Information ecosystem disrupting health, Ex #5: Communities experience multiple vulnerabilities together with health information inequalities

Here’s the next example I extrapolated from my recent lecture and discussion about how the information environment impacts public health.

The pursuit of health equity is not merely a specialized branch of our professional field. Rather, it is the foundation upon which the practice of public health is built.

In public health, our primary goal is to improve health and well-being while preventing disease and disability across entire populations. However, achieving these goals is profoundly influenced by our ability to address unequal health outcomes among different groups.

This is why one of the guiding principles in our work is to protect the most vulnerable.

Inequalities are never simple or one dimensional

What we often see in reality is that populations experiencing one kind of vulnerability are also experiencing others that compound the harm and health outcomes.

For example, Indigenous populations face health disparities due to historical marginalization, barriers to access and lack of culturally competent health services, while refugees and asylum seekers struggle with health access, legal uncertainties, and poor living conditions stemming from displacement.

Often, these are also populations that have little access to current, accurate and credible health information, in appropriate formats and languages.

And populations experiencing disparities across access to health services and products, in health information, are often also those that have a history of mistrust in the health system, health workers, products and/or the government.

I often talk about it with this image, to bring home the point that the understanding of the equity must be at the core when we work with different populations. The interplay of all three elements will impact how well either of the three will be achieved.

Digital information environment makes inequalities and health outcomes worse

When we bring into this the perspective of the digital information environment, it impacts all three elements.

The challenge here is that low level of literacies (information, digital, media and health literacies) interacts with social, economic, commercial and health information inequities of users online.

Here’s some examples:

• The elderly and their caregivers experience specific service and information needs, and can be more vulnerable to misinformation – see here example of the elderly in the UK being targeted by health misinformation
• Migrant communities tend to have weaker linkage to health services and live in a different information ecosystem from other people living in their new countries. This can lead to different uptake of health services and products and disparities in health outcomes – like, for example, low influenza vaccine uptake among Eastern European migrants in Scotland, or health misinformation vulnerabilities among Hispanic communities in the US.
• I’ve already written about aggressive marketing practices on health topics, but the resulting harm is even greater when you consider that such marketing often targets the most vulnerable populations. A recent UNICEF report, for example, warns that more than half of parents and pregnant women globally are exposed to aggressive formula milk marketing, which compromises child nutrition and is in violation of international agreements. Combine this with the fact that the food industry adds sugar to infant milk sold in poorer countries, and these information asymmetries become even more harmful in real life.
• Another group that is uniquely vulnerable are young women – needing reproductive, mental health and other health services. A recent global report describes how misinformation targeted at girls and young women often revolves around health and body image, influencing their understanding of nutrition, mental health, and physical well-being. This type of misinformation can have long-term effects on their health decisions and self-esteem
• Consider also that people in low and middle-income countries may experience health information inequities just because they live in a country with lower consumer protection regulations, where internet platforms are not forced to invest in content moderation, and where people search for health information in languages other than English.

Bottom line

When we assess the vulnerabilities to asymmetries in the information environment, we need to specifically understand the dynamics impacting the most vulnerable populations.

• Recognize that health information inequalities in digital spaces must be addressed, especially because people turn to them for health information on topics that may be embarrassing or stigmatizing to talk about in person with health providers, care givers or authority figures. Effective provision of digital health information that is current, accurate, and aligned with the online communities’ values can make a difference.
• Promote digital, information, media, and health literacy generally, but especially among vulnerable and at-risk populations. For example, address menstrual health literacy among young women.
• Enforce consumer protections against deceptive marketing, as well as the marketing of products that impact health of vulnerable populations such as children.
• Ensure that community engagement activities in vulnerable communities are aligned with service and product delivery, and both are adapted based on community feedback.