COVID-19 and Public Health Communications

What has changed, and how do we proceed?

The pandemic has shone a clear light on the importance of community risk factors in shaping health outcomes. Depending on where a family lives, they may or may not have had access to testing and vaccines and proper care, schools with the ability to implement adequate safety precautions, jobs that allow for remote work, safe and uncrowded commuting or transit options, personal protective equipment, grocery delivery services, safe spaces for gathering outdoors, and more. While the impacts of these differences are generally felt over lifetimes and generations, the speed and severity of the pandemic made it easier to observe these differences in real-time.

Even still, popular understanding maintains that health is primarily a product of health care, and that remaining differences are merely a result of personal choice. The piece that is often missing from that narrative is the understanding that those choices are limited due to place-based constraints that often play out over the course of a lifetime. 

While the sped-up timeline that has accompanied the COVID-19 pandemic could present unique communications opportunities, attempts to inform the public and shift opinions have gotten increasingly complicated in a highly politicized environment, full of othering, misinformation, and distrust.

To better understand public perception of these issues and possible communications opportunities to raise the profile of place-based determinants of health, the Nova Institute for Health commissioned a series of focus groups conducted by the Center on Society and Health at Virginia Commonwealth University, with recruitment support from the Millbank Memorial Fund. These groups consisted of participants with varying levels of political involvement (including active and former state legislators), differing ideologies, and widespread geographies, and helped us uncover some important takeaways as we continue to think about drawing attention to the importance of addressing certain place-based differences in a post-COVID world.  

The main themes we took away from this work are as follows.

  1. Right now, it is too early to use COVID-19 as a “themed talking point.” The issue and the experiences are too polarized. But a time is coming when the stories and takeaways can be used as a vehicle for underscoring important themes, and it will be important to seize that opportunity when it comes. The challenge is timing, as the pandemic will lose its poignancy when the memory is no longer fresh.
  2. Terms like “social determinants of health” and “public health” mean different things to different people. Breaking the habit of using familiar or more academic terms can be challenging, but speaking in plain language and avoiding potentially loaded terms can help reach and persuade new audiences. We found the phrase “community health” to be more relatable and well-received than “public health” or “population health.”
  3. Trust will need to be rebuilt—in leaders, public health, and science itself. The pandemic showed us the hazards of inconsistent messaging, especially by leaders, and it also taught us the need to respond deftly to changing science in ways that maintain public confidence.
  4. Mandates can be used creatively to protect health and safety, but with caution to not trample on personal freedom. Changing the “environment” to facilitate desired behaviors is often a more effective and subtler alternative.
  5. Appeal to both civic responsibility and personal responsibility. While health is certainly shaped by individual choices, it is important to support our communities and ensure the choices that support health and wellbeing are truly accessible to everyone. 
  6. Public health needs far more developed “story-campaigns,” which grab attention in evocative ways that statistics and epidemiology cannot.
  7. Accurate information is not enough—and is often readily available. Communicators should pay more attention to the way their audiences communicate, the channels and sources they use, and where the messages land.
  8. As our society has become more polarized, the tendency to use stereotypes has increased, but it is unhelpful. Audiences are not a monolith and are easily put off by messages that assume they are.
  9. “We” may not be the most effective messengers. We, as researchers or public health professionals, national leaders, or politicians, are less compelling than trusted leaders from within a community.

We hope these findings can offer our colleagues some support as they move on from pandemic communications and continue to advocate for changes that will better support community health and wellbeing. In the wake of the pandemic, complex and fraught controversies from abortion to gun violence and racial justice are at the center of public dialogue.

It’s safe to predict that the need for health professionals to do better in fostering healthy communication about sensitive issues will challenge us for some time. Learning new ways to frame conversations that encourage understanding, dialogue, and progress is urgent.

To learn more about this study, contact Dawn Stoltzfus.

Developing safety, persistence, trust

Healing is facilitated through safety, persistence, and trust.

  • Persistence: “People did not simply progress through this sequence and experience healing. The healing journey was a recursive, back and forth process. They found helpers, used the skills/resources that those helpers provided, found other helpers that provided more resources and used those skills and resources. As this process continued, people experienced a gradual amelioration of their suffering. Although many despaired at times, all demonstrated the quality of persistence—they refused to give up.”
  • Safety & Trust: “To connect to helpers, it was essential for people to feel safe in those relationships and able to trust that the person would be a helper and not a barrier to healing. Persons whose wounds included a violation of trust were especially careful about testing the safety of new relationships.”

Acquiring Resources

Resources support us as we heal. They include reframing, responsibility, and positivity. “Making connections enabled participants to acquire and refine resources and skills that were essential in their healing journey. People also brought their own personal strengths to the journey.”

  • Reframing: “A particularly important skill was the ability to reframe—that is to look at suffering through a different lens.” This does NOT mean minimizing trauma or pain, but rather it often means the opposite: understanding what happened was wrong, unfair, or uncontrollable and that we are not to blame for it.
    • “I think I kept trying to convince him I was crazy. And he kept saying, ‘No, you’re not crazy.’ […] You wouldn’t necessarily say a Vietnam Vet was crazy. You’d say they are responding like you’d expect to extraordinary circumstances.”
    • “I’m not the only one who have [sic] this problem. A lots, millions of people, you know. […] They don’t have nothing to do with that. I guess I have to live.”
  • Responsibility: While we don’t have control over what happened to us, we are the only ones who can help ourselves heal. “A third essential resource that people acquired or refined was the ability to take an appropriate amount of responsibility for their healing journeys. They participated actively in the process of healing. Once again, some participants already had developed this skill, and some acquired or refined it from their helpers.”
    “You need a lot of energy and a lot of work … it takes a lot of work. It doesn’t just happen. It’s not like a magic wand.” This patient understood that they had to actively participate in the healing process.
  • Positivity: “Another resource that people acquired or refined during their healing journey was choose to be positive—that is to have some optimism about their situation.” People have varying predispositions to positivity. In the study, positivity was important in helping people heal. This doesn’t mean a toxic positivity, but rather simply finding some good in life and feeling hopeful about our situations.

Helping Relationships

“Connection to others was an essential part of all the healing journeys.” Humans are social creatures, and even the most introverted of us need close relationships. Friends and family add meaning and value to life and help support us, in good times and bad. When we experience relational trauma, relationships can feel scary, but reestablishing safety and trust in relationships is where the healing happens. (To be clear, we do not mean reestablishing safety and trust with abusers, but rather finding other healing relationships.) “When safety and trust had been established, people were able to connect with helpers. The nature of the behaviours of helpers that fostered healing ranged from small acts of kindness to unconditional love.”

  • “Moving from being wounded, through suffering to healing, is possible. It is facilitated by developing safe, trusting relationships and by positive reframing that moves through the weight of responsibility to the ability to respond.”
  • “Relationships with health professionals were among these but were not necessarily any more important to the healing journey than other kinds of helpers, which included family members, friends, spirituality and their God, pets, support groups, administrators, case workers and supervisors.”

Healing

Healing probably means different things to different people, but one definition that emerged from the study is: “The re-establishment of a sense of integrity and wholeness.” Healing was an emergent property that resulted from each individuals’ complex healing journey, a result of bridged connections between resources and relationships. Healing, in this sense, does not mean cured—none of the study participants were cured of their ailments—”but all developed a sense of integrity and wholeness despite ongoing pain or other symptoms.” In varying degrees, “they were able to transcend their suffering and in some sense to flourish.” When we begin to heal, we find increased capacity for hope, renewed motivation to help others, and are more able to accept ourselves as we are.

Suffering

Suffering is the ongoing pain from wounding. There is debate about whether or not one actually needs to experience suffering on the path to healing.

Wounding

Wounding happens when we experience physical or emotional harm. It can stem from chronic illness or by physical or psychological trauma for which we do not have the tools to cope, or a combination of those factors. “The degree and quality of suffering experienced by each individual is framed by contextual factors that include personal characteristics, timing of their initial or ongoing wounding in the developmental life cycle and prior and current relationships.”