Understanding the Disinformation Space: What Health Communicators Can Learn from "Wellness World"

Image adapted from ContuEd.com licensed under CC BY-SA 4.0

A couple of weeks ago, we attended the Society for Health Communication’s annual conference. We heard from many excellent speakers and enjoyed the interactive virtual discussions, but one conversation in particular stands out in my memory.

In one of the breakout sessions, we talked about something very important that is often missing in discourse about health communication: why is it that wellness influencers are such a powerful force in the U.S.? And would it ever be possible for ethical health communication experts to gain the same traction?

In order to answer these questions, it is necessary to first understand the appeal of wellness influencers who peddle patently false information and exploit their audiences to gain wealth (note that I am not referring to legitimate, appropriately credentialed health influencers who offer accurate information–there are some wonderful physicians, epidemiologists, and public health experts who do a great job in this sphere!). While I am not a psychologist, I do spend a lot of time studying people’s interactions on social media, and I have observed similar patterns time and time again. 

Readers who remember their Psychology 101 courses may recall Maslow’s hierarchy of needs, a theory that aims to explain psychological motivation and is often displayed in pyramid form, with the most essential needs at the bottom and the least essential needs at the top. Maslow suggested that all humans are motivated by the following needs, in order from most to least essential: 1) physiological needs like, food, water, and rest; 2) safety and security; 3) love and belonging; 4) self-esteem; and finally, 5) self-actualization, or the feeling of living up to one’s full potential as a human being. These needs often overlap and individuals may not always proceed through the hierarchy in a linear fashion, but Maslow’s schema provides a helpful framework for understanding which needs are or are not being met by wellness influencers. 

First, let’s take a step back and visit the recent past. Although the COVID-19 pandemic has been declared “over,” residents of the U.S. have been given little opportunity to grieve and process the trauma of that period, both collectively and individually. In fact, there is such a wall of silence around the tragedy of the pandemic that influencers frequently censor the word “COVID”  on social media for fear of having their content flagged or demonetized. Why this repression? 

There are, of course, many reasons, but the pandemic was a profound shock to the system that perhaps permanently shook the public’s confidence in its institutions. The mythos of American exceptionalism encourages us to believe that we are a special country, exempt from the tragedies and trials the rest of the globe faces. And yet, even in one of the wealthiest nations in the world, in a country known worldwide for its innovation in science and medical research, a virus brought us to our proverbial knees. Our public health system failed us in myriad ways, and a full accounting of those failures is beyond the scope of this article; but suffice it to say, the pandemic deeply shook the confidence of many Americans, both on a personal and a collective level.

So let’s now consider the product that wellness influencers have to offer. In what I’ll refer to from here forward as “Wellness World,” the core message is one that offers the illusion of control–by purchasing a supplement, applying an essential oil, or following a fad diet, you too can take control of your health. The flipside of Wellness World is that those who don’t hop on the bandwagon must not really care about their health. If wellness is something that can be achieved with a few supplements, diet, and exercise, then why should society hold out a safety net for those whose health fails? 

Wellness World offers a convenient illusion that is highly appealing in the wake of the COVID-19 pandemic, a time when even so-called “experts” were unable to provide comfort or clarity. This illusion is also deeply appealing to Americans because of our unique history. Calvinism, a Christian religious doctrine that promotes the idea that good health and prosperity are signs that one is living in accordance with the will of God, still grips the American imagination. This doctrine places health firmly in the realm of the individual rather than the collective. After all, if you follow the rules and live a good life, health and wealth should follow; if they don’t, then the problem must be you. 

The message of wellness influencers is both seductive and powerful: you are in full control of your own health (provided you have the resources to buy whatever it is they are selling). You don’t need a medical degree, a doctorate, or a pharmacy license, or even to understand basic science. All you need to do is open your wallet. And what’s a few dollars if it gains you access to a better, healthier life? 

But Wellness World offers even more than control over one’s own health–it also provides a sense of community and belonging. Parasocial relationships are the hallmark of all forms of “influencing.” A parasocial relationship is one in which “people [form] intense – and crucially, one-sided – attachments to celebrities or public figures.” Social media creates the illusion of intimacy, fulfilling our need for love, acceptance, and belonging. Influencers are masters at building community, even if those communities are ultimately illusory and toxic. 

Returning to Maslow’s hierarchy, it becomes clear that wellness influencers are meeting multiple needs simultaneously: they provide a sense of safety by offering their followers a feeling of control in a chaotic and unpredictable environment; their online platforms offer community and belonging; and when followers purchase recommended products, devices, or services, it helps build self-esteem by reinforcing a self-image that projects health and happiness. 

However, these influencers rarely, if ever, help their followers meet the highest need on Maslow’s pyramid, that of self-actualization. And this is where, perhaps, health communicators can step in. Self-actualization is arguably the hardest need to pin down, perhaps because it looks a little bit different for each of us, and many of us never achieve it for various reasons. Essentially, a person who is self-actualized feels as though they have the power, agency, and resources to live a purposeful, meaningful life in accordance with their values. Wellness World certainly tries to sell self-actualization, but rarely, if ever, does it help its adherents achieve it. That’s because self-actualization is not something that can be bought and sold. It is only achieved through hard work and self-reflection.

Health communicators will always be at a disadvantage against Wellness World because truth and science are messy, and public health professionals must follow a strict code of ethics. However, we still have one advantage: we can help people achieve self-actualization.

There’s an emerging trend in health and science communications that aims to marry health as a personal value with larger social values. For example, a fellow conference attendee shared a recent anti-vaping campaign in the Democratic Republic of Congo. Rather than attempting to shame or frighten young people who vape, as many anti-vaping campaigns produced by public health organizations do, this campaign drew the attention of consumers to the social and environmental costs of vaping. The best part? The campaign was started by a young woman named Micah Ndango, who posted a video on TikTok where she vowed to quit vaping after learning how cobalt mining is affecting the unrest in the DR Congo. Her video went viral and has inspired others to join her cause. 

While this is only a small campaign, it is notable for three reasons: first, it is a grassroots movement started by a member of the community that is directly impacted. Second, it allows participants to declare that they belong to the same movement, which helps to build a community around shared values and actions. And third, it draws a clear connection between human health, environmental destruction, and economics. 

If self-actualization is predicated on our ability to make a positive difference in the world, then Ndango’s campaign is an example of how effective health communication can help people not only take steps to improve their health, but also to take on an active role in improving their society. 

Public health organizations are more than capable of developing communications strategies that promote true self-actualization, but doing so will require a sea change in terms of how health communications are conceptualized. Current models, such as the health belief model and theory of reasoned action, conceptualize communication as fundamentally top-down. Traditional communications campaigns are predicated on the principle that more information leads to better health decisions; however, research suggests that changing people’s behavior through communication is a much more complex process. Bottom-up approaches, such as the campaign initiated by Ndango, may offer better solutions that allow individuals to achieve self-actualization by advocating for their own needs.

Designing health communications that promote self-actualization is not an easy task, and it is likely to become even more challenging in the coming years. It requires true community engagement and acknowledgment of both direct and indirect causes of poor health outcomes. This means drawing clear connections between individual health and its structural determinants, while also empowering the public to take specific actions to address these determinants.

It also requires a commitment to community-centered research, using models like participatory action that involve the public directly in knowledge production. Crucially, it means talking to the people we are trying to reach and asking what is meaningful and valuable to them, understanding what barriers are preventing them from achieving self-actualization, and working with community leaders to develop initiatives that combine communication with action. 

We know one thing for sure: the old ways of communicating are largely ineffective in our hyperconnected, disinformation-fueled information economy. If health communicators want to make real change, we need to change too. And we need to take an active role in building the communities that will help facilitate those changes.