Health experts often come across as narrow-minded. We like data, and we believe we know exactly how it should be used to change behavior. We don’t understand how others can look at the same information and come to very different conclusions ― and when that happens, we often just tell them they’re wrong.
Turns out telling people they’re wrong (even when we have the best of intentions) often fails to win them over.
So if we’re so right, how do we more effectively educate others about health? We need to listen. That advice is only a cliché because we’re so bad at it.
Vaccines are a perfect example of this. Most Americans know the benefits of vaccines far outweigh any potential harms. A May 2018 poll showed 70 percent of Americans agree with this, saying vaccines are “very important.”
But this also means many Americans don’t agree. That same poll showed 18 percent of Americans had little to no confidence in vaccine safety. That’s almost 60 million people when generalized to the country’s population. And our current approach ― simply telling them they’re wrong ― has yet to change their minds. To truly convince them, we must ensure their concerns are a key part of the conversation.
Our brains interpret challenges to our beliefs as challenges to our very identity, and we respond in automatic self-defense. So it’s essential to engage in a way that separates the two, creating space for opposing facts to have more standing.
“We are more likely to believe new arguments when they come from 'ideological allies,' or people who usually agree with us.”
How do we respect this primal need for identity preservation? By asking others to explain their beliefs, rather than automatically correcting them.
A 2012 study asked individuals to rate how strongly they agreed or disagreed with various policy ideas (single payer health care, for example). They were then asked to fully explain the policies. Suddenly, most didn’t agree or disagree as strongly as they had before.
Explaining what we believe, and why, respects our sense of self and prompts us to address the limitations of our views on our own terms. And if we can present opposing facts from sources others already trust, even better. We are more likely to believe new arguments when they come from “ideological allies,” or people who usually agree with us. This means acknowledging the many reasons why certain people avoid vaccines.
Some individuals who do so believe vaccine-preventable diseases are no longer a threat to us ― and they feel if these diseases are virtually nonexistent, there’s no need to vaccinate against them. Of course, health experts know successful vaccination campaigns are the reason why the threat is so low, and that it will only remain low if Americans continue to vaccinate. Still, we can see why some people overlook this.
Others who refuse vaccines meticulously calculate their risk. If the perceived risk of harm from vaccination is higher than the perceived risk of disease, avoiding vaccination feels safer to them. Again, health experts know the risk of disease is as low as it is because most people vaccinate (creating population-level protection); however, at the individual level, actually getting sick can seem unlikely.
Then there are those who object to vaccines on religious grounds. Some oppose the physical components of the vaccines, such as animal-derived gelatin. Others believe medical interventions, including vaccines, interfere with divine authority and healing. Though official religious doctrine very rarely dictates vaccine refusal, some Americans interpret — or are taught — otherwise.
All of these reasons for avoiding vaccines have a certain degree of logic to the person who believes them, and so challenging them amounts to calling that person illogical. So it’s easy to understand why preaching safety and efficacy using data and numbers can be counterproductive. It often leads to the “backfire effect,” in which an opposing argument actually solidifies an individual’s original belief.
“Spreading out the administration of vaccines for a few children may be worth it if it keeps those families engaged in disease prevention.”
A better approach? Acknowledging that person’s beliefs directly. Recognizing differing opinions may lead to compromise ― neither complete victory nor total defeat. But if improving public health is truly our goal, any progress toward it is praiseworthy.
We often resist compromise when it comes to health. Most pediatricians resist alternative vaccination schedules, for example ― timelines that go against the American Academy of Pediatrics’ recommendations. And for good reason; the recommended schedule is clinically safe and effective, and encouraging any departure from that standard could create additional doubt about vaccines. Plus, delaying vaccines keeps children at risk longer than necessary.
But as Dr. Claire McCarthy of Boston Children’s Hospital points out, “Some vaccines are better than none.”
And she’s right. If the 93 percent of pediatricians who are asked about alternative vaccination schedules refuse to comply or even to discuss the matter, both community and individual protections suffer. Spreading out the administration of vaccines for a few children may be worth it if it keeps those families engaged in disease prevention.
The best conversation I’ve ever had about vaccines was with a friend who doesn’t vaccinate her children. I didn’t change her mind. I didn’t try to, either. Instead, I asked questions and offered evidence-based information when she welcomed it.
I admit, it was hard to bite my tongue and not just say she’s wrong. But our exchange shows that respectful conversation can help maintain an open dialogue between opposing viewpoints.
I’m of course all in when it comes to vaccines. Along with clean water and modern sanitation, vaccines are the powerhouse behind the eradication of many preventable diseases. But my confidence — our collective confidence — in them means nothing if we can’t have respectful discussions with others. If we refuse to listen, health education stops before it even begins.
Elsa Pearson is a policy analyst with the Boston University School of Public Health. She tweets at @epearsonbusph.