Heavy-handed interventions from governments arent the answer to hesitancy, building trust is – The Guardian

The publics relationship with health and authority has changed substantially over the previous decades, with people now demanding greater individual control and decision-making in healthcare.

The fancy words, epistemologies and sociological frameworks that underpin all this are all incredibly interesting, but it ultimately boils down to one word. Respect.

As we enter into whatever-week-this-is-actually-who-can-even-remember-what-time-as-a-concept-is-any-more of lockdown, pandemic fatigue is gripping us all and respect is becoming increasingly important.

Ongoing compliance with and support of public health directives cannot be taken for granted, but is dependent on mutually respectful relationships that foster goodwill. This requires authorities and the public to view each other as working constructively in partnership and is something we see across public health interventions.

Ive noticed clear parallels to my work on reaching out to vaccine hesitant parents to increase uptake, and there are a few lessons to learn from it.

While the odd charlatan or grifter is lurking around most people are actually trying in their own way to do the right thing by public health. However, misinformation, confusion or inability to access necessary resources often results in well-intentioned people having significantly different sometimes factually incorrect views of what this right thing is.

The problem comes when politicising such differences becomes more of a focus than addressing them.

Most Australians support public health interventions. In fact, politicians have learned during the pandemic they can receive significant political dividends from them. Its true in vaccination too, as support for vaccines in Australia is high and opposition low.

This has meant targeting non-compliant persons is a vote winner.

Populist approaches to public health are smart politics but they make for stupid policy. The political threshold for success in infectious disease management is a simple majority, but public health thresholds are much higher youll need to win over 90% of the population to achieve herd immunity in vaccine campaigns, for example.

This means to put it bluntly only a small percentage needs to be put offside to stuff it up for everyone. Only a very small minority are intransigently opposed to initiatives like lockdowns or vaccination, which means there is capacity to bring those genuinely sitting on the fence on board.

Unfortunately alienating the small percentage required to reach these thresholds remains a politically popular strategy.

Those not immediately taking up the intervention or wanting to ask questions about vaccines, for example, are often immediately pejoratively labelled as anti-vaxxers or selfish dummy mummies (an actual headline!).

Similar politicisation is occurring in Covid, where the infected and those in hotspots are increasingly viewed as possessing some form of moral failure.

Rather than bringing people on board, such responses can lead people to oppositional sources, as they are often the only ones offering empathy, understanding and respect.

People are more likely to be the victims of misinformation than they are the proponents or supporters of it.

Despite this, some politicians have now decided bringing the public along with them is too hard. Rather than trusting, communicating and working with the public to achieve goals, a one-way conversation has been imposed with threats for non-compliance.

Cutting off the two-way conversation is likely to erode trust, and being involved matters.

Weve heard multiple stories of parents who had no questions about vaccinating their children until they had negative experiences of provider-imposed loss of autonomy, decision-making and control during birthing in institutional settings, eroding their trust in medicine and making them question the very value of the institutions themselves.

We are likely to see a similar erosion of trust if public health interventions become something the government does to us rather than with us, which threatens compliance and sustainability of public health responses in the longer term.

Militarisation and policification of the governments response are certainly not helping, particularly in those communities who already have trust issues with those institutions.

Some of the harsher interventions are more pandemic security theatre than evidence-based public health. Rather than being told why initiatives are important, were told they just are, and that well be fined if we dont. Avoiding such discussions is counterproductive and breaks down trust.

Vaccine hesitancy studies highlight frustrations when doctors refuse to acknowledge any risks of vaccines, even when such risks are presented on product material (note: driving to the appointment is still the most dangerous part of vaccination).

Refusal to discuss particular issues and avoiding conversations erodes trust once you dont trust someone to be honest about one issue, it is likely you will wonder about other issues too. Governments need to be careful not to waste the publics trust and goodwill on harsh public health interventions that look like action, with little evidence, and even less explanation.

We shouldnt forget access issues and social determinants in this response. The back story of the person with an unvaccinated child was more likely to be related to access issues than opposition for example a single parent in precarious casual employment who cancelled the appointment because they were offered an additional shift, and couldnt make another one.

Access issues are key in the pandemic response too. Vaccinations and testing remain harder to access than they should be, one million people have been told to register with a non-existent platform or they cant enter or leave certain areas, and were seeing social supports for the most disadvantaged ramp down while the pandemic ramps up.

Compliance is not just about getting individuals to do the right thing, Its also about breaking down barriers to being able to do the right thing. We have a long way to go in this pandemic, but its going to be a lot longer if the government doesnt bring the public back as an active partner in managing its response.

We keep hearing that were all in this together, we need to see it as well.

Jon Wardle is a professor of public health at Southern Cross University

See original here:
Heavy-handed interventions from governments arent the answer to hesitancy, building trust is - The Guardian