Confronting Health Misinformation: The U.S. Surgeon General’s Advisory on Building a Healthy Information EnvironmentBecause it pollutes our information environment, misinformation is harmful to individual and public health. Together, we have the power to build a healthier information environment. Just as we have all benefited from efforts to improve air and water quality, we can all benefit from taking steps to improve the quality of health information we consume. Limiting the prevalence and impact of misinformation will help all of us make more informed decisions about our health and the health of our loved ones and communities... Addressing health misinformation will require a whole-of-society effort. We can start by focusing on the following areas of action: A Surgeon General’s Advisory is a public statement that calls the American people’s attention to a public health issue and provides recommendations for how that issue should be addressed. Advisories are reserved for significant public health challenges that need the American people’s immediate awareness. For additional background, visit SurgeonGeneral.gov.U.S. Public Health ServiceUSPHS_73eea5b8-39b3-11ec-933a-bca51983ea00Vivek H. Murthy, M.D., M.B.A.Vice Admiral, U.S. Public Health Service | Surgeon General of the United States ~ During the COVID-19 pandemic, there have been significant efforts to address health misinformation. Here are just a few examples:Trusted Community MembersTrusted community members, such as health professionals, faith leaders, and educators, have spoken directly to their communities to address COVID-19-related questions (e.g., in town halls, community meetings, via social and traditional media)Health ProfessionalsFaith LeadersResearchersResearchers have identified leading sources of COVID-19 misinformation, including misinformation “super-spreaders”Media OrganizationsMedia organizations have devoted more resources to identify and debunk misinformation about COVID-1946Technology PlatformsSome technology platforms have improved efforts to monitor and address misinformation by reducing the distribution of false or misleading posts and directing users to health information from credible sourcesGovernmentsGovernments have increased their efforts to disseminate clear public health information in partnership with trusted messengersEach of UsBut there is much more to be done, and each of us has a role to play. Before posting or sharing an item on social media, for example, we can take a moment to verify whether the information is accurate and whether the original source is trustworthy. If we're not sure, we can choose not to share. When talking to friends and family who have misperceptions, we can ask questions to understand their concerns, listen with empathy, and offer guidance on finding sources of accurate information.SocietyIt will take more than individual efforts, however, to address health misinformation. The threat of misinformation raises important questions we must answer together: How do we curb the spread of harmful misinformation while safeguarding user privacy and free expression? What kinds of measures should technology platforms, media entities, and other groups adopt to address misinformation? What role is appropriate for the government to play? How can local communities ensure that information being exchanged—online and offline—is reliable and trustworthy? How can we help family and friends who may have been exposed to harmful misinformation?IndividualsWhat Individuals, Families, and Communities Can Do ... * Learn how to identify and avoid sharing health misinformation. ~ When many of us share misinformation, we don’t do it intentionally: We are trying to inform others and don’t realize the information is false. Social media feeds, blogs, forums, and group chats allow people to follow a range of people, news outlets, and official sources. But not every post on social media can be considered reliable. And misinformation can flourish in group texts or email threads among friends and family. Verify accuracy of information by checking with trustworthy and credible sources. If you’re not sure, don’t share. * Engage with your friends and family on the problem of health misinformation. ~ If someone you care about has a misperception, you might be able to make inroads with them by first seeking to understand instead of passing judgment. Try new ways of engaging: Listen with empathy, establish common ground, ask questions, provide alternative explanations and sources of information, stay calm, and don’t expect success from one conversation. * Address health misinformation in your community. ~ Work with schools, community groups such as churches and parent-teacher associations, and trusted leaders such as educators and health care professionals to develop local strategies against misinformation. For example, invite local health professionals to schools or to faith congregations to talk about COVID-19 vaccine facts.FamiliesCommunitiesEducational InstitutionsWhat Educators and Educational Institutions Can Do ... * Strengthen and scale the use of evidence-based educational programs that build resilience to misinformation. ~ Media, science, digital, data, and health literacy programs should be implemented across all educational settings, including elementary, secondary, post-secondary and community settings. In addition to teaching people how to be more discerning about the credibility of news and other content, educators should cover a broader set of topics, such as information overload, internet infrastructure (e.g., IP addresses, metadata), the challenges of content moderation, the impact of algorithms on digital outputs, algorithmic bias, artificial intelligence (AI)-generated misinformation (e.g., deepfakes), visual verification skills, and how to talk to friends and family who are sharing misinformation. * Educate students and the public on common tactics used by those who spread misinformation online. ~ Recent research suggests that teaching people how to spot these tactics can reduce people's willingness to share misinformation. Examples of misinformation tactics used by those who deny scientific consensus on health issues include presenting unqualified people as experts; misleading consumers with logical fallacies; setting impossible expectations for scientific research; cherry-picking data or anecdotes; and introducing conspiracy theories. * Establish quality metrics to assess progress in information literacy. ~ While there is substantial media and information literacy work being carried out across the United States, there is a need for more consistent and empirically evaluated educational materials and practices.EducatorsHealth OrganizationsWhat Health Professionals and Health Organizations Can Do ... * Proactively engage with patients and the public on health misinformation. ~ Doctors, nurses, and other clinicians are highly trusted and can be effective in addressing health misinformation. If you are a clinician, take the time to understand each patient’s knowledge, beliefs, and values. Listen with empathy, and when possible, correct misinformation in personalized ways. When addressing health concerns, consider using less technical language that is accessible to all patients. Find opportunities to promote patient health literacy on a regular basis. * Use technology and media platforms to share accurate health information with the public. ~ For example, professional associations can equip their members to serve as subject matter experts for journalists and effectively communicate peer-reviewed research and expert opinions online. * Partner with community groups and other local organizations to prevent and address health misinformation. ~ For example, hospital systems can work with community members to develop localized public health messages. Associations and other health organizations should offer trainings for clinicians on how to address misinformation in ways that account for patients’ diverse needs, concerns, backgrounds, and experiences.Health ProfessionalsMedia OrganizationsWhat Journalists and Media Organizations Can Do ... * Train journalists, editors, and others to recognize, correct, and avoid amplifying misinformation. ~ Media organizations should develop in-house training programs and partner with journalism schools, nonprofits, technology platforms, and others to democratize access to high-quality training for all media outlets. * Proactively address the public’s questions. ~ When something is new—such as a vaccine— people will understandably have questions. By anticipating and proactively answering those questions, media organizations and journalists can help get ahead of misinformation and increase the public’s health and information literacy. * Provide the public with context to avoid skewing their perceptions about ongoing debates on health topics. ~ For example, when discussing conflicting views on an issue, give readers a sense of where the scientific community stands and how strong the available evidence is for different views. Consider questions like: How much disagreement is there among experts? Is a given explanation plausible even if it is unlikely? If evidence is not equally strong on all sides of an issue, avoid presenting it as such. * Carefully review information in preprints. ~ Preprints are research papers published online before peer review. They can provide scientists and the public with useful information, especially in rapidly evolving situations such as a pandemic. However, because preprints have not been independently reviewed, reporters should be careful about describing findings from preprints as conclusive. If reporting on such findings, include strong caveats where appropriate, seek out expert opinions, and provide readers with context. * Use a broader range of credible sources— particularly local sources. ~ Research shows us that people have varying levels of trust in different types of people and institutions. In addition to relying on federal and state public health authorities as sources, build relationships with local health professionals and local trusted, credible health organizations. * Consider headlines and images that inform rather than shock or provoke. ~ Headlines are often what audiences will see and remember. If a headline is designed to fact-check a rumor, where possible, lead with the truth instead of simply repeating details of the rumor. Images are often shared on social media alongside headlines and can be easily manipulated and used out of context. Picture desk and social media editors should consider how provocative and medically inaccurate imagery can be a vehicle for misinformation.JournalistsTechnology PlatformsWhat Technology Platforms Can Do ... * Assess the benefits and harms of products and platforms and take responsibility for addressing the harms. ~ In particular, make meaningful long-term investments to address misinformation, including product changes. Redesign recommendation algorithms to avoid amplifying misinformation, build in “frictions”— such as suggestions and warnings—to reduce the sharing of misinformation, and make it easier for users to report misinformation. * Give researchers access to useful data to properly analyze the spread and impact of misinformation. ~ Researchers need data on what people see and hear, not just what they engage with, and what content is moderated (e.g., labeled, removed, downranked), including data on automated accounts that spread misinformation. To protect user privacy, data can be anonymized and provided with user consent. * Strengthen the monitoring of misinformation. ~ Platforms should increase staffing of multilingual content moderation teams and improve the effectiveness of machine learning algorithms in languages other than English since non-English-language misinformation continues to proliferate. Platforms should also address misinformation in live streams, which are more difficult to moderate due to their temporary nature and use of audio and video. * Prioritize early detection of misinformation "super-spreaders" and repeat offenders. ~ Impose clear consequences for accounts that repeatedly violate platform policies. * Evaluate the effectiveness of internal policies and practices in addressing misinformation and be transparent with findings. ~ Publish standardized measures of how often users are exposed to misinformation and through what channels, what kinds of misinformation are most prevalent, and what share of misinformation is addressed in a timely manner. Communicate why certain content is flagged, removed, downranked, or left alone. Work to understand potential unintended consequences of content moderation, such as migration of users to less-moderated platforms. * Proactively address information deficits. ~ An information deficit occurs when there is high public interest in a topic but limited quality information available. Provide information from trusted and credible sources to prevent misconceptions from taking hold. * Amplify communications from trusted messengers and subject matter experts. ~ For example, work with health and medical professionals to reach target audiences. Direct users to a broader range of credible sources, including community organizations. It can be particularly helpful to connect people to local trusted leaders who provide accurate information. Prioritize protecting health professionals, journalists, and others from online harassment, including harassment resulting from people believing in misinformation.Research InstitutionsWhat Researchers and research institutions Can Do ... * Strengthen the monitoring of health questions, concerns, and misinformation. ~ Focus on a broader range of content and platforms, as well as on information flow across platforms. For example, examine image- and video-based content and content in multiple languages. To address existing research limitations, expand data collection methods (e.g., recruit social media users to voluntarily share data). * Assess the impact of health misinformation. ~ There is an urgent need to comprehensively quantify the harms of health misinformation. For example, how and under what conditions does misinformation affect beliefs, behaviors, and health outcomes? What is the role of emotion, cognition, and identity in causing misinformation to “stick”? What is the cost to society if misinformation is left unchecked? * Prioritize understanding how people are exposed to and affected by misinformation, and how this may vary for different subpopulations. ~ Tailor interventions to the needs of specific populations. Invite community members to participate in research design. * Evaluate the effectiveness of strategies and policies to prevent and address health misinformation. ~ For example, can flagging certain content as misinformation have unintended consequences? Is it possible to build resilience to misinformation through inoculation methods such as “prebunking”? (Debunking involves correcting misinformation once someone has been exposed to it. Prebunking, or preemptively debunking, involves warning people about misinformation they might come across so they will be less likely to believe it when exposed.)ResearchersFoundationsWhat Funders and Foundations Can Do ... * Move with urgency toward coordinated, at-scale investment to tackle misinformation. ~ Assess funding portfolios to ensure meaningful, multi-year commitments to promising research and programs. * Invest in quantifying the harms of misinformation and identifying evidence-based interventions. ~ Focus on areas facing private and public funding gaps. Examples could include independent and local journalism, accountability mechanisms for platforms, and community-based health literacy programs. Provide training and resources for grantees working in communities disproportionately affected by misinformation (e.g., areas with lower vaccine confidence). * Incentivize coordination across grantees to maximize reach, avoid duplication, and bring together a diversity of expertise. ~ For example, encourage coordination around monitoring health misinformation across multiple languages.FundersGovernmentsWhat Governments Can Do ... * Convene federal, state, local, territorial, tribal, private, nonprofit, and research partners ~ to explore the impact of health misinformation, identify best practices to prevent and address it, issue recommendations, and find common ground on difficult questions, including appropriate legal and regulatory measures that address health misinformation while protecting user privacy and freedom of expression. * Increase investment in research on misinformation. ~ For example, more research is needed to better define misinformation, document and process its harms, and identify best practices for preventing and addressing misinformation across mediums and diverse communities. * Continue to modernize public health communications. ~ Work to understand Americans’ health questions, concerns, and perceptions, especially for hard-to-reach populations. Deploy new messaging and community engagement strategies, including partnerships with trusted messengers. Proactively and rapidly release accurate, easy-to-understand health information in online and in-person settings. Invest in fact-checking and rumor control mechanisms where appropriate. * Increase resources and technical assistance to state and local public health agencies to help them better address questions, concerns, and misinformation. ~ For example, support the creation of teams within public health agencies that can identify local misinformation patterns and train public health misinformation and infodemic researchers. Work with local and state health leaders and associations to address ongoing needs. * Expand efforts to build long-term resilience to misinformation. ~ For example, promote educational programs that help people distinguish evidence-based information from opinion and personal stories.A healthier information environment_73eea766-39b3-11ec-933a-bca51983ea00To limit the prevalence and impact of misinformation_73eea86a-39b3-11ec-933a-bca51983ea00ToolsEquip Americans with tools_73eea9fa-39b3-11ec-933a-bca51983ea00Action 1AmericansTrusted Local Leadersto identify misinformation, make informed choices about what information they share, and address health misinformation in their communities, in partnership with trusted local leadersIdentificationIdentify misinformation_73eeaaf4-39b3-11ec-933a-bca51983ea001.1SharingMake informed choices about what information they share_2f2b9382-403e-11ec-8b84-62371c83ea001.2MisinformationAddress health misinformation in their communities_2f2b959e-403e-11ec-8b84-62371c83ea001.3CommunitiesResearchExpand research that deepens our understanding of health misinformation_73eeabda-39b3-11ec-933a-bca51983ea00Action 2including how it spreads and evolves; how and why it impacts people; who is most susceptible; and which strategies are most effective in addressing itSpread & EvolutionDeepen understanding of how health misinformation spreads and evolves_73eeacca-39b3-11ec-933a-bca51983ea002.1ImpactDeepen understanding of how and why health misinformation impacts people_2f2b9710-403e-11ec-8b84-62371c83ea002.2SusceptibilityDeepen understanding of who is most susceptible to health misinformation_2f2b9904-403e-11ec-8b84-62371c83ea002.3StrategiesDeepen understanding of which strategies are most effective in addressing health misinformation_2f2b9a62-403e-11ec-8b84-62371c83ea002.4Technology PlatformsImplement product design and policy changes on technology platforms to slow the spread of misinformation_73eeada6-39b3-11ec-933a-bca51983ea00Action 3Technology Platform DevelopersProductsImplement product design changes_73eeae8c-39b3-11ec-933a-bca51983ea003.1PoliciesImplement policy changes_2f2b9bca-403e-11ec-8b84-62371c83ea003.2ResilienceInvest in longer-term efforts to build resilience against health misinformation_73eeb062-39b3-11ec-933a-bca51983ea00Action 4Health PractitionersJournalistsLibrarianssuch as media, science, digital, data, and health literacy programs and training for health practitioners, journalists, librarians, and othersLiteracy ProgramsInvest in media, science, digital, data, and health literacy programs_73eeb13e-39b3-11ec-933a-bca51983ea004.1TrainingInvest in training_2f2b9d46-403e-11ec-8b84-62371c83ea004.2ConveningsConvene federal, state, local, territorial, tribal, private, nonprofit, and research partners_73eeb31e-39b3-11ec-933a-bca51983ea00Action 5Federal PartnersState PartnersLocal PartnersTerritorial PartnersTribal PartnersPrivate PartnersNonprofit PartnersResearch PartnersImpactExplore the impact of health misinformation_73eeb418-39b3-11ec-933a-bca51983ea005.1Best PracticesIdentify best practices to prevent and address it_73eeb4fe-39b3-11ec-933a-bca51983ea005.2RecommendationsIssue recommendations_73eeb5e4-39b3-11ec-933a-bca51983ea005.3ConsensusFind common ground on difficult questions, including appropriate legal and regulatory measures that address health misinformation while protecting user privacy and freedom of expression_73eeb6ca-39b3-11ec-933a-bca51983ea005.42021-11-07https://www.hhs.gov/sites/default/files/surgeon-general-misinformation-advisory.pdfOwenAmburOwen.Ambur@verizon.net