Intro to disinformation and public health

A talk aimed at cybersecurity, OSINT and strategic communications professionals, discussing the context of working on health information and information environment for health - and where the bridges between the cybersecurity, disinformation response and health system are.

1. 9 May 2024 disinformation, public health and information ecosystems Tina D Purnat Introduction to Discussion with MSc students in Cybersecurity @ Faculty of Electronics and Information Technology, Warsaw University of Technology This presentation  © 2024  by  Tina D Purnat  is licensed under  Attribution- NonCommercial - ShareAlike 4.0 International        

2. How you can use this slide deck Thanks for your interest in this topic. I developed this deck to support public health efforts and have made it available for others to use it as well. I’ve made full effort to acknowledge sources of information and adaptation of slides from other people. You are welcome to adapt the slide deck as per the license below. Please make an effort to properly credit the efforts of others that you use. This presentation  © 2024 by  Tina D Purnat  is licensed under  Attribution- NonCommercial - ShareAlike 4.0 International         You are free to: Share  — copy and redistribute the material in any medium or format Adapt  — remix, transform, and build upon the material The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms: Attribution  - You must give  appropriate credit  , provide a link to the license, and  indicate if changes were made  . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial   - You may not use the material for  commercial purposes  . ShareAlike   - If you remix, transform, or build upon the material, you must distribute your contributions under the  same license  as the original. No additional restrictions  - You may not apply legal terms or  technological measures  that legally restrict others from doing anything the license permits. Creator: https://www.linkedin.com/in/tinadpurnat/ Work is published at: https://tinapurnat.com

3. Public health and health information 1 Health misinformation 2 Key takeaways 4 Disinformation in health 3 Agenda

4. Protecting public health relies on people behaving in a certain way Smoking cessation Vaccination Handwashing Healthy eating Healthy public spaces Some examples:

5. Individual health decisions have population level impacts Smoking in public places Adherence to medication and treatment plans Transportation choices Safe sexual practices Contact tracing and quarantine Some examples:

6. Accumulative effect of decisions on health over time - depends on trust in government, health services, products and health workers over time Health system Health workers Trust in p olicies and governance related to health care, supply, service delivery Asymmetries in demand for care and prevention Asymmetries in demand for supplies and health technologies Trust in health workers; doxing and harassment Health worker own confidence in products and services, in own knowledge about guidance and information Health behaviors Risk perception of disease Trust in and acceptability of recommended behaviors and public health and social measures Trust in, safety and acceptability of devices, diagnostics, treatments and vaccines Social cohesion

7. Left unaddressed, these can contribute to erosion of trust health guidance, health interventions, health workers and health systems, reduce risk perception, discourage healthy behaviors and contribute to vaccine hesitancy. This can be prevented. Preventive efforts focus on questions, concerns, information voids first, because mis/disinfo mitigation is more reactive and limited in what can be done by health sector Questions Concerns Information voids Misinformation Disinformation More common, easier to address Less common, harder to address

8. Every failure of delivery of interventions, services and guidance in a people-centered way subtracts from the pool of trust, confidence and willingness of people to listen and adhere to what health authorities are recommending. Some examples include: Missed opportunities and failures accumulate and erode trust - making it even harder to act in emergency response Leveraging spokespeople and influencers that are not trusted medical voices and who tend to change their positions related to medical information over time, which can backfire. Late removal of outdated content on health authority web sites that propagates confusion and conspiracy thinking in the populations. Slow content updates through digital channels from health authorities that do not address most common questions and concerns. Issuing confusing guidance that is not appropriate for specific populations, such as people who are immunocompromised or pregnant. Utilizing the military to administer mass vaccinations among populations that do not trust the military which can instead spur conspiracy theories.

9. Systems and structures in health collide with the information environment Individual and community Questions Concerns Information diet Information overload Information avoidance Confusion Information Ecosystem Sensationalist reporting Sentiment Outdated information Low quality scientific information Rumors Information voids Mis- and disinformation Health system Conflicting messages Conflicting expert opinion Slow issuance of communication and guidance Paternalism Mismatch between message and medium Unsettled science Changing guidance Outdated health guidance and messaging Failing to counter rumors and misinformation in real time Inadequate digital content publishing Reference: https://www.linkedin.com/pulse/key-terms-infodemic-managers-information-environment-tina-d-purnat/

10. Public health principles of risk assessment and protecting the most vulnerable Vaccination prioritization Air quality regulations in industrial areas Nutritional programs for low-income families Some examples:

11. Mediators of impact of health information amplification, information diets and health seeking behaviors: Policy Commercial determinants of health information Credible, accurate health information Health information equity Digital, media, information, science and health literacy Adapted to routine public health from: https://internews.org/areas-of-expertise/humanitarian/projects/rooted-in-trust/

12. What can affect someone’s exposure and ability to act on health information, especially online? Form of internet access, whether on smartphone or computer Algorithms affect what information we see; we are likely to see content and connections that we agree with Access to the internet can be expensive, which may shape user behavior Digital literacy skills affect how well someone can navigate and understand digital information Social norms affecting who should access social media and why (gender) Language used to browse internet and use social media

13. Misinformation and disinformation are not new in health ... but the information and socio-economic environments have changed.

14. Stewart, R., Madonsela, A., Tshabalala, N., Etale, L., & Theunissen, N. (2022). The importance of social media users’ responses in tackling digital COVID-19 misinformation in Africa.  Digital Health ,  8 , 20552076221085070. Domain of impact - harms Consequence Physical Limited accurate knowledge about available treatments Misplaced actions Social Victimization and stigma Economic Falling for scams Panic buying Political Limited trust in officials Rejection of official guidelines Disregard of government-led responses Psychological Mental health epidemic Extreme anxiety Long-term depression Immediate and downstream impacts of information environment on health

15. Harmful narratives are common in many areas of health Vaccinations Alternative Medicine Nutrition and Diet Mental Health Sexual and Reproductive Health Chronic Diseases HIV/AIDS Cancer Exercise and Fitness Allergies and Intolerances Chronic Pain Substance Abuse Sleep Health Aging and Anti-Aging Genetic Testing and Personalized Medicine Environmental Health Health topic areas that are represented in health misinformation research

16. A person’s values can shape and predict the type of narratives that they perpetuate or resist Tells a story Uses humor or satire Pushes emotional buttons and appeals to audience values Contains images or video specifically formatted for a particular audience and channel Provides a simple explanation for a complex problem Uses language that is appealing to the audience (e.g. slang, memes) A “viral” narrative:

17. When health workers are harassed, doxed and attacked this is the alarm that something has gone very wrong between community and health system Source: https://www.ama-assn.org/practice-management/physician-health/physician-advocates-social-media-hate-nauseatingly-normal; https://www.washingtonpost.com/world/2024/04/30/pakistan-gunmen-polio-vaccination-police-attack/1c9af5fa-06e3-11ef-b60b-a512fc749f9b_story.html; https://www.npr.org/2019/11/28/783582331/it-was-unmistakably-a-directed-attack-4-ebola-workers-killed-in-congo; https://www.reuters.com/world/europe/austria-mourns-suicide-doctor-targetted-by-anti-vaccine-campaigners-2022-07-30/#:~:text=Austria%20mourns%20suicide%20of%20doctor%20targetted%20by%20anti%2DCOVID%20vaccine%20campaigners,-By%20Reuters&text=ZURICH%2C%20July%2030%20(Reuters),theorists%20took%20her%20own%20life.

18. What we have learned: Health misinformation becomes disinformation because narratives shift and can be hijacked A community expresses confusion about why a foreign-made vaccine is recommended to them, expressing preference for locally made vaccines Concerns gain momentum, becoming misinformation that foreign vaccine supplies were chosen due to hidden financial motives by leadership Negative sentiment and misinformation about vaccine origin is amplified with disinformation narratives undermining trust in government and becomes a talking point by a political candidate when public health concerns expressed by individuals are hijacked by values-based meta narratives that are intentionally spread to achieve an agenda and do harm to systems. Questions, concerns,information voids Misinformaton Disinformation

19. Profit Profit and influence/power over a health agenda Sowing wider distrust for political influence, health is hijacked Industry or organized fraudsters Can include deceptive marketing and marketing on health, lifestyle, food topics Agenda setting groups (like anti vaxxers) who also earn money to support their activities Can include legal organizing to counter judicial or regulatory decisions Infleunce campaigns, propaganda, disinformation in hybrid threats, cyberattacks Mistrust in humanitarian assistance and response Motivations for spreading health disinformation

20. hijack health-conscious communities Industry marketing and influencers https://www.washingtonpost.com/wellness/2024/04/03/diet-culture-nutrition-influencers-general-mills-processed-food/ https://www.wired.com/story/beef-industry-school-education/ https://www.nytimes.com/2023/05/10/well/move/fitness-influencers.html Source:

21. Health fraud, scams and deceptive marketing exploit vulnerabilities within the information environment Source: hhttps://www.forbes.com/sites/alexandralevine/2024/03/04/tiktok-supplements-nurses-doctors-influencers-bytedance-healthcare/ https://www.theguardian.com/science/2024/feb/03/the-situation-has-become-appalling-fake-scientific-papers-push-research-credibility-to-crisis-point https://www.wired.com/story/telegram-covid-19-vaccination-fakes/ https://www.reuters.com/business/healthcare-pharmaceuticals/novo-nordisk-warns-online-offers-fake-ozempic-wegovy-are-rise-2023-10-12/

22. Well-funded and well-organized “anti” movement counters health advice and politicizes health. Source: https://www.washingtonpost.com/technology/2023/09/23/online-misinformation-jim-jordan/ ; https://link.springer.com/article/10.1057/s41271-021-00318-6; https://www.politico.com/news/2023/09/24/anti-vaxxers-political-power-00116527 ; https://www.washingtonpost.com/nation/2024/02/21/covid-misinformation-earnings/ https://www.npr.org/2023/05/04/1173697394/as-the-pandemic-winds-down-anti-vaccine-activists-are-building-a-legal-network https://www.marketplace.org/2023/07/14/covid-19-lawsuits-media-coverage-misinformation/

23. Disinformation and cyber threats weaken global health security and health systems. Source: https://docs.house.gov/meetings/VR/VR00/20191113/110183/HHRG-116-VR00-Wstate-BarashV-20191113.pdf https://www.340ftg.afrc.af.mil/News/Article-Display/Article/2343192/disinformation-and-disease-operating-in-the-information-environment-during-fore/ https://jcom.sissa.it/article/pubid/JCOM_1905_2020_A02/

24. Bottom line It is therefore a more vulnerable topic to be hijacked by disinformation. Health is becoming politicized This makes provision of health services and population health and wellbeing difficult. We are in crisis of trust in institutions They are therefore especially harmful in the environment and public health science domains. The anti-science movements are driven by anti-government sentiment The diversity of approaches across regions and countries could make it harder to respond to cross-border, digital threats and disinformation campaigns. Global fragmentaiton of regulating information environment, internet platforms, AI and technology, influencer marketing Health systems are not prepared to address population health information needs ...especially in the context of a networked, social, digitized information environment, or cybersecurity threats in it

25. Dark patterns (deceptive design) are concepts from human centered design and “designed environment” practices of how the information ecosystem affects user behavior and results in people being vulnerable to digital information flows and information and context bias. Vulnerability patterns of health information environment https://www.vox.com/recode/22351108/dark-patterns-ui-web-design-privacy

26. In public health, we need a similar view of our systems and structures. A vulnerability pattern emerges when the same structures or processes are in place to address reoccurring information environment challenges, even though they have failed in t challenges, even though they have failed in the past.he past. A vulnerability pattern is a series of failures that recur and/or are not addressed through leading to specific issues that continue to perpetuate. Vulnerability patterns of health information environment https://en.wikipedia.org/wiki/Tacoma_Narrows_Bridge_(1940)

27. Key considerations for future actions on health disinformation Be careful in partnerships built in the health space because health authorities are expected to be apolitical to be able to achieve their mission. Precision response to disinformation needs to be coupled with mitigation of secondary effects that manifest overtime. We need to involve health professionals when developing regulations and measures on disinformation. Inevitably, there will be health topics involved and the decisions on this are made without health professionals, patient advocates (in addition to consumer advocates and the public). Greater coherence in follow-up needed in health sector’s response to disinformation’s secondary effects on health, trust and sservices. Careful parntership and clear roles across sectors are needed Disinformation mitigation vs longer term health effects Greater understanding of parntership in needed across sectors Better and more coherent follow up are needed

28. Source: https://www.foreignaffairs.com/russian-federation/dont-hype-disinformation-threat “We are over-hyping the threat of foreign disinformation and influence operations, giving threat actors more credit than they deserve, and in doing so, are doing real harm to our information environment and to trust in institutions. “ “... exaggerating the threat (as much, if not more than underplaying it) often only serves to help our adversaries. “ Disrupting disinformation must be done thoroughly, accurately, and proportionally.

29. Thank you very much! tinapurnat.com Resources for infodemic managers