This fiscal year, the U.S. Department of Health and Human Services (HHS) has a discretionary spending budget of $144.3 billion. That money will generate important scientific knowledge; track the spread of infectious diseases; advance the approval of new drugs and medical devices, identify defective health products and tainted food and cosmetics, and encourage us to avoid tobacco, watch our blood pressure, control our weight, and respond to public health and medical crises.
All these things must be communicated effectively to empower Americans to make appropriate health decisions for themselves, their families and communities.
Previous HHS health communication efforts — the National High Blood Pressure Education Program, the National Breast and Cervical Cancer Early Detection Program and more recent campaigns for smoking cessation (“TIPS from former smokers”), tobacco use prevention (“Real Cost”) and the Health Insurance Marketplace National Enrollment Campaign — have brought together of broad public-private coalitions to extend and improve the quality of American lives.
Buoyed by successes like these, the Centers for Disease Control and Prevention in 2004 created an autonomous National Center for Health Marketing (NCHM) to support the agency’s goals with new science-based, consumer-focused health marketing programs, products, and services. For a few years, NCHM indeed served as a center of excellence in health communications. But by 2009, internal CDC politics had undermined its authority, reassigned its functions to other parts of the agency, and ultimately shut it down.
In retrospect, this was the beginning of an ill-timed downward spiral in the U.S. government’s ability to communicate clearly about health.
The government’s health communications competence hit rock bottom in the COVID era, when Washington was notably unable to communicate with one voice — something a few of us called for in a National Academies of Medicine even before the pandemic was declared official in March 2020. The downgrading of government health communication also ran parallel with the rise of competing, often divisive sources of pandemic and other health information. Those sources have proven far more adept than HHS in applying new messaging technologies, including generative AI, which government is now effectively powerless to compete with or regulate. Today, trust in government health sources and belief in government health messages is dangerously low.
Lately, some senior government health science leaders have suggested reconsidering the unique role health communications should play in achieving the mission of HHS and the Public Health Service (PHS) agencies. In a recent JAMA editorial, FDA Commissioner Robert Califf and Peter Marks, director of the Center for Biologics Evaluation and Research, called for more and better health communications to combat competing voices. Former NIH Director and presidential science adviser Francis Collins has ruefully admitted his (and NIH’s) failure to recognize the more pivotal role communications should have played during the pandemic.
In his book “Warp Speed,” former HHS Deputy chief of staff Paul Mango questioned the government’s entire pandemic communication strategy. He decried the reliance on traditional media, web pages and “authoritative voices” and suggested the need for a senior “communications lead,” as well as the need for development of expanded HHS social media presence, social media listening and social media influencing.
Late last year, the National Academies held a workshop on Effective Health Communication Within the Current Information Environment and the Role of the Federal Government. While this Robert Wood Johnson Foundation-sponsored discussion asserted the value and need for federal investment in health communication, the panelists did not offer concrete recommendations on how to implement it.
The ultimate authority to operate all federal government programs, including health communications, comes of course from Congress. Currently, lawmakers are debating reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), legislation that will lay the foundation for the nation’s future response to natural and manmade disasters. At this point in the act’s legislative history, communication is only briefly mentioned. That’s an improvement on the previous version that did not mention public and partner communications at all.
Ideally, PAHPA raises the opportunity for Congress to adopt a “whole of government approach” to provide clear and consistent communications with external groups and the public. Whether it does so remains to be seen. In any case, HHS and PHS agencies are not now organized to confront the challenges of revolutionary communications technology, widespread misinformation and rampant loss of trust in the public health establishment.
To better reach the public and restore trust in health and science, HHS should establish an independent Center for Excellence in Health Communication. Its mission would be to support HHS agencies and offices with effective, two-way, customer-focused health communications programs. The new center’s work would begin with budget formulation and include communications contract development and oversight. The goal would be to create consistent program quality based on experience, best practices and research, including common language and guidance on reach, frequency, messages, partnerships and budget estimation.
Based on numerous indicators of trust, the American public is clearly dissatisfied with government generally and public health in particular. If political leaders want our government to deliver better results for their constituents, a radical transformation in how the federal government communicates with the public about health could be a catalyst.
Helping individuals, families and communities understand the information they need to make the best possible health decisions should lead to better health outcomes. All we need is the will to do so.
Scott C. Ratzan, MD, MPA, MA, is founding editor of the Journal of Health Communication and distinguished lecturer at the City University of New York Graduate School of Public Health and Health Policy.
Mark Weber, MBA, was previously deputy assistant secretary for public affairs and human services in the U.S. Department of Health and Human Services.
Kenneth H. Rabin, Ph.D., MA, is a senior scholar at the City University of New York Graduate School of Public Health and Health Policy.
The authors are organizers of the recently formed Council for Quality Health Communication.