Rebuilding trust in public health: the battle against misinformation

Women, people who feel financially insecure, people with low levels of education, and people who feel discriminated against consistently have lower levels of trust than other groups. The OECD survey also found that only about a third of people find government statistics trustworthy and easy to understand. So, if many people do not trust government sources, where do they go for health information?

The challenging role of social media and health influencers

Social media is clearly an important source of health information for many people.

Most young adults obtain health information – whether passively or proactively – via social media platforms such as TikTok. But, worryingly, around half of the medical advice on TikTok is either false or misleading, which can have damaging consequences. The ‘sunburning’ trend on TikTok in 2024 is just one example, whereby an influencer with 450,000 followers claimed that sunburn and sea water had ‘burned off’ her acne. Another influencer with 3,000 followers claimed that tanning beds help with acne and acne scarring. These videos have now been removed by TikTok – but the potential for long-term health problems, including skin cancer, is clear.

Social media is a Wild West of health information, and a lack of fact-checking is only part of the problem. Algorithms are designed to keep people on a given platform for as long as possible. This means displaying content that the users will want to read or watch.

While algorithms can tailor content that aligns to the hobbies and interests of users, they also lead to echo chambers in which people only see content that confirms their views, giving the impression that these views are widely held.

When that content is false, and leads to people adopting false beliefs, the impact on public health can be dangerous. People may avoid interventions (such as vaccinations) that could protect them, or be less inclined to seek effective medical treatment e.g. for cancer, heart disease and other conditions. Misinformation can also contribute to a proliferation of unsafe behaviours, including disordered eating and sexual risk-taking.

Where does health misinformation come from and why is it shared so widely?

Studies have found that health misinformation is often created by members of online communities that favour conspiracy theories; largely, they are people acting alone rather than being associated with an institution. In 2021, the Center for Countering Digital Hate (CCDH) published a report which found that 12 leading anti-vaxxers – including Robert F Kennedy Jr (who was one of the most prolific contributors of the 12) – are responsible for more than 70% of anti-vax content on Facebook.

The misinformation these individuals propagate is often couched in discussions that revolve around rhetoric, and in personal arguments that tap into powerful negative emotions such as fear, anger and sadness. Health misinformation is often developed in a way that seems reasonable and appears to be credible to the person viewing it – which can be an important factor in people believing that it is accurate.

On social media, misinformation is more popular than accurate information, which may explain why people create and share it in the first place; it’s not just for influence, but also for money. The CCDH report estimates that the anti-vax industry is worth at least $36 million a year.

That’s not to say people will believe everything they read. People from all backgrounds use search engines in an effort to verify claims. Unfortunately, when they use search engines to check the veracity of health information, they may unwittingly come across a propaganda feedback loop in which multiple outlets report the same misinformation, or a data void whereby the terms they use bring up results that confirm the misinformation. One study found that 15% of people searching online to verify health information will come across at least one link to an unreliable source if the information is accurate. In comparison, 38% will encounter a link to an unreliable source if the information they are seeking to verify is inaccurate.

What can be done to combat health misinformation?

We face a difficult and complex problem. We cannot rely on companies such as X, TikTok and Meta to self-regulate. Not only are they contributing to the problem, they are also making it worse as they move away from any semblance of fact-checking and towards an agenda of ‘free speech’. Greater regulation could play a role in improving the situation, but it will need to be implemented carefully to avoid the perception that governments are curtailing speech – which would be counterproductive and create even more mistrust.

To combat misinformation, we need to build trust in government institutions and the public health information they produce. This means providing evidence-based messaging that is presented clearly and in a way that acknowledges people’s different perspectives, knowledge and beliefs.

Health information also needs to be tailored to resonate with different audiences – and it can use a range of platforms to do so. For example, providing the evidence and statistics behind public health advice may be important for some people, allowing them to easily verify claims they hear and read. For others, it would mean acknowledging and dispelling myths and counterclaims with clear arguments and evidence. A one-year partnership between the World Health Organization and TikTok could be a good testbed for how to do it effectively.

Improving health and digital literacy, as well as critical thinking, would also help ensure that people are empowered to be more discerning of what they hear and read. This must start in schools and continue to be promoted through campaigns and interventions by public health agencies, in collaboration with other societal stakeholders, such as local councils and civil society organisations. A vibrant, diverse and independent media landscape is also important in ensuring that people have access to a range of sources and are less reliant on social media for health information.