Public health is the science of improving health and safety within communities. Fabrice Julien, assistant professor of health and wellness at UNC Asheville, knows that it’s also an art.
Julien teaches health communication and the theory of health promotion at UNCA. He thinks a lot about how to break through medical distrust and skepticism, as well as how that mistrust did not start with the COVID-19 pandemic. Successful health communication, he says, needs to focus on “understanding how that mistrust has come about in an effort to remove it.”
“I think there is a consequence to blaming individuals for their skepticism,” Julien continues. “Skepticism and mistrust are default positions from the public as soon as public health problems [arise].”
Julien was born in Haiti and moved to the United States at age 8. Raised in Atlanta, he found his way to the public health field from a desire to understand politics and “the complexities related to health decision-making and explanations behind the disparities that linger in our American society.” He holds a doctorate in medical sociology and master’s degrees in public health and sociology.
Julien spoke with Xpress about the causes of medical mistrust, the problem with relying on figureheads to disseminate information and why a hip-hop song was great health care communication. This interview has been condensed for length and edited for clarity.
People of color and women have both been historically ignored, dismissed and even abused in the medical field. What is the health community doing to address the resulting mistrust?
The cohorts that are coming into the public health realm now are being trained on these matters and are taught to consider them. But we have to acknowledge that there’s a large group of individuals out there who are currently practicing and that may not have been part of their training.
I think what’s most important here is having individuals, members of these communities, in these major institutions and public health agencies. The boardroom — is it just composed of health care workers, or is it composed of those who are being served?
In your opinion, what is at the root of medical mistrust?
Communication between [experts and the public] isn’t really taking place until something serious happens. What kind of groundwork is being laid consistently as time progresses? Part of the reason that mistrust is happening is there’s not enough investment during the quiet periods.
Also, we have to be honest with ourselves about the financial situation around health in America — in particular how health conditions that individuals go through can end up disrupting lives from a financial standpoint and bankrupting folks. Some of the mistrust may be more reflective of the deserved bitterness, of care not being administered from a utilitarian perspective, of care being limited to those who have the means. That’s an unfortunate reality, and in a way, we’re dealing with the wrath of that reality.
How can the medical field use the media more effectively to earn people’s trust?
In my health communication class right now, I stress that [messaging is] complex, multistepped and needs to be tailored. There are these important pillars of exceptional communication. That goes back to Aristotle and his focus on trust, emotion and reason. If the messaging is focused on trust with ethos, focused on pathos with emotion, focused on logos with reason, then you’re going to have more success reaching members of the general public.
There is this myth that experts have, which is as long as you focus on just the logos side — as long as you just focus on reason, presenting the numbers, the data — that should be enough. But that’s not how the general public finds, interprets and evaluates information. You have to appeal to emotion; you have to appeal to trust. And oftentimes it’s not the person who’s doing the work who should have the microphone.
At the beginning of the pandemic, politicians like Governor Andrew Cuomo and President Donald Trump would do regular press conferences that were must-see viewing for a lot of people. Neither of them are medical professionals, but their communication styles resonated with different people.
What we found in the last year or so is that for one person’s figurehead, there’s a counterfigurehead. This will be an interesting case study, this time that we’re living in.
What I suppose textbooks will write on this is that we took the wrong approach by having the scientists at the forefront of communication. Just because you are a pathologist or a virologist does not mean that you have done the training of how to communicate information. It’s frustrating, because I know for a fact that these agencies have health communication experts.
Gov. Cuomo was an interesting case study. I have a hunch that the governor had media training, more so than some other folks. In a lot of ways the governor was appealing to all three of those pillars of exceptional communication.
What would be an example of effective health communication that earned people’s trust?
I think about the press conference that Magic Johnson gave [in 1991] to announce his then-retirement from basketball. It was a press conference trying to inform the public about HIV — which had incorrectly been ascribed to particular members of the American population — how it was indiscriminate about who it could infect. That press conference represented those three pillars and a lot of good came from it: HIV testing increased.
A more recent example comes from the rapper Logic — the suicide hotline track [“1-800-273-8255”]. I thought that was exceptional health communication, because it appealed to pathos with his own stories with his mental health issues. There have been studies about the impact that’s had on youth, the hotline being called and saving more lives.
Do you think we are living during a uniquely mistrustful time?
That’s not the case — mistrust and distrust have been around for some time. I think back to Robert Putnam and his thesis on Americans bowling alone, civic life collapsing and how that was a foreshadow of what we would come to see today.