Public health messages are facing a new challenge: not only reaching people, but being heard. In an age of mistrust, misinformation and backlash, this issue explores how communication can build trust while addressing the health challenges shaping Europe.
This month the Dutch Health Council (Gezondheidsraad) published something simple but hard to hear - there is no safe amount of alcohol. Every glass carries a risk to health. The Council advised the Minister of Health to actively “denormalise” drinking in Dutch society. It found strong evidence that the risk of seven types of cancer rises with any amount of alcohol, alongside a higher risk of organ damage. The Council also pointed to road accidents, deaths and emergency room visits linked to drinking, with total costs estimated at 2 to 6 billion euros a year.
Within hours, social media was overloaded with hostile comments, accusations of a “nanny state,” people declaring they would now drink even more. As a health promoter, reading these comments is disheartening and frustrating. When careful, evidence-based advice is presented, social media comments are filled with anger. And a natural response is to wonder whether we should change our communication, tone the message down, target better or not communicate at all? Do our messages reach our goal and contribute to improving the population’s health, or do they worsen it by triggering resistance? This is a key question, as our messages are not only about alcohol, but also address tobacco, vaping, unhealthy foods, overconsumption of meat, gambling, lack of physical activity, etc. which can all be overwhelming, lead to polarised debates and backlash.
Yet, the instinct to change our communication or communicate less to the public is probably wrong — and carries its own risks.
Backlash is not the opposite of impact
Nasty comments are not a sign that public health communication does not work; rather, they are proof that it touches a nerve with people who feel discomfort with what they hear and feel that their personal freedom is threatened. Psychologists call this phenomenon “reactance”: when people feel their freedom is being restricted or judged, they push back, sometimes by doing more of the very thing they are being told to stop. Reactance online is the very visible response to persuasive health messages: people become motivated to reject such messages, especially when they come from a perceived authority. That is exactly what happened online after the Dutch Health Council’s advice: it was not really a debate about the science. It was a defense of a habit people do not want to be judged about, or change. And unfortunately, social platforms seem to reward toxicity with visibility, and these loudest, angriest voices seem to be in the majority, while they only reflect the opinions of a minority of people.
Silence isn’t the answer
Going silent, however, is the real risk.
If we were to go silent because the angriest voices dominate, we would not do justice to the quieter, more supportive majority that is not heard. We must engage better with these more moderate voices, listen to their concerns, translate, and use these arguments to reach the wider public. This means, in other words, that we step up our health communication and counterbalance the very negative social media comments from the minority who disagree. The comment section on social media is therefore not a side issue. It should be part of the intervention or public health campaign. We must also think about different kinds of engagement, rather than just posting a message. This is about building two-way conversations, but without amplifying the platform for the most toxic voices, as well as shielding us from even nastier comments. We must bring in trusted community voices, not only experts, since messages from perceived authorities can trigger more resistance, not less. Policymakers must also regulate the tech industry for comment design. If algorithms reward anger by ranking hostile replies first, this is a regulation issue, and not just a communications problem. There are many ways to improve public health communication in an increasingly digital and polarised world, and some of the articles in this new edition of the EuroHealthNet Magazine provide further helpful analysis and suggestions.
From alcohol to a wider communication challenge
The Health Council’s advice on alcohol is likely to face even more resistance in the Netherlands, like elsewhere in Europe, before norms shift — as was the case with smoking. The angry comments are not a sign that public health communication has failed. They are a sign of a reaction that national health institutes across Europe need to learn how to deal with, rather than ignore or turn away from.
Building a fairer future for health communication
Health communication is being reshaped by technology at a dizzying pace. The possibilities for reaching audiences have never been greater. But as the field evolves and we search for the best ways to communicate, this Magazine issue explores what it means to build a health communications landscape that is not only future-facing and effective but fairer and more inclusive, too.
Across Europe, the forces shaping health are becoming harder to ignore. Climate change is driving rising health risks, digital transformation is creating new barriers for those already excluded, and misinformation is testing public trust in health guidance.
From the Lancet Countdown in Europe’s warning on heat-related deaths, to reflections on digital exclusion, vaccine confidence, and the future of public health communication, this collection explores how evidence, trust and lived experience can shape a healthier and more equitable Europe. At its heart is a shared challenge: ensuring that health systems and communication evolve with the communities they serve.
I hope this edition sparks new ideas and conversations.
- Caroline
Caroline Costongs
Caroline Costongs is Director of EuroHealthNet and expert in public health and health promotion. Caroline leads a multi-disciplinary team working on European and (sub)national policy, advocacy, research and capacity building addressing health inequalities. Caroline is active in various EU and WHO fora, Advisory Boards and various EU projects, and is a member of the ICC – International Council for the European Public Health Conference.