Expert Commentary

How we can improve public health messaging about COVID-19

We examine research on public health messaging to understand why the coronavirus appears to have a disparate impact on U.S. minorities.

health communication pandemic minority communities

Black Americans appear to have a higher risk of COVID-19 infection compared with other racial groups, preliminary data from the U.S. Centers for Disease Control and Prevention show.

Federal officials don’t yet know the race of almost 60% of the people nationwide confirmed to have the disease caused by the new coronavirus. But about 30% of those for which they do have such details are black. In the states that are reporting racial and ethnic information, black people account for about 13% of their total population but 34% of their COVID-19 deaths, according to the Coronavirus Resource Center at Johns Hopkins University.

Records collected by city and state governments indicate Latinos and Native Americans in some parts of the U.S. also are disproportionately affected by the deadly virus. In Boston, Latinos comprise 19% of COVID-19 cases there. Meanwhile, in New Mexico, 50% of the people who have COVID-19 are Native American.

Health-related disparities are not new in the U.S. Throughout the decades, black and brown people, in many cases, have suffered worse health outcomes than white people. Health experts say there are likely numerous reasons behind those trends, including racism, poverty and a lack of access to health care.

In recent weeks, government leaders and others have questioned why the coronavirus seems to have an outsized impact on minorities. Looking for insights, we pored over research on public health messaging and pandemics.

Below, we highlight a sampling of studies, most of which focus on the 2009 pandemic of H1N1, also known as the swine flu. The research suggests different segments of the population have different levels of access to the most accurate and up-to-date information about a health crisis. But researchers explain that various demographic factors — age and income as well as race, for example — appear to play a role.

Several years ago, a team of researchers from the Harvard School of Public Health reviewed 118 studies on the issue. Their analysis, published in 2014, suggests that “to reduce communication inequalities during a large scale emergency, such as a pandemic, public health officials should focus their communication efforts on the young, the less educated and the indigent because there is evidence that these are the people at risk of not knowing about the threat, perceiving the threat to be of low risk and ultimately being less likely to follow recommended behaviors.”

In the academic articles below, researchers offer solutions or recommend ways public health professionals can improve the way they communicate about pandemics. Some articles, for example, stress the need for authorities to use plain language and tailor their public health messaging to specific audiences.


Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic
Hutchins, Sonja S.; et al. American Journal of Public Health, October 2009.

Data suggest that racial and ethnic minorities face a higher risk of becoming severely ill or dying during an influenza pandemic, according to this study. Its authors look at the factors that likely contribute to this disparity. They also highlight suggestions for improving health communication and collaboration within minority communities — suggestions that came out of a two-day summit the CDC convened in mid-2008.

“Racial/ethnic minority populations may have less capacity to implement these essential pandemic influenza interventions and to tolerate a pandemic because of broad disparities in underlying health status and social factors, such as socioeconomic disadvantages; cultural, educational, and linguistic barriers; and lack of access to and use of health care,” the authors write.

Some of the suggestions discussed:

  • “Include racial/ethnic minority populations, their service providers, and trusted community leaders in all aspects of preparedness planning and response plans for a pandemic.”
  • “Provide culturally competent and low-literacy pre-pandemic educational and communication materials across diverse racial/ethnic minority populations with effective messages (e.g., visual ads with simple instructions) and multiple channels. Channels should include trusted sources of information (e.g., community members and organizations) ethnic media, comic books, radio, and television).”
  • “Educate early about isolation, quarantine, hygiene, and use of PPDs [personal protective devices], building on education and communication focusing on behavioral change and not merely on increasing knowledge (e.g., hand washing as a means of protecting self and family from deadly virus).”

Media Use and Communication Inequalities in a Public Health Emergency: A Case Study of 2009–2010 Pandemic Influenza A Virus Subtype H1N1
Lin, Leesa; et al. Public Health Reports, November 2014.

This study looks at how “communication inequalities” — differences in people’s exposure to public health information and their ability to process and act on it — might hinder public efforts to prevent and address a pandemic outbreak.

To better understand the issue, researchers conducted a survey of 1,569 U.S. adults, drawn from a nationally representative sample. From late February 2010 to early March 2010, researchers collected participants’ answers to questions about their knowledge of the H1N1 virus, sources of information and steps they took to avoid infection.

Here’s what they learned: Adults with a high school education or less relied more on local and network TV news for H1N1 information than did adults with higher levels of education. They relied less on local newspapers and internet sources than better educated adults. Meanwhile, only 15% of adults surveyed said they actively sought information about H1N1. Most of those participants had completed at least some college.

Researchers also learned that adults who faced fewer communication barriers and had more knowledge of the virus were more likely to practice good hand hygiene and social distancing. “Information seekers, people with higher SES [socioeconomic status], and those with high media exposure were less likely to adopt incorrect prevention behaviors than information non-seekers, those with lower SES, and those with low media exposure,” the authors write.

The authors recommend that health officials consider the sociodemographic characteristics of their target audience when planning public health messaging campaigns. They explain that it is “important to effectively and promptly use the media outlets people are routinely exposed to most often to provide knowledge and preventive behaviors at proper health literacy levels after a pandemic begins, particularly as this outlet seems to be the way many low SES non-seekers received the threat-related information.”

What Have We learned About Communication Inequalities During the H1N1 Pandemic: A Systematic Review of the Literature
Lin, Leesa; et al. BMC Public Health, May 2014.

Researchers examined 118 research studies on health communication during the H1N1 pandemic to determine whether certain factors influenced the likelihood that people followed medical professionals’ recommendations for preventing infections. The authors learned that differences across segments of the population — age and education, for instance — affected the kinds of information people received and their responses to the virus.

People with lower levels of education were often exposed to different information than individuals with higher levels of education. The less educated got their information from the TV rather than newspapers and other information sources, the researchers write.

The paper notes that medical experts should be thoughtful about the language they use in public health messaging. “The fact that during the H1N1 pandemic, people with a higher educational level were better informed about the risks is not a surprise but suggests that public health communication messages are still delivered at a literacy level that does not meet the needs of the less educated,” the researchers explain.

They also find that transparency is an important component of health communication. “An honest reporting of what the threat looks like, through a presentation of known and unknown factors, seems to have a better impact on people’s knowledge, attitudes and beliefs, including trust in the way the government is handling the emergency,” they write.

Pandemics and Health Equity: Lessons Learned From the H1N1 Response in Los Angeles County
Plough, Alonzo; et al. Journal of Public Health Management and Practice, January/February 2011.

The researchers examine the Los Angeles County Department of Public Health’s strategy and efforts to get residents vaccinated against the H1N1 virus in 2009. Between Oct. 23, 2009 and Dec. 8, 2009, nearly 200,000 people received the H1N1 vaccine at 109 county-operated vaccination clinics. However, vaccination rates varied widely across racial and ethnic groups.

The disparity was largest among black people, who make up 9.1% of the county’s overall population yet received 3% of the H1N1 vaccines administered at county vaccination clinics. Latinos, who comprised 47.3% of the population, received 47% of the H1N1 vaccines. Asians, who make up 13.2% of the population, received 28.5% of the clinic vaccines.

The researchers found multiple reasons for the disparities. For one, a survey showed that black people in the area were much more likely to believe the vaccine would have adverse effects, when compared with people from other racial and ethnic groups. Also, residents received information in their communities that ran counter to what health professionals said.

“The major themes of these community messages were mistrust in government and that the vaccine was not safe,” the authors write. “Prominent faith-based leaders in the African American community were reported to be advising congregation members against H1N1 vaccination due to safety concerns. Disc Jockeys from a station with a predominately African American audience were reported to be advising listeners against H1N1 vaccination.”

The authors write that the key to a successful emergency response “relies on trust building and collaboration with community partners in the preparedness phase, long before any evidence of an impending pandemic or other adverse health event.”


Please check out our other coronavirus-related resources, including tips on covering biomedical research preprints and a roundup of research that looks at how infectious disease outbreaks affect people’s mental health. Also, check out our feature on rural broadband in the time of coronavirus.

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