Injustice-induced mistrust – its impact on infodemic management and health response and what to do about it – World

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Introduction

The COVID-19 pandemic, along with other recent health crises, has highlighted the detrimental impact of misinformation and mistrust of health information on health systems. Studies highlight negative associations between mistrust and various aspects of health response, including health outcomes, use of preventive health services, willingness to receive care (including vaccination), emergency mortality rates, risk perception, and overall acceptance of health measures (Lee & Lin 2011, Musa et al. 2009,
Ahorsu 2021, Reiersen et al. 2022, Bollyky 2022, Pian et al. 2021). Understanding what causes mistrust in health information and what possible actions can mitigate or address the impact that mistrust has on the effectiveness of health emergency response is critical (Mulukom 2022). Given the significant role that trust plays during a health response, it becomes critical to take a deeper look at what the main drivers of trust in health information are during a health crisis. This research is part of Internews’ Rooted in Trust (RiT) project, which since 2020 has partnered with over 41 local organizations in 15 different humanitarian settings to address the unprecedented scale and speed of health-related rumors and misinformation. As part of our project, we found that inequality is an important driver of mistrust, particularly for at-risk communities in humanitarian settings.
Inequality has also been shown to be an important social determinant of health that can influence health outcomes (WHO, 2008).

A census of the existing literature indicates a significant gap that this article aims to begin to address. Some studies conceptualized information inequality as a lack of access to factual and scientific information and highlighted how it contributes to the growth of misinformation (Mostagir & Siderius, 2022). However, managing the ‘infodemic’1 has shown that access to scientific evidence alone does not necessarily limit the spread of health misinformation (Internews, 2020). Consequently, other studies have increasingly focused on structural inequalities and their role as social determinants of health in order to understand their impact on inequality-induced mistrust and misinformation. These studies highlight how societal issues such as structural racism, vulnerability and discrimination influence marginalized communities’ mistrust of health-related information with impacts on health outcomes (Musa et al., 2009; Jaiswal et al., 2020; Bazargan et al. 2021, Rasheeta 2020, Da Silva et al 2021, Smith 2021).

However, many of these studies have focused primarily on at-risk communities in high-income settings, particularly in the United States. As a result, there is a void in the literature when it comes to understanding how inequality-driven mistrust works for at-risk communities in low-income settings, particularly in humanitarian contexts.

Factors such as unreliable health care systems, widespread poverty and inequality, geopolitical conflicts, postcolonial tensions, and weak institutions can alter the ways in which injustice-induced distrust operates in these contexts.

Additionally, existing studies have primarily examined how injustice-induced distrust affects health behaviors, without adequate attention to its impact on infodemic management, health emergency response, or humanitarian response.

This paper aims to address these gaps by exploring the ways in which injustice can contribute to mistrust of information among communities at risk in a humanitarian context. The goal is to shed light on the potential impacts of this mistrust on health emergency response and the management of the “infodemic.”

To achieve this, the paper provides an empirical account through case studies conducted with internally displaced communities in northern Iraq and indigenous communities in the Colombian and Brazilian Amazon regions.

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