Communications and Public Health: the Vaccine and Fluoride Connection
Contributed by: Brittany Seymour
The field of health communication is rapidly evolving due to new and emerging social media modalities. In an age where information is literally and instantaneously at our fingertips, people are galvanized to seek answers and make health decisions more independently, relying less on the knowledge of health experts or experienced practitioners. So, what is the contemporary communication role of pubic health experts?
The state of California is a striking example of the cause and effect of modern health communication challenges. Personal belief exemption rates for childhood vaccinations in California doubled from 2007-2013. As information sharing platforms exploded, more parents turned to the internet for answers, where questionable and low quality resources dominate many health topics. As such, vaccination coverage fell below protective thresholds by the 2014 school year. California became the epicenter of the largest measles outbreak in the US in nearly a generation. The disease has since emerged in 27 states over the course of 6 months. Many of those hospitalized with complications were infants, too young to be vaccinated. In response, CA legislators have passed one of the strictest bills in the country, which would eliminate personal belief and religious exemptions and require nearly all public school children to be vaccinated.
Given our current ethos of autonomy and hyper-personalized health information-seeking behavior, depriving parents of a choice is a strategy that has the potential to fail. Internet users today are not merely passive consumers of online content. We are content creators with every Facebook or blog post and content curators with each retweet and link we share, attaching our own sentiments and attitudes to every post we publish to cyberspace. Accordingly, the internet is a fluid environment where people are engaging in constant virtual conversation, connecting with one another through a vibrant web of links, shares, and social influences. Health communication challenges are not solely a problem of information quality, but also of social network norms and values, where content accuracy is often secondary to network sociology and influence. And one of the strongest guiding values of much of the online network is a balance of choice and autonomy; it’s what drives many vaccine-hesitant parents to the internet, where they are equal, active, empowered decision-makers in the conversation.
This phenomenon, nicknamed the three Cs of today’s internet – creation, curation, and conversation – reflects the fact that in today’s interlinked digital society, public health and policy experts are not the only influencers in the conversation on fluoride. Fluoridation, like childhood vaccinations, teeters on the delicate cusp of prevention, public policy, and personal choice. Like vaccines, the science is clear and the benefits exponentially outweigh what minimal risks these interventions may pose; despite this, community water fluoridation continues to be contested because personal values play a critical role in how health messages about fluoridation are received. The messengers, target audience, influencers within that audience, and delivery of the message all play an important role. Appealing to the value systems of our target audience and optimizing the three Cs of the internet to personalize our messages in a manner deemed socially acceptable is crucial. These social health communication strategies require innovative and unconventional approaches for actively and continually engaging in the digital conversation with our audiences.
Dental public health can learn from the California measles outbreak; we must not allow social influencers, who are not experts, to threaten 70 years of one of public health’s greatest achievements and devolve back to historically high rates of dental caries in the US, particularly when their platform is a foundation of misinformation. Public health advocates must continue to combat this threat and deliberate on critical strategies to modernize dental public health communication so that the voices of expertise and evidence can become more influential online. This value-based approach will guarantee policy its important place, while still preserving the autonomy of choice that is so important to people today. By restoring the scientific integrity of online conversations about fluoridation, we can empower online networks, arm them with the facts, optimize personalized decision-making processes, and positively influence their ultimate choice: to fluoridate.
Brittany Seymour is an Assistant Professor of Oral Health Policy and Epidemiology at Harvard School of Dental Medicine where she studies digital health communication science. As the Inaugural Harvard Global Health Institute Fellow, she launched the Harvard Health and Media Collaborative and the Social Media and Health Fellowship program for students, where fellows have worked on projects in the United States, Rwanda, Uganda, and South Africa. Her work has explored digital communication around water fluoridation, childhood vaccinations, the Ebola epidemic, and adolescent HIV/AIDS. This year, she will be a Fellow at the Berkman Center for Internet & Society at Harvard, an interdisciplinary and diverse community of academics and practitioners supporting its mission to engage the challenges and opportunities of cyberspace.