In times of crisis, truth holds power. Hence, distortion of the truth can prove catastrophic for society. Misinformation is not a new phenomenon — from conspiracy theories about 9/11 to climate change denial. Yet perhaps none can rival the misinformation circulated during the COVID-19 pandemic, a phenomenon that preyed on human weakness. To effectively combat the misinformation pandemic, we must return to the foundational apparatus through which truth is disseminated — education.
The Misinformation Pandemic
The COVID-19 pandemic has established itself as one of the deadliest plagues in history, with an estimated death toll of over 6 million worldwide. Its impact extends beyond the senseless loss of human life — from 2019 to 2020, the median global GDP dropped by 3.9%, making it the worst economic downturn since the Great Depression. Still, the remarkable strength and resilience of the scientific community led to the development of a working vaccine by the end of 2020. To date, around 70% of the U.S. population is fully vaccinated. Yet, from one of the greatest successes of the pandemic — the vaccine — arose one of the most widespread topics of misinformation. Vaccine hesitancy has been a major factor of concern against combatting the pandemic. Common vaccine falsehoods fueled a rise in anti-vax sentiment, which in turn led to greater transmission of new and dangerous variants.
Beyond vaccinations, misinformation about countless COVID-related topics has been spread, from early treatment to variant propagation to immune regulation. For instance, the promotion of ivermectin as a COVID-19 treatment has been very controversial due to the lack of convincing evidence for both its efficacy and safety. Not only can these unverified treatments be ineffective but also potentially dangerous in large doses. Other common narratives are not health-related at all — this includes scapegoating groups of people and conspiracy theories regarding the origins of the virus.
Perhaps above all else, social media greatly exacerbates the spread of misinformation. Social media is a key platform through which misinformation gains momentum, detrimentally affecting community health. Tantalizing clickbait headlines are more likely to gain readership for a publication. Additionally, negative news elicits stronger and more sustained reactions than positive news, and most COVID misinformation feeds on the fears of already vulnerable populations. Misinformation thrives when the public is not sufficiently knowledgeable on a topic of discussion, which was certainly the case for the COVID-19 pandemic, which elicited considerable fear, desperation, and uncertainty. Amidst these turbulent times, the public is more likely to turn to any inkling of hope, reflecting a perfect opportunity for falsities to flourish.
Combating Misinformation
Currently, misinformation is tackled on a case-by-case basis. Today, much of this responsibility has been thrust into the hands of fact-checking algorithms on social media platforms. In the short run, these algorithms can prevent the dissemination of a few misleading news articles, but simply “fact-checking” every claim on social media is neither sustainable nor effective. These AI-based algorithms can reflect biases like flagging race-based, colloquial language as potentially offensive at higher rates, which promotes discrimination. We have done very little to address the root cause of misinformation, and it is almost certain that such a “misinformation pandemic” will arise, once again, in the event of another public health crisis. The tragedies of the COVID-19 pandemic ought to provide valuable learning opportunities, so what long-term solution can we implement?
The concept of public health literacy sits at the core of effective solutions against misinformation. Public health literacy is defined by researchers at the University of South Carolina as “the degree to which individuals and groups can obtain, process, understand, evaluate, and act on information needed to make public health decisions that benefit the community.” The rise and spread of misinformation unveiled the dangerously low levels of public health literacy in the national and global citizenry. Misinformation only propagates when people cannot distinguish truth from fiction — a hallmark of low public health literacy. Those who have higher levels of public health literacy internalize a greater capacity for doubting misinformation, thereby restricting its spread. Therefore, improving the level of global public health literacy through nonpartisan, fact-based education is the way to go.
What is Public Health Education?
At its core, the mission of public health education is to promote public health literacy. In particular, instruction on epidemiology — the scientific foundation of public health that combines statistics, biology, and sociology in real-world relevant ways — is a powerful vehicle to do so. Yet, epidemiology is rarely emphasized in the traditional K-12 curriculum. Core epidemiological principles like the basic reproduction number, the chain of infection, and herd immunity are not a part of students’ pre-collegiate education. These concepts entered the mainstream only in the event of a public health crisis like COVID. We shouldn’t need the worst pandemic in over a century to broaden understanding of these concepts: They should be treated as an immunization against misinformation.
In addition to a paucity of courses on public health or epidemiology, core concepts within these fields are neglected in standard curricula of courses like biology. Although public health is a growing field of study among undergraduates, it has yet to be implemented into high schools. Moreover, the college enrollment rate among high school students is about 60%, and only a fraction of those students go on to study a health-related field. For a field as applicable and interdisciplinary as public health, this startling lack of curricular representation is troubling.
Although limited research has been conducted on public health education, the current evidence for its efficacy is promising. Dr. Michael Bracken, a professor of epidemiology at Yale University, found that epidemiology education is an effective way of helping students understand science-based causes and treatments of disease. On top of that, epidemiology education provides students with the skills to debunk misinformation. Epidemiological knowledge is essential in sifting through a “tsunami” of media messaging. Beyond merely promoting public health literacy, epidemiology, and public health education are effective ways to promote students’ critical thinking skills. Dr. Emily D’Agostino, an epidemiologist and professor at Duke University School of Medicine, conducted a study in 2019 on the multi-faceted benefits of public health education, which included social awareness through the encouragement of whole, population-based thinking. Other studies conducted have demonstrated gains in scientific literacy for high school students who were given epidemiology instruction. Unlike traditional clinical medicine, public health as a field challenges the student to think beyond oneself as the primary health unit and consider how the entire population dynamic can be affected by a single person’s actions. In an interview with the HPR, Dr. D’Agostino attests that, “epidemiology can be a way of thinking” and “can be taught in a way that promotes scientific literacy.” On top of that, epidemiology is a way to connect youth with science, allowing them to “think like a scientist.”
Perhaps one of the most outstanding benefits of public health and epidemiology education is that it is fact-based and nonpartisan. During such politically-charged times exacerbated by the COVID-19 pandemic, it is increasingly rare to find solutions that create peace among the population at large. Issues like vaccines, mask mandates, and school closures have denigrated into raucous public debates. Public health education would offer an important middle ground for this polarizing discourse, a nonpartisan solution that is critically missing. It is the closest that we can get to the “truth” in a scientific establishment so deeply intertwined with factional politics. Starting from the basic pillars of public health that are indisputably backed by decades of scientific research is unifying and effective.
Given these clear benefits, why aren’t public health and epidemiology education more readily implemented in classrooms? Dr. D’Agostino explains that a relative lack of research on public health education and the complexity of epidemiological concepts impedes this endeavor. Although the existing research on effective epidemiological pedagogy is promising, it is difficult to persuade teachers and policymakers to amend existing educational standards without more comprehensive models. In an interview with the HPR, Trudi Ellerman, Education Director at the Center for Disease Control and Prevention Museum, also outlined a ripple effect in the lack of attention paid to public health education resulting from a lack of funding. As a result of this lack of funding, standalone epidemiology courses are difficult to implement in classrooms. There is a lack of qualified teachers and classroom assignments for teachers to use. Even without creating standalone courses, it is difficult for teachers to find time in their busy schedules to add additional material that does not correspond to the state curriculum.
Another issue is the localization of education. Dr. Cynthia Baur, the Director of the Horowitz Center for Health Literacy and a professor at the University of Maryland, attested in an interview with the HPR that education policy cannot be imposed in a top-down manner by the federal government. Rather, it is a local matter that requires more intensive state-by-state advocacy for curricular change. Many more key players and stakeholders are involved, making it a more difficult change to impose on a broad scale. Dr. Baur was involved in the creation of HB1082 in the Maryland legislature alongside Delegate Joseline Peña-Melnyk from the Maryland House of Delegates. This bill would in part require plain language in public communications about health, safety, and social services benefits, and establish grant requirements related to health literacy. Dr. Baur further stated that maintaining clear, simple communication amidst the stream of information disseminated during the pandemic would vastly improve the public’s trust in scientific institutions. Alongside funding and research, strong policy proposals are also influential in promoting public health education.
Democratizing Public Health Education
However, the needle has begun to shift, especially with the catastrophe of COVID. Public health education is widely regarded as a method of improving public health literacy, and that starts with a robust public health education infrastructure for youth. Project Unmasked is a global campaign that has been doing just that: advocating for public health literacy through equitable education for youth and creating a variety of curricula, classroom assignments, and projects for students to explore epidemiology and public health. Other organizations like the CDC Museum have been working on initiatives like STEM-based epidemiology lessons for teachers, summer epidemiology camps for students, as well as training and workforce development programs for future epidemiologists.
Education is and always will be a powerful tool for societal improvement. From public health literacy campaigns to health communication legislation, the foundational operating strategy is the promotion of education in a way that is equitable and accessible to all. To create broad-scale positive change in society, returning back to the basics is key.
This piece initially ran under the title “Back to the Basics: Education as the Solution to Misinformation.”
Image by Ivan Aleksic licensed under the Unsplash License.
