. We talk a lot about those who are in positions of power, what they look like, what their experiences were, their upbringings, and how that informs their viewpoints and what biases they bring to that work. And I’d mentioned to you before this conversation, that I have been in several conversations the last many, many months with various clients who were talking about the sources of their information, and when I dug and challenged on where their sources were, it was often a singular white man who was the source of the information. Not to say the source is wrong, but how are we diversifying those sources? How are we digging in to really understand that information, to challenge and reduce the bias that we all bring to our work, right? Not just science communications, but to all of our work. And so, as we’re wrapping down here, I’ve got two more questions I want to ask you, and one actually gets to that point of design. Now, if we are thinking about science communication being able to be designed for the margins, let’s say, for communities that are often forgotten about in communication, that are often undervalued in how they are brought into the conversation to begin with, right? We can’t go back. What happened has happened with COVID. How do we go forward? How do we think about adjusting, or changing, or altering science communication moving forward, so we can more thoughtfully design for all communities?
Todd Newman: One item that comes to my mind when I hear a lot of the great work that’s being done in health communication specifically, is designing research at the start with community partners. And we’ve started doing that in our research, and having the community partners, whether it’s a local nonprofit, other organizations like that, to A, have some buy-in, because a bunch of researchers coming into a community, "Oh, we want to collect data on you," that doesn’t get very far. And it’s about having these frank conversations about how can this research impact you and impact your day-to-day life, and how can this be manageable? And I think you see that in a lot of funding that’s going on now in terms of communication is having this connection between research and practitioner. So I think that’s a major step in terms of thinking about ways to bring this into the design process moving forward.
Emily Howell: Yeah, and building on Todd’s point, that idea that you really have to center that into your design from the beginning, it can’t just be sort of an afterthought like, "Oh, and by the way, we’ll also reach out to these particular publics." And I think there’s more and more recognition going on that when you’re designing for the margins, everything is better, because if you’re able to reach the people who are least reached, it means that you’ve sort of created these more equitable structures that everyone ends up benefiting from, even though that wasn’t sort of the center goal. And so, I mean, the pandemic made that so clear, and we also saw that the researchers who already had deep connections and collaborations with communities were able to just react instantly, and start to address community needs. And so, now more and more people are looking to those examples and saying, "Well, how did you do that? How do you build this?", and trying to really do that in a more rigorous and intentional way, so that we are designing for the margins, but also seeing the margins is so key to everything.
Natalie Burke: It’s interesting, because I think effective communications requires us to take equitable approaches, as opposed to taking equal approaches, right? Like the difference between equity and equality becomes really very, very important in this topic in particular. And when I think about how many people reached out to me and said, "I need to communicate to my family about this, what should I do?" And even more recently, as teenagers started to get vaccinated, I had a lot of people who were reaching out, and asking questions, and so on. And so I shared, there were a couple of articles that I thought did a really nice job explaining why, and really helping to dispel what I think were some of the myths that were starting to float around. If you had the opportunity to talk to someone, because as much as this is about communication that happens at that 50,000 foot level, it’s also about the communication that takes place via text, and on a phone call, and at a dining table, at the end of the driveway, when I see my neighbor when I’m putting out the trash. In those moments, if we’re talking about something, and I’m going to use vaccination as the example, can you, in a very simple way, say what the approach someone should take to try to win hearts and minds, and to activate people and engage people so that they can move forward in a way that is going to support public health?
Todd Newman: One of the things that comes to mind, and this is a big part of the work that was done at the Alan Alda Center, and the role of empathy, and Alan Alda has a saying that, "When you’re communicating to someone, it’s not just the willingness to change them, but the willingness for you to be changed as well." And I think there’s a humility in that, in terms of going into conversations thinking that you have to change someone, but if you go into that conversation with a mindset of understanding what it is beneath the hesitancy, beneath whatever might be counteracting what you think should be best for them and understanding that, that goes a long way. And I think that’s a key part of effective communication, is the willingness to change yourself in a communication context, not just the other person.
Carrie Fox: Alan Alda has this fantastic book called, If I Understood You, Would I Have This Look on My Face?, and I use it in nearly every media and message training that I do. And that rings really true to me, that so much of this is thinking through the lens of empathy, how we’re applying truly the principles of design thinking, to challenge the traditional norms of communication. And so, as Natalie said at the top, the work that you both are doing and your colleagues are doing, is so critical. This is such a big, complex problem to determine how do we communicate, translate, trickle down, trickle up messages, that in the end, are designed to make us all healthier? So as we wrap up today, Emily, Todd, thank you so much for being with us. Thanks for your time and your work, and we look forward to staying in touch.
Emily Howell: [inaudible 00:31:26].
Natalie Burke: Thanks for the work you do.
Todd Newman: Great. Thank you.
Carrie Fox: Thanks for listening to another episode of Mission Forward. The Mission Forward Podcast is produced with the support of Nimra Haroon, and the Mission Partners team. Engineering by Pete Wright. Music this week is Living, by Vortex. Thanks for your support, and we’ll see you next time.
