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The CDC Needs to Talk to Psychologists

Social-behavioral scientists need a larger voice in CDC messaging.

The CDC's recent updated guidelines on mask usage seem to have created more confusion and controversy than celebration. Just as mask wearing had become the new normal for Americans in many parts of the country, and even a symbol of caution and consideration for others, the mandates were largely lifted without much warning. While it is true that COVID-19 case numbers and deaths are dropping, and a substantial chunk of the American populace is now vaccinated, it was still seemingly a work in progress, with appeals to the unvaccinated being the next hurdle. Instead, it seemed, the CDC put one cart before the horse.

The CDC’s messaging during the pandemic (and frankly, that of international public health organizations such as the WHO as well) largely has been motivated by two major but often disparate factors: epidemiologic data science and politics. The former is obviously a cornerstone of scientifically informing public health advocacy and policymaking, and the latter a sometimes tricky and unavoidable morass to navigate as a government agency. What is missing is the best method to bridge the two concerns: a greater focus on behavioral and social science and analysis through a public health perspective. This focus seems curiously absent in many public health initiatives to date during the pandemic.

Public health is a multidisciplinary scientific field focused, as per the CDC's own definition (via CEA Winslow) of “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” Public health professionals focus on practicing medicine often on a population-based level, with an emphasis on prevention and safety. They coordinate fields such as epidemiology, which focuses on surveillance and tracking data related to the occurrence of diseases and associated phenomena; biostatistics; social sciences; health education; and more.

During the pandemic, we have rightly focused on messaging regarding the transmission of COVID-19 and how to reduce its tragic impact on society. Sadly, multiple factors led to the bungling of this messaging early in the pandemic, with prolonged and painful consequences. Even worse, at times data science seemed to run right into the face of politics, especially as the past administration refused to provide simple, unified messaging on masking. Despite longstanding initiatives and laws on wearing seatbelts and other simple, low-risk methods for preventing death and injury, masking was needlessly transformed into a controversy split down party lines—into a debate about personal liberty when it should have been viewed as a simple activity with high benefit, minimal expense, and practically zero harm.

In general it seems that pandemic public health messaging and policy has ignored possibly the most important factor in persuading populations: how to influence behavior. And despite the fact that public health includes social sciences and behavioral health under its umbrella, and the existence of several designated health behavior research departments and institutes, it seems that any emphasis on these disciplines specifically related to pandemic messaging and the CDC's subsequent vaccination campaign has been woefully sold short, at the cost of coherence. I do not know the details of the CDC’s inner workings or structural processes, but I truly wonder if there is sufficient emphasis on coordinating the social and behavioral sciences into its policy messaging and decisions. Roughly per their online organizational chart, they have subdivisions for public health general implementation, general surveillance, and two additional branches focusing on non-infectious and infectious diseases. They also have a director’s office informed by associate directors in communication, laboratory science/safety, policy/strategy, and a chief medical officer.

How social and behavioral science is integrated into these divisions in unclear, and there is apparently no specific office for this work. But it feels like this is a potential missing link toward better understanding and potentially bridging the data science tracked by epidemiology and surveillance into the field of public communication and strategy.

Even in medicine in general, behavioral health (aka psychiatry/psychology) feels like a neglected stepchild, despite being a key background link between all forms of health and disease. Behavior underpins much of what we do to take care of ourselves, as well as our lifestyle choices. The mind and body are inextricably linked. It runs deeper than the superficial chiding that many physicians undertake in telling us to eat healthy and exercise. It takes a fundamental empathy and understanding for why people do what they do, what motivates them, what matters to them, how to listen to them. Being nonjudgmental and humanistic, and seeking a compassionate connection with your patients, is what ultimately can convince them to potentially shift harmful behaviors, although it often can be a slow and frustrating process.

In public health, social and behavioral science can undertake important research to analyze what underlies people’s fears and reluctance to shift certain thoughts and behaviors. These fields of inquiry are in the perfect position to investigate on a broader and deeper level what is behind particular patterns of anti-vaccination and anti-masking concerns, and what may work to gently shift these perspectives. Some thoughtful media articles have done anecdotal surveys and hosted focus groups in this regard, so formal social-psychological research could be even more powerful in discovering on a wider level what underpins these people’s concerns. I have seen some powerful examples of this type of public health social and behavioral research in influence and messaging, such as several studies on using church settings to educate Black patients on cancer prevention or COVID-19 facts, or studies looking at social media campaigns and digital analytics to reach out to teens and young adults with depression. I don’t understand why something as major as the pandemic cannot receive a dedicated body of urgent research and engage a high-level team of experts accordingly. If such a team somehow already exists, their information and justifications with regard to major COVID-19 and vaccination initiatives need to be better highlighted.

Such a team could help curate public health communications and messaging in a more effective and informed fashion. They could predict or anticipate how a particular recommendation will be received, the potential scenarios people will ask about, and how best to translate it to specific population segments. This team’s research would help justify and rationalize what messages are sent, instead of the mass confusion and tangled scenarios we have faced to date (parodied quite nicely in Saturday Night Live's opening sketch on May 15). The platform of the CDC, WHO and similar organizations is obviously a difficult and controversial place to be, often caught between a rock and a hard place when it comes to exactly what to say to a group as broad and varied as the general public. But with a specialized social-behavioral team behind the messaging, at least they would know that it was based on something more solid than just the whims of political infighting or the obscure logic of pure numerical data alone.

It’s possible that, depending on the particular tide politics is taking, even social-behavioral data would be ignored along with epidemiology and other scientific expertise, as has happened in the past year. But this holistic emphasis still seems like a worthy place to mitigate and start integrating these as-yet clunky and separate priorities which have led to botched and murky communication with the public. It seems like a missing link sitting in plain sight to better bridge the gap between scientific expertise and public acceptance and awareness, at a time where such gaps have led to mass tragedy.

References

McNeill LH, et al. Engaging Black Churches to Address Cancer Health Disparities: Project CHURCH. Public Health 2018:6(191).

Moreno M, et al. A Pilot Evaluation of Associations Between Displayed Depression References on Facebook and Self-Reported Depression Using a Clinical Scale. Journal of Behavioral Health Science and Research (2012) 39:295-304.

https://www.theatlantic.com/ideas/archive/2021/02/vaccine-hesitancy-isn…

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