Don't go chasing infodemic butterflies

The past three years have seen a major advance in how we understand misinformation and its effects.

• We know that people process and act on information emotionally;
• We know that people form opinions based on their previous experience and based on reinforcement from their own social networks;
• We know that the information environment impacts people's perceptions and access to information with its structures, not only content.
• Digital communities are curated by algorithms, people's own digital behavior and choices, and interactions, and their interplay with their offline lives.

There are major societal challenges that we will need to tackle to fix the flaws in our information ecosystem(s).

Instead of chasing individual pieces of health misinformation like a person chasing after butterflies with a small net, we need to zoom out and look at all of the information environment and how it may be conducive to creation and amplification of health misinformation.

This is difficult to do when there haven't been any coordinated global actions to address the health-related infodemic. Such action could have major local effects.

We should be looking into regulating social media responsibly, encouraging ethical and responsible tech and AI development, and consider the needs of the most vulnerable first.

Until this happens, what do we do in the mean time?

Thankfully, some smart people who work with media, social media and communities in conflict sones and humanitarian crises, have thought some of this through. There, information, access to it, and who creates and amplifies it has life and death consequences.

I've long admired Internews, a nonprofit who works in the toughest of environments to help the most vulnerable with access to health information. Their project Rooted in trust has produced some of the most coherent frameworks and accompanying tools that help understand the dynamics of the information environment and people's relationship with and use of health information.

While Internews works in places where health systems are broken and people's basic safety needs go unmet, I've asked myself, how we could apply the model of an information environment that Internews postulated to health systems that do function.

Below is a graphic of the five elements that the colleagues at Internews defined as the elements of a healthy information environment - one that makes health information available to people that need it, supported by people's ability to process information and by business practices of media and private sector.

The Internews model understands the information environment through the communications lens, which is not surprising since they focus on the media.

So I asked myself, how do these elements map against public health objectives in promoting health and well-being through prevention and health care delivery. From this perspective, the information environment is the layer between the health system and community which can be supportive of health systems and ease interactions between the two - or be opaque and can create friction.

So this is what Elisabeth Wilhelm and I came up with as we discussed the Internews framing - our ideas for public health analogs on the outside, and the Internews model in the inside of the graphic.

There are the five elements of a healthy information environment that helps a functional health system better interact with communities and individuals:

1. Credible, accurate health information – designed and distributed to address population information needs and promote healthy behaviors
2. Health information equity – availability and accessibility of health information and infrastructure to all populations everywhere in formats and channels that are acceptable and actionable
3. Digital, media and health literacy – end users’ ability to understand and act on health information and recognize health misinformation
4. Commercial determinants of health information – private sector forces that impact health information quality, distribution and amplification
5. Policy – who is responsible for providing credible, accurate health information

Infodemics affect the whole of society and therefore require a multi-pronged approach to address. At the same time, we know that health authorities do not have much control of many aspects of the information environment.

So the above model can help focus the efforts on what the health system can influence in relation to health information, how it is generated, used and acted on. I'm looking for inspiration in other models in this space that look at the information environment and how it may intersect with communities and health systems ???? ??

Let me know if you have any suggestions.