How can you best ensure people listen to and change their behaviour as a result of public health advice during a crisis? Elias Papaioannou, Professor of Economics at London Business School and Academic Director of the Wheeler Institute for Business and Development was joined in conversation with Imran Rasul, Professor of Economics at University College London, to discuss how public health authorities can effectively relay information during the Coronavirus pandemic.
- People react differently to the same information, so it is important to adapt messaging, and the messenger, depending on whose behaviours public health authorities want to impact;
- Studies of the reaction of Brazilian women to the Zika virus shows they made changes, either delaying pregnancy or wearing more repellent/protective clothing, but their approach was different based on different factors;
- Trust in media outlets had a huge impact on the success of public health campaigns; for example, in Brazilian states where there was more trust in media, there was a greater reduction in conception rates;
- The clarity of messaging can also be impacted by the government’s policy approach; the extent to which individuals are compelled to adhere to restrictions will influence the impact of measures, as will the message’s consistency and simplicity;
- The global economy needs to become more robust, as the rate and complexity of outbreaks are set to continue to increase.
Different parts of society find information through alternative channels, so it is not just about the message, it is also about the messenger
Rasul has studied the impact of the Zika virus in Brazil and has some clear lessons for the COIVD-19 crisis. Zika virus can cause congenital malformations, so it primarily impacted women who were giving birth. Therefore, Rasul was able to study fertility rates while there was public awareness of Zika, as well as once public health measures were in place. On average, conception rates fell 7% as a result of the information being spread about the virus, driven primarily by highly educated women in more affluent households. For women from lower socioeconomic, it is harder and more expensive to delay fertility, so they are more exposed to the risk. However, looking at the risk ratios after the women have given birth, the risk was equalised, indicating women in lower-income households are changing their behaviour during pregnancy to avoid the risk of being infected in the first place, rather than delaying pregnancy itself. As the cost of using repellents or wearing clothes that protect the skin is lower than that of delaying pregnancy, there is evidence that people across income groups are taking action as a response to the Zika virus, but with different responses based on their socioeconomic class.
Further investigation looked at the way households reacted to messaging about the Zika virus. The Brazilian Government disseminated information about Zika virus in a relatively homogenous way, yet different households reacted to varying degrees. Furthermore, the public health message was not as explicit as advising everyone to delay pregnancy; there was a nuanced approach which was not as emphatic, which may have led to varying response levels. Similarly, doctors were taking different approaches when encountering pregnant women. Strikingly, there was variation across Brazilian states that showed where trust in certain media outlets had a clear correlation with how people responded to the information provided.
Based on Rasul’s research, it was clear that people were more likely to delay pregnancy in those places where trust in media is greater, so clearly the not just about the message disseminated by public health officials, it’s also about the messenger they use. Moreover, there needs to be care given as to how trust is embedded in different outlets, as well as the consistency and clearness of the messaging. Rasul believes that the homogeneity or trustworthiness of messages is driven by its simplicity and consistency; this will impact how populations react to government messaging. Governments need to consider how financial or other incentives also impact response rates.
Instead of being a societal equaliser, the impact of the pandemic is determined in many ways by pre-existing inequalities
Risk factors for COVID-19 include pre-existing health conditions, so pre-existing inequalities are being magnified by the crisis. People working in different sectors, key workers and even gender is impacting the level of exposure risk; these risk factors spread across a broad range of dimensions and the impact may well be a broadening of inequality. Moreover, inequality may be widened across generations, as children who are graduating are not able to enter the labour market.
Underlying factors that are leading to outbreaks are going to be difficult to reverse
When looking at the trends over the last 30 years, it is clear that the frequency and complexity of outbreaks are increasing. Drivers of this include increased urbanization, rising temperatures, increased mixing of human and animal populations, which will be difficult trends to reverse. Therefore, we need to be better prepared for these shocks and make the global economy more robust. We will need greater preparedness to tackle both public health issues at the same time as an economic shock. Papaioannou thinks economists will have a key role to play, alongside epidemiologists and data scientists to understand these issues.
Elias Papaioannou’s conversation with Imran Rasul is part of the Wheeler Institute’s COVID-19 series – bringing together the expertise and experience of our extended community to understand, illuminate and offer solutions to the challenges created by COVID-19. Our differentiating factor is the role of business in addressing these challenges, with a focus on the implications and actions for those in developing countries.
If you’re interested in following the Wheeler Institute COVID-19 series, check out our last episode ‘Strong, coordinated, collective action is required to prevent the COVID-19 crisis from turning into a global catastrophe’, with Pierre-Oliver Gourinchas.
Elias Papaioannou is academic director of the Wheeler Institute for Business and Development and professor of economics at London Business School, focusing on international finance, political economy, applied econometrics and growth and development.
Imran Rasul is a Professor of Economics at University College London, co-director of the Centre for the Microeconomic Analysis of Public Policy at the Institute for Fiscal Studies, and Research Programme Director in the Firms portfolio, at the International Growth Centre.