A Mishandling of (Mis)information: The Role of Public Health Messaging in the Amplification of America’s Systemic Inequities
Written by Nicole Blum, MS4
Edited by John Purakal, MD
The novel coronavirus (SARS-CoV-2) pandemic continues to shake the fault lines of inequity underlying America’s foundation. In cities across the country, poverty, homelessness, and racism are fueling engorged disparities in Covid-19 outcomes for vulnerable and marginalized populations. In Philadelphia, residents living in a zip code with a median household income of $37,000 were found to be five times less likely to be tested for Covid-19 than those living in a neighborhood with a median household income of $90,000 (1). In Boston, 36% of individuals staying in a homeless shelter tested positive for Covid-19 (2). In Chicago, black and Latinx case rates are more than twice as high as white residents, and black residents are three times more likely to die from Covid-19 (3). Although there has been some acknowledgement of inequities surrounding Covid-19, much of the rhetoric from government leaders and the media, at best, ignores and, at worst, reinforces vast systemic issues and endangers vulnerable populations.
Covid-19 public messaging adopts a precariously reassuring tone that has remained more or less unchanged since the president declared a national state of emergency. Government officials and media outlets alike continue to emphasize that the virus poses a significantly greater threat to individuals with preexisting medical conditions. These sorts of statements, while objectively true, make the erroneous—and perilous—assumption that Americans have appropriate access to healthcare and possess proficient health literacy skills to appreciate the threat of disease.
It is imperative to state the obvious here: People must be able to access the healthcare system to be diagnosed with a medical condition. The 2018 National Health Interview Survey revealed that 87.6% of Americans have a usual place to go for medical care (4). This implies that 40 million Americans, including many members of vulnerable populations, may be unaware of a preexisting condition that puts them at an increased risk of severe Covid-19. At a time when health is at the forefront of the country’s attention, political leaders and the public need to be reminded that the ability for Americans to know of—let alone properly treat—their medical conditions is a privilege in this country. Current pandemic messaging, in effect, ignores 40 million Americans already ostracized from the healthcare system.
Additionally, vulnerable populations are exceedingly prone to certain conditions that magnify the risk of severe Covid-19 such as hypertension and asthma. Where are the conversations about the drastic disparities in prevalence of hypertension among black individuals that are largely due to socioeconomic status and psychosocial stress (5)? Why are amplified voices failing to speak about the countless years of discriminatory public policy that puts so many Americans at risk? Why have some broadcasted that Covid-19 the “the great equalizer” when individuals inherently predisposed to conditions that increase the severity of Covid-19 are also the same people unable to access care? Ignorance is bliss with deadly consequences.
Even for Americans who are able to obtain adequate medical care, low health literacy remains a significant barrier to preventing disease transmission. Only 12% of adults possess proficient health literacy skills and “have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (6, 7).” Thus, basic and effective communication is key to promoting collective action and reducing coronavirus transmission. Statements implying that Covid-19 primarily affects those with underlying health conditions downplays the threat of the virus, inadvertently discouraging “low-risk” individuals from practicing social distancing and wearing facemasks. Many at-risk Americans do not possess the health literacy skills to understand the virus and the importance of these measures for the population as a whole. Therefore, politicians, journalists, and other influential people must exhibit caution when discussing recommendations from public health experts. This includes untangling political influences from factual information.
Communication regarding Covid-19 is similar to a long game of telephone with players altering the message along the way. Numerous sources of information and biases are confounding the already stressful and confusing situation for many Americans. Imagine if 911 dispatchers addressed emergencies in the same way unproven theories and political biases are seeping into Covid-19 messages. This public health emergency necessitates simple and factual communication from expert sources that does not leave room for interpretation. We cannot afford to exaggerate the strife between individual freedoms and social responsibility at the expense of lives in the midst of a misinformation overload.
The pandemic has served as an unfortunate exposé of social determinants of health in the United States. But, it is an incredibly loud alarm that our nation cannot ignore. Now is the time for our country to not simply acknowledge—but palpably address—the social and systemic barriers many individuals face in this country. Change commences by nationally mandating the collection of comprehensive demographic data on Covid-19 patients and accurately communicating the reality of the pandemic. Public health information, ideally from one designated source, should be disseminated with a keen awareness of health literacy limitations and in a way that demonstrates integrity—even when the truth is uncomfortable.
Although there is no current cure for coronavirus, elucidating public health messages and admitting both acute and chronic systemic failures are obligatory steps toward America’s recovery.
Schlosberg, J., Davis, L., & Ghebremedhin, S. (2020). Philadelphia doctor takes to streets to help black communities get tested for COVID-19. ABC News.
Baggett, T., Keyes, H., Sporn, N., & Gaeta, J. (2020). Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston. JAMA. doi:10.1001/jama.2020.6887
Chicago Department of Public Health (2020). Chicago COVID-19 Update May 3, 2020. Chicago.gov.
Norris, T., Schiller, J. S., & Clarke, T. C. (2018). Early release of selected estimates based on data from the National Health Interview Survey. National Center for Health Statistics.
Pickering T. (1999). Cardiovascular pathways: socioeconomic status and stress effects on hypertension and cardiovascular function. Annals of the New York Academy of Sciences, 896, 262–277.
Kutner, M., Greenburg, E., Jin, Y., & Paulsen, C. (2006). The Health Literacy of America's Adults: Results from the 2003 National Assessment of Adult Literacy. NCES 2006-483. National Center for Education Statistics.
Health Literacy | Healthy People 2020. (2020). Healthypeople.gov.
