Trust Issues (Part II)
Earning the public's ear
In last week’s post we discussed the rise of information and the role of primary care in countering that misinformation, accompanied by an excerpt from Dr. Jane Philpottt’s new book Health for All on what a robust primary care network that could achieve that level of relationship would look like.
In that post, I largely concentrated on the role of bad faith actors as the source of misinformation. That’s a real problem, and increasing political polarization, accompanied by the rise of bot farms and now AI, is making it even worse. But there’s also a need for those who advocate for evidence-based decision-making to reflect on their role in creating space for bad information.
Today I want to share Lessons 4 and 5 from the final chapter of my latest book, A Healthy Future. The first is on the importance of fighting for the facts misinformation, the second is about trust.
Trust is not a given, it has to be earned and maintained. In a relationship, when people feel they have been betrayed by someone they trust, the benefit of the doubt is lost. You don’t even return to the level of grace given to a stranger, you have to work through built-in suspicion. When experts communicate badly, the trust of the public can easily be lost, and the benefit of the doubt given to friends and family, social media or other non-objective sources. By failing to communicate our knowledge, and its limitations, in a way that people can understand and rely upon, we may be pushing people to the very information sources we’re trying to combat.
A recent report from the Institute for Research on Public Policy, along with restating what so many have said (including this newsletter in the above post) about the need for an expert review of Canada’s pandemic response, made some pointed recommendations about misinformation and trust.
LESSON 4: PUBLIC INSTITUTIONS CANNOT WORK WITHOUT PUBLIC TRUST
Public trust was deeply affected by the pandemic and we need to build it back or the next crisis will be infinitely more difficult to overcome. To rebuild this trust, we recommend the following:
10. Create a pan-Canadian task force to tackle misinformation and disinformation and help governments understand how to mitigate disinformation/misinformation in future crises that require similar interventions.
11. Build inclusive and meaningful relationships with civil society leaders before the crisis hits.
12. The federal government should initiate a pan-Canadian comprehensive, collaborative lessons-learned examination that would systematically examine how our public institutions performed during the most demanding public health emergency of our time.
These are clear and actionable points and, as the excerpt below reminds us, failing to fight misinformation cost lives during COVID and preventing future avoidable tragedy depends on us creating an information environment where the truth wins out.
Excerpt 1, Lesson 4. Facts are worth fighting for
In many ways, the story of COVID is one of both a communicable disease and a communication disease. Or, in the words of World Health Organization director-general Dr. Tedros Adhanom Ghebreyesus: “We’re not just fighting an epidemic; we’re fighting an infodemic. Fake news spreads faster and more easily than this coronavirus and is just as dangerous.” We were told to reduce our contacts and stay in our bubbles. Social media already had us there. The decline of traditional media means that sources of information more subject to scrutiny of their quality and veracity have given way to the unaccountable fever swamps of specialized rage-farming sites, YouTube rabbit holes, and the toxic trolling of Facebook feeds, Twitter replies, and comment sections. If misinformation was a smouldering fire, COVID was a steady stream of gasoline.
Twila Lamont was a thirty-six-year-old mother of six from Yorkton. When COVID hit her household in November 2021, she and her husband, Derek Langan, decided they should ride it out at home because the hospitals were full. The Saskatchewan Health Authority had stopped their previous practice of daily calls to check up on identified positives. Had they been calling, they might have learned that things were going very badly. Derek hardly left his bed for two weeks and wasn’t aware of how ill his wife was. She was found unresponsive. Despite being barely able to walk, Derek attempted CPR, but it was too late for Twila. Derek later told the CBC that they decided not to get vaccinated because of things they’d read on Facebook, stories he now sees as “myths and conspiracy theories.”
Combatting disinformation is now central to the project of maintaining liberal democracy and public health.
These same Facebook myths and conspiracy theories are now in- forming the actions of governments. Disingenuous politicians fed into this from early days, with then US president Donald Trump a primary culprit. Dissenting scientific voices were given platforms on popular podcasts and propaganda news channels, not because their views were well examined and found credible but because they were dissenting. Reputations that should have been damaged by repeating falsehoods were instead enhanced and fringe falsehoods became mainstream mes- sages. As Stephen Maher pointed out, writing in Maclean’s, “there are three times as many COVID deaths in Trump-supporting counties, where vaccination rates are low, as there are in Democratic counties. In Canada, the areas most heavily influenced by Trump-style politics are also the areas with the highest rates of vaccine resistance.” Just as resonating vibrations can destroy a bridge, the exponential spread of lies without consequence is a threat not only to public health in a pandemic but to the institutions that form the foundation of a nation.
Combatting disinformation is now central to the project of maintaining liberal democracy and public health. We ignore poisonous resistance at our peril, but caving to it is not the answer. What is the role of the social media giants in policing the veracity of what is shared on their platforms? How do parliaments and legislatures promote facts and discourage falsehoods? How can civil society and scholars compete in the clickbait marketplace with those unfettered by ethics?
The immediate crisis of a rapidly emerging and changing pandemic laid bare the challenge of communicating complex issues in the face of deliberate disinformation. Too many people are unwilling to change until it’s too late, even when too late is in two weeks. We’ve learned the hard way that we must plan ahead and prepare for the worst, no matter how hard making decisions for tomorrow may be. We also learned how hard it is to bring people into that planning. It is daunting to think how we will be able to ask people to make major changes and sacrifices for some-hing as large and nebulous as climate change when sustaining minor inconveniences in the face of imminent danger was too much to ask.
In the face of mounting disinformation, we will need stronger voices for evidence-based solutions. We saw increased advocacy from many sectors and professions during the pandemic. Some of these voices were extremely effective and drove change; others got caught up in the same cycle of likes and retweets that drives their opponents, becoming more extreme in their positions and undermining their own credibility. Academic institutions and governments can work together to study what kinds of evidence-based advocacy work and amplify credible sources. We need to help people with knowledge and understanding to say the hard things and have them heard, to spread neither doom and gloom nor false hope, but a vision of the best future we can build together.
If you want people to trust you, you need to trust them first.
Connected to this fight for the facts is the need to acknowledge that people can, will and even should doubt the experts. Critical evaluation of what public health and elected leaders are saying is happening and it’s a good thing. The problem is when that critical thinking turns to outright rejection and replacement of the best scientific understanding with the Joe Rogan’s and RFK Jr’s of the world.
Over at Your Local Epidemiologist, Katelyn Jetelina published this image on declining trust in scientists in the US and how that breaks down along political lines. The chart highlights the risk of believing in science becoming an identifier of political tribe rather than a commonly-held belief, and of partisan divides making conversation between those with opposing viewpoints impossible. She then took the brave step of engaging in a rare conversation with someone who was fighting her efforts a skeptic of the efforts to control COVID.
There are important points made about how scientific information was communicated during the pandemic and how mistakes made in the process had people tuning out official channels. Perhaps more importantly is the willingness to engage in dialogue.
As the slide above from the Edelman Trust Barometer’s Trust and Health Report shows, people want to be actively involved in decision-making about their health. “Trust me, I’m a doctor” is no longer a convincing message. Today’s public wants to know the reasons behind public policy choices and advice. This brings us back to the point around relationships and primary care, that those opportunities for meaningful one-on-one dialogue matter a great deal. It also gives some key advice to those communicating with the public: if you want people to trust you, you need to trust them first.
Excerpt 2, Lesson 5. We need to trust people with the truth, even as the truth changes
Our scientific and public understanding of the virus has grown dramatic- ally and quickly. The change can be tracked with the changes in ourvocabulary, from “novel coronavirus” to familiarity with subsets of various variants, from “surface transmission” to “hygiene theatre.” When we say to follow the science, inherent in that idea is that our scientific under- standing develops and we must be able to adapt to new knowledge. The great risk lies in insisting that what we know at one point is what we will always know and refusing to change earlier assumptions as we learn more. In the dance of the pandemic, the science leads. The steps change; we have to learn to follow.
Much as a patient might move from a hyperglycemic emergency to adjusting to the reality of living with diabetes, we have moved with COVID from immediate response to medium-term mitigation and long-term adaptation. Daily inconveniences, like testing sugars or keeping a box of masks in the car for when they are needed, become substantial changes that reflect what we’ve learned about how to stay healthy, be they constant diet and lifestyle demands on the personal level or new approaches to public policy at the societal level. The right choices change and the challenges of communicating them become more complex.
Downplaying the seriousness of the situation and restricting the data erode public trust in official channels. As André Picard noted in a March 2022 Globe and Mail column, “throughout the pandemic we have consistently looked for ways to downplay its severity, from claiming older people felled by COVID-19 were going to die anyhow, to distinguishing people hospitalized ‘from’ COVID-19 from those ‘with’ COVID-19.” Despite having some of the world’s most sophisticated and accurate modelling, what was seen by the Saskatchewan public was largely the result of leaks or freedom of information requests rather than proactive sharing of information. When it was shared, “best case scenarios” were emphasized without the acknowledgment that these could only be achieved with significant change. “Road maps” for coming choices were either absent or solely focused on how to respond if things got better, not what to do if they got worse. We had a chance to let people see the facts and invite them into a conversation about how to shape the days ahead, and we blew it in favour of brightsiding. When we acknowledge problems and mistakes honestly, people are willing to engage. When everything is about damage control and spin, people walk away.
That’s why trusting people with the truth and demonstrating that trust through transparency is so crucial. Knowing how many cases there were, where they were located, where deaths were occurring – this is the kind of information that helps people understand their risk and make wise choices. Knowing the next steps if things worsen or improve gives people agency. When people feel trusted, they are more likely to trust. When information is kept from people, that’s when suspicion creeps in, leaving people uncertain about how to act or even susceptible to the types of conspiracy theories that are flourishing today.
If you set people up to think things are simple, straightforward, and once and for all, they will be frustrated when they aren’t.
Part of trusting people includes telling them not just what you know but what you don’t. In the earliest days of the pandemic, we were shunning masks and disinfecting our groceries. Later, vaccines were going to end things once and for all. Again from Picard: “If there is one overarching lesson from the pandemic, it is that messaging matters. And the messages need to be nuanced. We need a lot less black-and-white, and a lot more grey.” Not only do we need to share with people the information we do have, we also need to be honest about what we don’t know. When we let people know in advance that things will change, it allows the space for our understanding and messaging to evolve. If you set people up to think things are simple, straightforward, and once and for all, they will be frustrated when they aren’t.
Despite the Omicron wave being among the deadliest in our pan- demic experience, most people remember it as the end, because that’s when we stopped receiving daily updates on cases, hospitalizations, and deaths. Stretching these updates out to weekly and later monthly took away the means to stay engaged. It may not have worked to reduce the transmission of the virus, but it was tremendously successful in reducing the attention being paid to it. Rather than learning the lesson that greater transparency will improve the public response to challenging times, I worry some leaders will decide that it’s to their benefit to stop sharing information sooner. For example, in response to growing concern in the fall of 2022 that there were no family physicians taking new patients in Regina or Saskatoon, the public posting of that information was discontinued.
Telling people less in order to decrease criticism is not the path to a healthier, more open society. Responsible leaders who genuinely want to combat misinformation need to make information as widely available and accessible as possible. It’s not a matter of simply telling people to trust in the experts; that sort of technocratic response will not work in a democratic society. The decisions on how to build a healthier future need to be in the hands of the people. This leaves a challenge in the hands of the politically engaged public: exercising our democratic rights includes demanding all the facts. We need to insist that governments trust us with the truth.
It’s so nice to read from a expert, my anxiety level went down. We need more of this, thanks Ryan