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I saw earlier the same ideas in this op-ed coming from Nate Silver and the data bros types, so I'm disappointed to see Marcus promoting this. This thread is going to be a bit of drudge on the basics of what health messaging is, how it works, and what's wrong w/ the op-ed 
https://twitter.com/JuliaLMarcus/status/1354420724803497985
https://twitter.com/JuliaLMarcus/status/1354420724803497985
I'm a mixed-methods researcher that writes health messaging, similar to LSE methodology. The health guidance is the underlying scientific info and recommendations contained in the health message. #scicomm #COVID19
That's written by relevant policy experts and I receive it as a brief as part of the background information that informs my research. I can't alter the health guidance to make the health messaging more palatable for the public as she's suggesting. I'm not qualified to do that.
I can understand the confusion here maybe because we create behavior change (social marketing) campaigns and these include policy changes not just marketing like PSAs, so there are policy experts in behavior change.
There are also behavioral health policy experts.
There are also behavioral health policy experts.
People who are experts in behavioral health or behavioral science might write health messaging themselves; however, there has been more divergence between these fields and there's likely separate people working together doing this.
Policy experts are starting to use more complex modeling like AI based ecological models or social epidemiological modeling that attempts to account for human behavior. Hopefully this will make recommendations for interventions much better than they were in the 1990's.
These seem to be the experts drawing Marcus' ire, and I can understand why she might get frustrated with them because it can get overly paternalistic sometimes.
However, the first thing to understand is that these are mostly different groups of people in #publichealth.
However, the first thing to understand is that these are mostly different groups of people in #publichealth.
Also, something that seems like it would be protective can in fact increase risk. For instance, owning a gun to protect against robbery increases risk of death for the gun owner, so people do need to study these associations.
I deeply appreciate behavioral health experts.
I deeply appreciate behavioral health experts.
As far as I know, the guidance on continued NPI's for a few months while vaccines roll-out is coming from policy experts in vaccine science and epidemiology. The vax isn't 100% effective to prevent illness so w/ high risk of exposure, you might get sick. https://twitter.com/commonhealth/status/1354073662329147398?s=20
The vaccines will lower the likelihood that we can spread the illness, but we don't know by how much yet. The people first in line for the vaccine are the most at risk of death or at risk of spreading it to people at risk of death. These groups represent over 90% of the deaths.
Since thousands of at-risk people are dying per day, most public health experts agree these people need more protection, not to substitute protective behaviors yet because their statistical risk of death is unacceptably high rn.
Recommendations always include a value judgement
Recommendations always include a value judgement
Marcus clearly values social interaction very, very highly. Her recommendations will result in more deaths but will allow more social interaction. She's an epi and can calculate how many more deaths her recommendations would cause and she has an obligation to provide that info.
Marcus says substitution will result in only a "tiny" increased risk of death for them, but what she considers tiny might not be to others, especially considering that we are so close to getting to a place where it will be pretty safe to interact.
As far as her comparison to PreP and condom substitution goes: No one has suggested that the vaccine be withheld from people so that they continue wearing a mask and social distance.
PrEP is also over 99% effective, HIV less contagious than #covid19, and there are effective treatments if you catch it. Yet, public health still reminds people to use condoms and to get tested, too. I doubt she considers that "moral panic" or demoralizing messaging.
Infectious disease prevention is all about the Swiss Cheese model. Deaths from HIV have been brought down by having multiple layers of protection. The vaccine for covid19 is a bit less that 95% effective but it's one of the layers and unlike PrEP, we can build herd immunity.
Right now, we're rolling out more layers of protection- better masks, rapid tests, vaccines for more people, ventilation guidance, and more research into better treatments if someone catches it.
The stronger the layers we can develop, the sooner life will be normal. Will there be a time when we don't need masks and can hug people and fly to visit our older relatives? Of course! We have to get enough people vaccinated first.
It's good to put on a bullet proof vest, but it's better to stop the bullets from flying. Vaccines protect us best when there's herd immunity and we aren't encountering the virus everywhere. I think we can emphasis optimism w/o telling people to risk their lives.
The purpose of health messaging is to better explain parts of the health guidance people say they didn't understand so they understand why it's important to do and why it will work, address the concerns they have, and provide practical or emotional assistance.
Hopefully, the messaging will build confidence in the efficacy of the intervention and the personal efficacy of the individual.
Marcus, Nate Silver and others have charged that people who create health messaging lie and tell people to do things they know is unnecessary.
Marcus, Nate Silver and others have charged that people who create health messaging lie and tell people to do things they know is unnecessary.
I guess I can't speak for everyone who writes health messaging, but I've never considered writing a health message telling someone to do something they didn't need to do (continue all protective behaviors following vaccination until rates decline)
because I actually wanted them to do something else (not have rona raves.) I consider behavioral science insights in writing health messaging but its much more subtle than this. It's more like I'm considering how wording might make you see risk differently.
I also segment audiences psychographically. The type of person who would have "rona raves" would have a particular set of characteristics, so if I wanted to target them for messaging I would create messaging for them specifically.
It wouldn't make any sense to create messaging that appeared to be for one group but was actually for a different target audience, because that wouldn't be effective. We also use market segmentation, so where the message was placed would be in completely the wrong forms of media
