Oversimplified efforts to counter health misinformation are missing the mark

A cacophony of definitions

Firstly, we need more clarity and consistency in definitions to assess and foster a healthier information environment. Many words describe the quality of information: untrustworthy, low quality, unverified, unbalanced, contradictory, deceptive, or sensationalised, among others. But each conveys a different value judgment and thus frames the problem differently. Misinformation is false or inaccurate information. Disinformation is deliberately false information, spread for political or monetary gain.

The terms misinformation and disinformation are often conflated in research and policy, failing to recognise that the definition of the problem influences how it is tackled. Labelling something as misinformation is a value judgment on its accuracy. Disinformation is a value judgment on intent for distribution of inaccurate content. Each requires a different solution.

Medicalising a systemic challenge to health

Secondly, we should not individualise a problem that is structural, as has been done with many issues in public health. This can lead to individualised solutions, ignoring the complex dynamics at play. It is important to focus on the root causes of the problem, not simply treat how it manifests on an individual level that is easier to observe.

Popular covid-19 pandemic era strategies often focused on the individual, such as expecting doctors to debunk misinformation patients shared,8 or building resilience to health misinformation through social inoculation.12 These tactics shift the focus and burden of confronting a systematic problem onto the individual, who has little control over the digital onslaught of information they receive. We need to consider how consumer protection laws and regulatory mechanisms can improve the general availability and quality of health information on websites, internet platforms, and apps.

More complex than communications alone

Thirdly, the covid-19 pandemic demonstrated the limited success of trying to communicate our way out of mis- and disinformation,1314 showing how complex and contextualised the problem is. Persistent focus on factual public health information and “better comms” alone will set us up to fail.

For example, journalists and health organisations tried fact checking health claims online, but these did not always reach the intended audiences.1516 We should be holding internet platforms to account for weakening design and moderation policies that were meant to protect users from harmful narratives and harassment.17 Unfortunately, accurate, reliable information does not compete well against emotionally manipulative anecdotes, especially if amplified by cultural influencers.18

Well intended efforts by public health organisations to promote better moderation of health misinformation, including deleting content and banning users,19 can lead to a backlash from people claiming government over-reach or censorship.18

Similarly limited were the attempts by health workers who went online to challenge health misinformation directly, only to experience harassment and doxing.2021

Ineffective counter measures can have dire consequences: misinformation and reframed facts became embedded into policies and guidance. For example, in the US, state legislation echoed language of abortion misinformation that was amplified online and then promulgated non-evidence based policies.22

Contextualised approaches to current and future challenges

Users curate and shape their online experiences by training their personal feeds for information they want. Advertisers happily take advantage of detailed user analytics to advertise products and ideas to consumers, regardless of accuracy.

Public health and medical professionals can no longer assume that more communication or stronger social media campaigns will be sufficient in reaching their intended audiences or informing their health decisions. Instead, we must understand how users seek health information and services online, engage them there, and respond to their concerns and information needs, but recognise we have an audience watching.23

If we do not recognise the drivers of health narratives online and how users are influenced by the information environment broadly, we are concerned that public health research and practice will develop and mobilise solutions that will continue to fail.