Tina D Purnat

Public health

Health misinformation

Infodemic management

Digital and health policy

Health information and informatics

Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat
Tina D Purnat

Public health

Health misinformation

Infodemic management

Digital and health policy

Health information and informatics

Blog Post

Information ecosystem disrupting health, Ex #6: A well-funded and well-organized “anti” movement counters health advice and politicizes health

Gone are the days when we thought that a focus on messages is sufficient to enable behavior change (RIP the “information deficit model”).

  • Or, when we thought that if people just had the “right” information, they would make healthy decisions (RIP the “knowledge deficit model”).
  • Or, when we thought that individual behavior change is sufficient to overcome systemic problems.
  • Or, when we thought that behavioral nudges are sufficient to enact meaningful behavior change in health.
  • Or, when we thought that people will trust health services and products as long as the science and evidence was well-communicated to them.

Achieving collective action is more complex than simple models that ignore this complexity.

The issue that health systems are also dealing with are the very well-funded “anti” movements, especially on certain health topics, like reproductive health and vaccines.

There’s an organized opposition to the health system, its mandate and tools.

The organized “anti” networks can be harmful because they exploit the “anti” sentiment of a wider group of individuals to either turn a profit, promote a political agenda, or both at the same time.

A byproduct of this “anti” activity is also further politicization of health and polarization of discussions by reinforcing mistrust in government and institutions.

“anti” beliefs in health are not monolithic and are socially reinforced

The share of people with hardened “anti” beliefs in our societies is small. But those whose world views may link up with the hard “anti” narratives is bigger.

  • We tend to think about health advocacy and circulating narratives as topic-based – that people are vaccine sceptic or not, that they share misinformation or not, etc. In reality, people don’t think in topic-specific buckets on issues. For example, COVID-19 misinformation mixed with misinformation on GMOs, alternative treatments, wellness, and even astrology.
  • People react to narratives that are compatible with their own beliefs, concerns, worldview and values. They’re also more likely to share and amplify such narratives.
  • This means that narratives and beliefs are reinforced through a shared social linkage among members of a community, and even if some people exit the network or new ones come in over time.
  • In communities, health topics mix and run parallel to other concerns and experiences in a community. A recent such example is the analysis of Hispanic community’s concerns in South Florida which showed that information needs span from health through elections.
  • When we decide to trust, we draw upon a set of personal biases, experiences, interactions, and viewpoints, each influencing our judgment in its own distinct way. We understand any additional information we come across through the lens of past information and experiences.
  • Coercive actions and confrontations against “anti” believers often harden the polarizations because “anti” believers experience them as proof of their world view. For example, banning “vaccine misinformation spreaders” in social media has not changed the misinformation narratives that circulate in communities.
  • Because “anti” views are a social construct, we cannot diffuse them with solutions focused only on the individual (like improving critical thinking and literacy). Strategies that attempt to reduce polarization of views within a community (to open up discussion), and structural approaches (like regulation) are equally important.

The changing social and political environment for public health is challenging confidence in public health services and products

Health as a topic is increasingly intertwined with various political issues, reflecting broader societal debates and values. Health authority work becomes less effective and takes more effort to implement in such an environment.

  • When it is accepted that health and well-being are more of a political topic than a matter of common good, then health-related narratives can be more easily misused for political, profiteering, and influencing motives.
  • This politicization of health is taking place at the same time trust in institutions is eroding. This requires even more effort and partnerships from a health authority when it is providing services to people who have questions, concerns, information needs, or have low confidence in public health services and products.
  • Public health efforts can also be eroded by the anti-science movement that links up different topics and reduces confidence in public health (or increased confidence in “alternatives”).

The organized “anti” networks in health leverage people’s questions, concerns and eroded confidence for their own profit and political gain.

The “anti” movements are not just about simple social media activity discussing particular topics or spreading mis- and disinformation. They have grown sophisticated and organized, and counter the work of health authorities and public health professionals.

Take the example of the antivaxx and anti-abortion movements.

Anti-vaccine and anti-abortion efforts consist of varied groups of people with different agendas. But the bottom line is that they advocate for systemic, political, economic, and legal changes that would erode use of vaccines, and make abortion and other politicized health products and services not only inaccessible and unsafe, but also illegal.

Motivations for promoting such activities vary.

Similarly, the organized anti-science sentiment leverages the internet for advocacy, coordination and fundraising – especially focusing on public health and environmental science topics (GMOs, anti LGBTQ+ pseudoscience network, climate denial, etc). (As a side note, I think that the drivers behind the anti-science attitudes are the underlying shared mistrust of government and governmental regulations. They have spread from United States through conservative political networks to other countries.)

Additional problem with so devalued health advice, scientific evidence, or politicized health is that they are promoted by narratives that can be easily hijacked and leveraged by foreign disinformation campaigns by state actors to sow mistrust in institutions and cause confusion and conflict in targeted countries. Here’s an example of such a Russian anti-science campaign aimed at the US.

The “anti” movements are small in numbers but have large societal impacts.

I call these dynamics “movements” because localized groups and communities that blend different issues are complemented by organized, well-funded networks of “anti” advocates that push buttons in political, business, and legal systems.

1/ They have large funding – they either self-generate it online and/or get the funding from large politically motivated donors.

2/ They use organic tactics that span online, systemic and in-person approaches.

3/ They link up through networks and aspire to have impact globally, not only in own countries.

Bottom line

The “anti” networks in health use a combination of tactics, and so should any efforts to counter them.

They also leverage the mistrust and low confidence in a wider set of communities, so any preventive measures must address the questions, concerns, and needs for information and services in a wider set of communities.

Here’s what we could do:

Address vocal science deniers, but be careful

  • When speaking with people denying scientific evidence, there are refutation techniques that can be used in such conversation. However, public health professionals have historically been reluctant to directly confront vocal vaccine deniers or anti-abortion activists to reduce the opportunity for the organized anti-vaxxers or anti-abortion activists to use the experience or recordings of the conversations in their follow-up misinformation campaigns. WHO has a good resource on considerations on responding to vocal vaccine deniers in public, and I think this is easily adapted to other polarizing health topics.
  • Strategies for addressing the “anti” viewpoints in health should be designed with the perspective of communities affected by the “anti” viewpoints, organizations serving people in the “anti” movement, and health professionals.

Analyze and understand the organized “anti” network legal, financial and social activity

  • More research needs to be done and published in the online activities of “anti” social networks to identify the narratives and their underlying drivers in different communities, and international/organizational connections of the social networks.
  • More research needs to be done on the legal tactics, arguments and cases that are being brought by the “anti” movements, either for purposes of intimidation or for changing legal precedents and practice.
  • In addition to making knowledge resources available to health authorities who are being sued for their public health policies, there’s also a need for a network of legal experts that are familiar with “anti” movements’ legal practices who can be called as expert witnesses in support of public health or other science. (The antivax networks already have organized expert witnesses – see examples from Australia and the US.)
  • More research needs to be done and published on how different “anti” initiatives are funded, both from institutional or large private donors or through organized fundraising campaigns and profit-making activities.

Go beyond organized “anti” groups, and work in communities that might share touch points with the “anti” campaigns

  • Strategies to address “anti” beliefs need to focus not only on the communities that hold the specific beliefs but also on those who are “adjacent” and share similar interests and values and, therefore, may adopt the sentiment and beliefs over time.
  • Community-based network analysis like this or this needs to become more routinized to identify which communities are mediating the spread of narratives on a particular topic, and what other topics or geographies are aligning with them. This should inform strategies and approaches to engage them.
  • Addressing these issues in a country or community must be based on meeting community needs (for services, products, and information), addressing eventual grievances of the community against the health system or authorities, designing a supportive environment for health behaviors, and leveraging the social norms and behavioral approaches to drive social and behavior change.

Mitigate harm and protect people in the in real-world

  • In instances where “anti” narratives translate into harassment and attacks, legal protections must be put in place and implemented to protect the most vulnerable from direct harm.

Leverage networks of cross-disciplinary practitioners and scientists that can develop a comprehensive multi-prong strategy to protect the communities, the health system and its partners from organized “anti” health movements

  • To detect and understand the disinformation campaigns, work with disinformation researchers and law enforcement experts.
  • Establish practitioner and expert network for the exchange of information, and collective troubleshooting. Any research, analysis, and intervention strategy development needs to include a multitude of expertise, from social and behavior change, disinformation research, political science, media science, law and ethics, communications, and others.
  • Prioritize supporting the capacity of local organizations and authorities to address the impacts of the “anti” movements over planning one-size fits all global solutions.