The most important scarce resources in politics are time and attention. Sure, money matters, but savvy poli­ticians can always work their networks to seed, find, or harvest more money. No amount of political savvy or con­nections can generate more time or attention.

Nowhere is this problem more prevalent than in the area of health policy. Health policy is often highly techni­cal, shrouded in verbiage that is not accessible to the aver­age voter or legislator, and can change rapidly. Combine these problems with the reality that health policy is also extremely important and is the subject of massive lobby­ing efforts, and it becomes clear that the job of commu­nicating health policy effectively is extremely challenging.

The challenge is even greater in an era of low trust. Trust acts as a lubricant for complicated information. In the absence of trust, each interaction with information has more friction and is more difficult to complete. While trust in institutions has been waning since the early 1970s, the COVID-19 pandemic and related political fallout have reduced trust to levels that border on anemic.1

Despite the challenges, scholars and practitioners must find a way forward, as health communication is increasingly important to any society, but particularly a democratic republic such as ours where public opinion can still influence public policy. From this vantage point, some citizens’ disbelief that face masks can improve pub­lic health, for example, is not simply a curiosity; it is neces­sary to understand and challenge these attitudes to create a better society. Similarly, anti-vaccination sentiment is more powerful in a democratic republic because it will result in politicians who are less willing to pass policies that encourage vaccinations. Effective health communica­tion, therefore, is as critical to public health outcomes as the knowledge upon which it relies.

Anyone even remotely familiar with health com­munications has seen rumors and misinformation run amok—rumors and misinformation that, left to spread to the wrong hands, can result in bad public policy and poor health outcomes. A well-meaning practitioner might be tempted to simply try to quash those rumors by directly refuting them. Unfortunately, as political scientist Adam Berinsky demonstrates in a piece in the British Journal of Political Science, attempting to publicly quash rumors may actually make matters worse, increasing the prevalence of rumors and misinformation by drawing attention to them.2 These results follow from other work on misinforma­tion in American politics. A series of papers by political scientist Brendon Nyhan and colleagues demonstrate that correcting misinformation, particularly on controversial, value-laden issues, can generate backlash.3 The result of that backlash may be that some people will hold onto their misinformation more tightly after being corrected.4 Nyhan’s work also extends to health policy and health communications.5 For example, he and his colleagues find that correcting misinformation about the Zika virus in Brazil does not seem to change behaviors. Corrections made by people or resources from the opposing party are particularly ineffective and are the most likely to produce negative outcomes.6

So, what is to be done?

There is some evidence that norming behavior among like-minded people can help—at least in the short run. For example, reminding Republican skeptics that promi­nent co-partisans support masking, or reminding anti-establishment liberals who are vaccine skeptics that many of their co-partisans support vaccinations, can help shift public opinion and be less likely to backfire. In a piece in the New England Journal of Medicine, Richard Baron, M.D., and the aforementioned Berinsky argue that “intentionally recruiting civic-minded people to deliver medical and sci­entific facts that run counter to the public’s expectations of those people’s own interests might be effective”.7

As this issue of the North Carolina Medical Journal dem­onstrates, we are living in an area of low trust, and that trust is unevenly spread throughout society. Some people trust more than others and some sources are considered more trustworthy than others. To make matters even more difficult, the specifics of who trusts whom can vary by background, political affiliation, and ideological outlook.

It is not enough for practitioners who wish to accu­rately communicate difficult information about health and health policy to simply “speak truth to power” and expect outcomes to change. Instead, they must cultivate a hetero­geneous network of policymakers and influencers to make the case for them.

From this perspective, health communication in a time of low trust needs to be thought of as a critical process, not a single, invisible act. Research outcomes and preferred health policy must make it from the researcher to a diverse network of sources, who then speak to their respective communities.

Paying attention to the reality of the low-trust environ­ment, the highly technical nature of health communications, and the fleeting nature of public attention is the only way to achieve the policy and public health outcomes that will ultimately benefit society.

Disclosure of interests

The author reports no conflicts.