Honesty and Public Health Communication: Part 2

Written by Rebecca Brown

This post is based on two recently accepted articles: Brown and de Barra ‘A Taxonomy of Non-Honesty in Public Health Communication’, and de Barra and Brown ‘Public Health Communication Should be More Transparent’.

In a previous post, I discussed some of the requirements for public health institutions to count as ‘honest’. I now want to follow that up to discuss some of the ways in which public health communication seems to fall short of honesty.

I’ll follow Christian Miller’s definition of the term ‘honesty’ to refer to a character trait that involves being disposed, centrally and reliably, to not intentionally distort the facts as one sees them. As discussed previously, it is pretty hard to get at the intentions of agents. We can rarely – if ever – say with certainty that a particular agent intended some outcome, since that information is available only to the agent herself. Instead, we must rely on extrapolating from whatever evidence is available to us.

This can make it hard to prove a failure of honesty, since we must often rely upon a ‘best guess’ as to the agent’s motivation when they acted in a particular way. For the kinds of cases I’m interested in – communications from public health organisations – it is even trickier, as it is not clear what agent is responsible for the communicative act in question (it could be an individual within an organisation, the organisation itself, or some subset of the organisation/individuals within it). But assuming certainty isn’t required, we might still judge that an agent (group or individual) probably intended to mislead or otherwise distort facts if the way they presented information could reliably be expected to create false beliefs in the recipient, and if we would reasonably expect the communicator to have known this. With that in mind, we might speculate about the honesty or otherwise of public health communication.

Public health communication frequently engages in a number of practices that look like they might not meet the demands of honesty. Some examples are:

Magnitude neglect where public health communication doesn’t provide an indication of the expected effect size of the benefit / harm discussed. This could include, for instance, saying that screening reduces your chance of dying from cervical cancer, without telling you by how much your risk of death is reduced.

Harm neglect involves providing information about the benefits of recommended behaviour changes / interventions without mentioning any possible harms.

Relative over absolute risk presentation. Whilst communicators rarely provide quantified effect sizes of the benefits associated with a recommended behaviour, when they do provide such estimates they often use relative risks rather than absolute risks. This will tend to inflate people’s estimate of the size of the benefit they can expect. For example, an intervention that reduces your risk of developing diabetes from 0.001% to 0.0005% cuts your risk in half – that is, reduces it by 50%. The first way of presenting this (using absolute risks) makes the change seem quite small; the second way (in relative risks) makes it seem much bigger. Public health communicators will often use relative risks to describe health benefits, which tend to make them seem much more impressive.

Mismatched reporting takes the above tendency, and pairs it with a tendency to report the harms of recommended behaviours in terms of absolute risks. If relative risks inflate people’s expectations, absolute risks deflate them. Pairing benefits described in relative risks with harms describes in absolute risks seems geared to encourage people to overestimate benefits whilst underestimating harms.

Causation laundering occurs when the content of public health communication implies a causal link between phenomena when it is difficult to know to what extent the relationship is causal. For instance, the health benefits of exercise are widely proclaimed (the NHS describes it as a “miracle cure”. Yet it is very difficult to extrapolate what health benefits associated with exercise are a result of exercise making people healthier, and what results from healthier people doing more exercise. Public health communicators sometimes gloss over such ambiguity, and imply that the causal relationship acts only in one direction – that is, exercise causes good health, rather than the other way around.

These ways of communicating health information, amongst others, seem likely to encourage people to form overoptimistic beliefs about the benefits of various health behaviour changes. Moreover, this seems predictably likely and – we might speculate – intentional. If this is indeed the case – if public health communicators intentionally frame their messages so as to encourage people to form overly optimistic (and inaccurate) beliefs about the likely benefits of health behaviour change – then this is inconsistent with communicating honestly.

This leaves out the question of whether or not there is anything wrong with failing to communicate honestly. Whilst there will almost certainly be cases where honesty is not all-things-considered desirable (e.g. it is better to tell a lie to protect an innocent victim from a murderer than to tell the truth and condemn them to death, contra Kant) it is not clear that public health communication is typically one such case. Indeed, it seems unlikely, given the emphasis on honesty in clinical communication, and the importance of allowing people to make well-informed decisions about how to lead their lives and take care of their health.

Most of the behaviours considered here – relating to diet, exercise, cancer screening and other preventative behaviours – require people to forego pleasures in the pursuit of longer term health. Whilst public health professionals might emphasise that there is “no safe” drinking level, individuals might reasonable decide that the benefits of alcohol consumption outweigh the risks. But people can only make these decisions sensibly if they are accurately informed about the harms and the benefits of these behaviours. And this requires public health communication to give a non-distorted, honest, picture of the available evidence.

References

Brown and de Barra (in press) ‘A Taxonomy of Non-Honesty in Public Health Communication’ Public Health Ethics

de Barra and Brown (in press) ‘Public Health Communication Should be More Transparent’ Nature Human Behaviour

Miller (2021) Honesty: The Philosophy and Psychology of a Neglected Virtue, Oxford University Press