How to talk about public health

Chances are if you asked someone about public health’s communications crisis, they would say “which one?” Or, if they’re being flippant, “public health communicates?” It’s never simple to talk about something that on its good days is invisible. During the COVID-19 pandemic, the mismatch between some public health recommendations and the public’s actions created “a reckoning” for public health communications, said Dr. Katelyn Jetelina, PhD, assistant professor adjunct of epidemiology at the Yale School of Public Health (YSPH). That reckoning is partly due to the lack of emphasis on the importance of teaching students how to communicate, she said: “I was never taught one hour of one course on how to do communication when I was getting my master's and my PhD.” The good news, she said, is that communications “can be easily incorporated into schools of public health and needs to be a huge priority.”

And YSPH is leaning in. Jetelina will offer a new course at YSPH in the spring term, “Navigating the Media Landscape for Maximum Public Health Impact,” co-taught with Naria Halliwell, a former producer at ABC News. Jetelina and Halliwell’s course will focus on skills development, both for traditional media, like writing op-eds and learning how to answer tough interview questions, and for new media, like crafting social media posts that could go viral.

Their course will reflect how the atomization of media sources affects which ideas get communicated, to whom, and how. Social media has become the biggest mass medium ever, used by 5.2 billion people across the globe, or 64% of the world’s population. YouTube alone has 2.5 billion users, and 90% of U.S. youth say they use it (with 73% saying they use it daily). Few televised events reach this scale: globally, the Olympics or the World Cup soccer tournament, or in the United States, the Super Bowl, come close.

But during these televised events, all viewers are seeing the same thing. On social media, in contrast, people receive information across a number of networks and sources. Public health has had to scramble to have a credible presence in this realm – while the public’s trust in social media increases. About 53 percent of people in the U.S. say they get news from social media at least some of the time, according to research released by Pew Research Center in October. The same research found that adults between 18 and 29 trust social media as much as they do traditional media. A Healthline/YouGov survey of U.S. adults found that more than half use the medium for health information, while just one-third ask their doctors.

One important difference between old media and new, is that social media demands a different tone and degree of personal connection. The markers of authenticity have changed. This can be uncomfortable for academia, which is used to relying on markers of expertise. Now, relationships matter as much as data. Jetelina, for example, launched her popular newsletter Your Local Epidemiologist during the pandemic to help her neighbors cut through confusing and contradictory messages about COVID-19. Her tone invites her readers to knock on her door and borrow a cup of expert knowledge, along with humble acknowledgment about what she doesn’t know. That combo has drawn more than 400,000 subscribers.

Dr. Gregg Gonsalves, PhD ’17, YC ’11, associate professor of epidemiology (microbial diseases), said academic public health has run into the problem of having an institutional voice when it needs a street voice. “That’s part of what’s happening in public health right now — the institutional voice seems to really be falling flat.” Gonsalves became one of the most visible social media presences in public health by using the same firebrand, “don’t give a s***” techniques he used as an activist in the 1990s with the AIDS Coalition to Unleash Power (ACT UP). These techniques were rooted in deep understanding of, and trust from, the people who ACT UP worked on behalf of. He’s pleased to see the focus on communications education and thinks Jetelina and Halliwell’s course will give students excellent grounding in new ways to transmit scientific knowledge. He adds that students also must learn to think critically about false narratives. “Trust was purposely undermined. We have to fight to get it back.”

Ranney calls social media a strong fit for public health because the field understands how to engage authentically with communities, just as the best social media accounts do. Still, she said, “there is not a prescription, a ‘yes, do this always’ that we can provide [for public health communications]. Rather, it is an iterative learning process.”

Public health as a field can continue to be shell-shocked or it can turn this crisis of communications into an opportunity. This imperative echoes lessons from a century ago, when the novel Arrowsmith (1925) skewered its public health protagonist, Martin Arrowsmith, for his top-down, one-way communications process, prone to disdain for people who don’t follow his directives. He often finds himself ignored or sidelined, and his refusal to adapt to community input and needs proves tragic.

The need to define new, nimble strategies was the main takeaway of “Training Health Communicators: A New Approach” from the August New England Journal of Medicine op- ed by Jetelina, Dean Ranney, Dr. Ted Melnick, MD, MHS, associate professor of emergency medicine at Yale School of Medicine and of biostatistics at YSPH, and Resident Physician and Yale Emergency Scholar Dr. Kristen Panthagani, MD, PhD, who writes the newsletter You Can Know Things.

YSPH is, correspondingly, creatively expanding communications education across the school.

In 2024, Dr. Marney White, PhD, MS ‘09, professor of public health (social and behavioral sciences) launched the skills-based “Health Communication and the Media,” which she is teaching again in the spring term, with new updates to include more audio/visual skills development. White’s course grew out of her experience participating in the Public Voices Fellowship at Yale, with its emphasis on making research understandable to the general public. She also wanted to draw on her previous career in advertising and expertise in behavioral psychology. “I felt an obligation to provide education on what media provides and advertising provides, to get the attention of people, sustain the appeal and use communications psychology to educate, perform and persuade,” she said. “That’s been a shortcoming of public health — we believe that health should be valued; everyone wants to work toward their own wellness. We’re wrong,” White said, noting that people can be aware that something is “bad” for them but still do it, because of social or environmental rewards. Successful marketing and ad campaigns give immediate emotional rewards, she said. “The class aims to harness what we know about successful advertising and apply it to public health.”

To further broaden the aperture of communication, YSPH is infusing both formal and informal aspects of communications into YSPH. Besides bringing Jetelina and Halliwell to teach, Ranney notes that many professors across YSPH are incorporating communications modules in their courses. New leadership courses taught by Senior Fellows Ashwin Vasan and Anne Zink include modules on crisis communications. Ranney also is proud of funding student internships with YSPH’s Office of Communications and Marketing and “our unbelievably talented social media lead.” (See “5 tips” article.) In February, YSPH will host a day-long event on Trust in Public Health that will bring different perspectives and frames on novel strategies for communication to campus.

Lots of people are focusing on myths and false narratives about health, which are being amplified by social media. But “the discussion around misinformation is a distraction,” Ranney said, calling misinformation a symptom, not the underlying problem. To treat the underlying problem, we need to make sure that people’s health needs are being met when, where, and by people whom they trust. Indeed, a recent survey from KFF found that social media users remain skeptical of the health information they see there: less than half of social media users say they trust most or some health information they get from social, and close to two-thirds think social media influencers are in it for the money. This skepticism is an opportunity for public health to step up – with stories, authenticity, and good quality evidence.

Ultimately, the key is teaching students a form of communication that is not top-down, but multi-directional, that involves listening more than telling and sharing experiences. Both the world and the workforce are changing, and YSPH is changing its educational approach to meet new needs.