Persuasion and the Health of Populations

In my last post, I wrote about the value of performance and how the roles we play can help us to better support the health of the public. Persuasion is a natural extension of this conversation about how our public presentation can best serve our work. Some thoughts, then, on the importance of persuasion and the steps we can take to become more persuasive as a field.

The challenge of persuasion has been vividly present in the challenge of advancing effective policies around masking during COVID-19. Masking has long been a contentious topic, with much debate over the efficacy of masking and the role of public policy in enforcing mask mandates.

There has been much recent commotion generated by a Cochrane analysis that found in its own summary “uncertainty about the effects of face masks.” At core, it appears that masks’ ability to prevent the spread of COVID-19 depends, in part, on the kinds of masks being worn and the willingness of populations to consistently wear them. And while there seems little question that an individual can better protect themselves by wearing a mask, the data on the efficacy of masking at the population level remains mixed.

So, is population-level masking a viable strategy to reduce spread of infectious disease? Well, it depends, and centrally it depends on whether or not most are willing to wear masks, i.e., on the adoption of the intervention. Certainly, early in the pandemic, it looked like a national mask mandate was a prudent step for us to take as we worked to learn more about the disease and prevent its spread, which is why I, along with colleagues, advocated for one.

However, the more we learn about masking, the clearer it is that the effectiveness of masks depends on public compliance, which can be difficult to enforce and which, in the long-term, requires a persuaded public. It is this persuasion that we often neglected to invest in during the height of the pandemic, allowing instead the issue of masking to be subsumed into the broader social and cultural arguments around how best to manage a crisis that were raging at the time.

The goals of public health are radical, transformative. Beyond advancing any single policy or shoring up any given institution, we aim to shape a healthier world. It is with this in mind that, as I see it, for public health to achieve this goal in the long-term, it needs the support of broad majorities to enact durable change. This will take persuasion.

How then, can we do a better job of persuading the public?

We need to get better at communicating the “whys” of our recommendations rather than just the “whats.”

In an article about the uses of persuasion vs. coercion, K. C. Cole wrote, “Persuasion requires understanding. Coercion requires only power.”¹ To effectively persuade, we must help the public understand the reasons behind what we ask it to do. Even if we are not able to fully convey all the details—the complicated data that often underlie our recommendations—the simple act of trying to explain ourselves can stand as a good faith effort to engage with, rather than coerce, the public. The more we are seen attempting to engage, the likelier it is that the public will recognize that public health is not a faceless monolith trying to bend people to its will but is, instead, a collection of individuals doing their best to help others.

We need to put ourselves in a position to be credible.

Whether or not a piece of advice is followed does not just depend on its empiric basis, or even on whether it is the right action to take. It also depends on the person giving it—on their credibility and their relationship with the person or people being advised. Imagine getting an identical piece of good advice first from your parents and then from someone who you feel has cheated you in the past. It is likely you would follow the advice from your parents and think twice about doing so when it came from someone you do not see as credible.

We in public health have a responsibility to make sure that we are seen as credible by the populations we serve. This means applying a high standard of rigor to our recommendations so that they are always seen to be supported by a foundation of reasoned analysis. It also means working to avoid the appearance of partisan bias or of taking actions motivated by anything other than the pursuit of the public good. At the heart of these efforts should be the aspiration of clarity in all our communications and consistency in our commitment to data.

We need to be unimpeachable in our promotion of rules that are defensible, sensible, and reasonable.

It is far easier to persuade someone that they should take a medicine when they are sick than it is to persuade them that the sky is green. In the first case, what is being called for is sensible, reasonable, and backed up by data. In the second, what is being argued for is patently absurd.

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We should not be in the business of arguing for absurdities. We should instead take pains to find ourselves always on the side of rules that are defensible, sensible, and reasonable. Such rules have the benefit of being better suited to the process of persuasion, by allowing us to appeal to the better, more rational angels of the public’s nature.

People need to like us.

This may seem obvious, but it is difficult to persuade anyone of anything when the people we would persuade do not like us. Perhaps it is occasionally possible to do so in times of fear, when the conditions of crisis make whoever seems to speak with authority the most persuasive by default, but in normal times, being liked is a precondition to being persuasive. For this reason, we need to be likeable by being truthful, credible, and willing to embrace an ethos of joy. By emphasizing such an ethos, and by prioritizing persuasion over the use of power, we can help ensure this moment yields healthy populations that are disposed to work with us rather than against us.

This piece was also posted on Substack.