Saturday, October 3, 2009

Parents not planning to vaccinate their children - why are we surprised?

As I’ve been tracking and analyzing swine flu, H1N1 messages since last spring I see the current public understanding a logical and direct outgrowth of narrowly conceived communication strategy and even narrower appreciation of public health literacy.

Parents, people are as intent as ever on their families’ health and safety.
Yet a Consumer Reports study finds that only 35% polled intend to have their child vaccinated.
Huston - we have a problem.

But what could the problem be?
The psychologist, George Miller once said -
When you’re disagreeing with someone, STOP.
Then say to yourself - “What this other person is saying is true.”
And then ask yourself “What could this be true of?”
Instead of being dismayed and wringing our hands about the public that just doesn’t get the seriousness of H1N1, let’s try a little thought experiment

Outside of Duane Reade
I’ve been interviewing people about swine flu, H1N1 out on the street since last Spring.  And not surprising, people are using whatever health literacy abilities they have to make decisions about the risk of swine flu, and now, the safety of the vaccination.
As I reported in a post (9/15), I asked a woman why they’re recommending “we sneeze into our sleeve?” 
Confidently she say -
“For the environment,”  .”You save the paper….”

And a man explains his strategy for hand washing -
“Well, gotta see what it [the flue[ winds up being. Right now I’m just using the hand cleaner stuff instead of soap and water. So we’ll see if that does the trick.”
I flipply called this “magical thinking” 
But it’s not. It’s health literacy at work.  (Remember Miller’s challenge - think about what the person is saying and then ask yourself, “What could this be true of?”
The more I talk to people, the more I’m constructing a better idea of the health literacy people have and are using about H1N1 ( and viruses more generally).
If you look at the key health messages that have been promoted from the federal HHS/CDC level down to local governments and experts it’s been 3 clear and simple messages:
  1. Wash your hands often
  2. Sneeze into your sleeve
  3. Stay home if you’re sick
But the fundamentally important health information that has been virtually ignored involves communicating ( and repeating) core health literacy concepts in clear and understandable ways.  These include:

  • What does it mean that this is a “new” virus?
  • Why is that important to me and my family?
  • What do vaccines do to protect us and why is it risky to let children “naturally” develop immunity during a pandemic?
As we wrote in our textbook on health literacy,  “A silent killer maneuvers just below the surface of almost all the health and public safety issues in the 21st century. The silent killer is low health literacy – the reality that almost half of adults in the U.S., over 90 million people struggle to find, understand, and correctly use health information. (Zarcadoolas, Pleasant & Greer, 2006).

As I track and study the swine flu communication I am placing it, thus far, in the category of a missed opportunity.
Public health officials may have incorporated popular social media strategies into their toolbox, but the messages have been driven by the old dissemination model - just get the facts out there and people will take good health and safety actions.

My Question?
Is it possible that the compact to create clear and simple health information has over-promised - not lived up to its billing? What if the complexity of health information in the first half of the 21st century requires more than simple representations of science, medicine and decision-making?
Wash your hands….sneeze into your sleeve?
What if we the intentions to simplify are good, but many of the executions are bad?
And so, this universal simplification has yielded a public health communication by subtraction, the consequences of which are that we are unwittingly perpetuating limited access to the complex and nuanced information necessary for patients and publics to make informed decisions about health.

And, we could take this argument one step further.
What if we entertain the idea that this un-interrogated over-simplification of health and safety information is also very likely to perpetuate an unequal access to society’s larger information commons.  So what we communicate ( and don’t) contributes to the historical and tragic difference between the haves and the have nots.  This time with potentially deadly condequences.

I’d really like to hear your thoughts about how swine flu is being communicated?
Anyone else talking to people about what they understand and plan to do?