Abstract
In this article, we discuss the ways in which the United Kingdom and the United States communicate health information to their respective citizens. While this article is not limited to the study of COVID-19 health communications, we look at the institutions that were tasked with communication responsibilities regarding the COVID-19 virus in the United States and United Kingdom. To highlight the possible repercussions on the general public of each nation, we present a review of the institutions of communication as a gateway for discussion and an opportunity to unveil discrepancies and inequitable forms of communication. These institutions are the Centers for Disease Control and Prevention, the National Institutes of Health in the United States, and the National Health Service in the United Kingdom. We consider the language and vocabulary used within these organizations’ mission statements, privacy policies, digital channels and platforms, regulations for advice and feedback from federal agents as well the general public, and accessibility. We use an intersectional lens to explore the nuanced and multifarious impacts of communication praxis and aim to discuss how these have led to limitations of passive and comprehensive communication influences in both nations and their relation to health infrastructure. By understanding the constraints of health infrastructure on the current disenfranchised citizens in both the United States and United Kingdom, we can register the adverse behavioral imprint on individuals as a result and finally call for further research into the impact of reconstructive governmental health communications.
Introduction
The COVID-19 pandemic has exacerbated the trend of the preceding decades for governmental health information to be moved to online platforms and has made access to online health information more valuable and imperative than before the pandemic. In this article, we review the online information about COVID provided by national health-related organizations 1 in America (the Centers for Disease Control and Prevention [CDC] and the National Institutes of Health [NIH]) and Britain (the National Health Service [NHS]). We consider the language and vocabulary used within these organizations’ mission statements, privacy policies, digital channels and platforms, regulations in terms of advice and feedback, and accessibility. We look at the structural differences between the institutions in the United States and United Kingdom and how these may impact information delivery. Furthermore, we weigh the active benefits and threats from the messaging publicized on these government agencies’ official websites, and communication differences between the U.S. and U.K. organizations. Using an intersectional lens, we explore and discuss the impacts of communication praxis and how these have led to communication limitations in relation to health infrastructure. By understanding the constraints of health infrastructure on the disenfranchised citizens in both countries, we register the adverse behavioral repercussions on individuals and call for further research into the impact of reconstructive governmental health communications.
Background
Mission Statements
The CDC (United States)
The CDC’s mission is to lead through science and advanced technology in their attempts to prevent diseases and tackle the biggest problems causing death and possible disability among the American people (CDC, 2021b). 2 With the help of public health leaders, the CDC promotes health and safety behaviors within communities and the environment. They confront the national health threats that surround them with advanced laboratory analyses and data to detect the quickest possible solutions to fighting disease that reaches the United States. As the United States’ leading health protection agency, the CDC is committed to providing empirical, science-based knowledge at national, state, and local levels to improve the livelihood of public health infrastructure among individual and community health care (CDC, 2022). Holding the responsibility to service the American people, the CDC prioritizes benefits to the public interest above the interests of the institution.
The NIH (United States)
The NIH is the government’s principal medical research agency in the United States in discovering disease threats and health improvement with innovative research strategies to expand knowledge and known information in medical and associated sciences to improve the nation’s well-being. Their mission is to seek fundamental knowledge about the nature and behavior of living systems and apply that knowledge to enhance health, lengthen life, and reduce illness and disability (NIH, 2017). To maintain the order of the goals listed above, the NIH supports programs that are designed to continuously improve the health of the nation by investing research in biological, medicinal, environmental, and psychosomatic studies to dissect the causes, diagnosis, prevention, and cures of human diseases 3 (NIH, 2018).
The NHS (United Kingdom)
The NHS in the United Kingdom is the leading health organization responsible for providing comprehensive social healthcare guides to improve the health of their citizens. They provide thousands of validated resources to improve people’s experience with them; help people make the best choices about their health, care, and well-being; and reduce pressure on active frontline services in the United Kingdom. The NHS holds the responsibility to provide U.K. citizens with an engine of safe and reliable health resources that are made to fit their users’ needs, prioritizing transparency and accuracy, to prompt people to take the right action at the most appropriate time (NHS, 2019).
In the section that follows, we examine the privacy policies of these health organizations related to the roles and actions articulated in this section.
Privacy Policies
The CDC and the NIH (United States)
The CDC and NIH follow privacy policies enforced by the Department of Health and Human Services to meet the appropriate federal requirements that ensure the practices being advocated on their online platforms are citizen centered. The Department of Health and Human Services states that all new federal digital projects must satisfy the Digital Government Strategy requirements which employ the use of government-issued information to be accessed anytime, anywhere, and by any available device to provide consistent access across all federal agencies (U.S. Department of Health and Human Services, 2023b).
The CDC employs their Plain Writing Plan to verify the language used for the organization’s published information is easily understood for public use. The steps taken to utilize this plan comply with the Plain Writing Act of 2010, which, “requires all federal agencies to write plainly when they communicate with the public.” Both the CDC and NIH state that they will not disclose, give, sell, or transfer any personal information about visitors unless required by law enforcement or by statute. The data that are acquired and stored by the CDC’s and NIH’s website do not individually identify any persons (U.S. Department of Health and Human Services, 2022).
Any third-party websites and applications that the CDC or NIH collaborate with are assessed to ensure that their privacy regulations are in accordance with HHS policy. The Privacy Impact Assessments (PIA) are completed by Operation Divisions before partnering with each respective third-party agency. All PIA are available to the public upon completion for users to have prior access to the invasive protocols each digital platform engages in (U.S. Department of Health and Human Services, 2023a).
The NHS (United Kingdom)
The NHS works in accordance with the data protections regulations in the United Kingdom to process data that are obtained from users. The NHS upholds transparency when communicating their use of analytic cookies on their site by complying with the Nation Data Opt-out Policy. To reassure the user that the data they are acquiring are being used for the good of health and care, the NHS provides four detailed sections which explain the details of how they keep their patients’ data safe (NHS, 2018).
With a grounded understanding of the rapidly growing medical industry, the NHS editorial content is systematically reviewed for evidence updates, or feedback from users or stakeholders every 3 years or amended immediately if deemed necessary. (The only exception of these content reviewal standards stated by the NHS website is for the “Behind the Headlines” publications, which “provides an unbiased and evidence-based analysis of health stories that make the news.” This content follows a slightly different production process.) The NHS website is owned and funded by the Department of Health and Social Care and does not partake in any form of advertising or acceptance of corporate sponsorship (NHS, 2021).
Regulations for Advice and Feedback
The CDC and the NIH (United States)
The CDC has a collection of 19 Federal Advisory Committees (FAC) that serve as a vehicle to administer recommendations and advice for their published records from a broad range of public health issues between experts and stakeholders. The members of the committees are brought in to help with the decision-making process of the CDC’s efforts and commitment to improving people’s health. The contributions made by these FAC are overseen by high levels of government such as Congress, the President of the United States, and the General Services Administrator (delegated by the President), as well as actively being overseen by the Strategic Business Initiatives Unit (SBI) FAC Management Program.
Those who are appointed to be a member of the 19 FAC, the official CDC FAC Nomination guide states that in order to recruit nominees that are the best-qualified experts and/or are interested in serving on one of the advisory committees, nominees must be U.S. citizens who are free of conflicts of interest. The CDC classifies sources of conflicts of interest by evaluating financial, employment, research, or contract relationship concerns. Generally, those who are nominated must be qualified experts in their field with previous experience in preventing human disease, disability, and injury. Nominees from the general public are considered for candidacy by having non-scientific qualifications that contribute social, community, consumer, or affected population perspectives on the respective committees’ responsibilities. As required by the FAC Act, Committees must be fairly balanced in terms of points of view (CDC, 2022).
The Office of Communications and Public Liaison (OCPL) is made up of nine leaders who oversee communications on the NIH’s 13 communication resource sites and platforms, programs, and activities to the public, the media, and stakeholder communities. OCPL coordinates its activities with communication offices in the NIH’s 27 Institutes and Centers (U.S. Department of Health and Human Services, 2020b).
Public access to records and documents of a FAC board, sub-committee, or workgroup meeting are enforced by the Freedom of Information Act (FOIA) in order for the public to maintain access to records. Individuals can request FOIA records that are under the agency’s possession if not already within the public domain (CDC, 2021a). The Advisory Board is required to make requested records available unless the records are protected to withhold information from disclosure by certain FOIA exemptions. Such exemptions include:
Information that is classified to protect national security, related solely to the internal personnel rules and practices of an agency, is prohibited from disclosure by another federal law, are trade secrets or commercial or financial information that is confidential or privileged, information that, if disclosed, would invade another individual’s personal privacy, concerns the supervision of financial institutions, or provides geological information on wells. (CDC, 2020)
The NHS (United Kingdom)
The NHS creates inventive content by identifying the user’s needs first by testing ideas with members of the public and utilizing their feedback to learn about the strengths and weaknesses of their site and to facilitate improvements. Content is derived from peer-reviewed scientific research and from the direct experience of clinicians, other health professionals, patients, and the wider public. This covers all content, both data driven—directories and comparative data—and editorial. For editorial standards of accuracy and impartiality and for the diversity of opinion, the NHS consults active doctors or specialized clinicians working directly with the health issue under investigation, national charities and patient organizations with recognized expertise, and patients or ordinary members of the wider public who may have been impacted by the health topic or issue (NHS, 2022).
Accessibility
The CDC and the NIH (United States)
The CDC and NIH’s accessibility statement requires a commitment to providing access to informative resources and public records for individuals with disabilities, including motor, auditory, cognitive, seizure/neurological, and visual impairments, that meet or exceed the requirements of Section 508 of the Rehabilitation Act (U.S. Access Board, 2018). Section 508 requires federal agencies to provide disabled individuals equal access to electronic information and data comparable to those who do not have disabilities unless an inappropriate or unnecessary burden is imposed on the agency 4 (U.S. Department of Health and Human Services, 2023c).
The U.S. Government classifies and passes bills to grant funding in various programs and regions associated with CDC public health initiatives. The institution allocates funding based on budgets designated to various states, research initiatives, and public health issues causing major deficits among public health safety. The official CDC website does not state whether they receive sponsorships and or donation-based contributions from third-party, commercial, or private organizations (CDC, 2021a).
To hold its distinguished status as the largest source of funding for medical research in the world, all the research the NIH conducts is held to strenuous standards to promote the highest level of scientific integrity, public accountability, and social responsibility. Just over 83% of NIH’s funding is awarded for extramural research, granted to an estimated 50,000 competitive grants to more than 300,000 researchers at over 2,500 universities, medical schools, and other research institutions across the country. Independently, 10% of the NIH’s budget supports projects conducted by nearly 6,000 scientists in its own laboratories (U.S. Department of Health and Human Services, 2020a).
In regard to receiving external funding from commercial entities or the public, there are some exceptions when it comes to receiving CDC and NIH records that are not deemed to authorize public access. Based upon FOIA requests to have access to CDC and NIH records, there is a fee associated with processing FOIA requests. FOIA divides requesters into three categories:
Commercial use requesters are charged for any search time, document review, and duplication.
News media, educational, or scientific requesters are charged for duplication only, after the first 100 pages.
All other requesters are charged for search time (after 2 hours) and duplication (after 100 pages).
The FOIA provides a link to the department regulations to follow when specifying one’s statement to request a record. If an individual or institution discloses that the record they are requesting is in the public interest, because it is likely to contribute significantly to public understanding of the operations and activities of the organization, they can fill out a waiver form to remove the exponential records processing fee. All the material is otherwise available on the federal agency website free of charge (Financial Crimes Enforcement Network, 2010).
The department regulations link provided transfers to an official U.S. Department of Health and Human Services website stating that the link provided is not found (CDC, 2019).
The NHS (United Kingdom)
The NHS strives to provide “objective and trustworthy information and guidance on all aspects of health and healthcare,” according to the official NHS U.K. website. Seven principles the NHS aim to enforce their ethicality standards for editorials are accuracy, impartiality, and diversity of opinion, accountability, serving the public, taste and decency, privacy, and funding. To maintain authentic, safe, and evidence-based content, the NHS enforces clinical signing-off of their content including peer revision of scientific research (NHS, 2022). All clinical content must be reviewed and signed off by a member of the NHS Digital clinical assurance team, confirming that it is accurate, clinically safe, and has been developed in the light of relevant evidence before it is published for public service. In addition, the NHS provides a source that contains references of peer-reviewed scientific research linked to the content displayed on the NHS digital platforms (via NHS Evidence), or resources used in the development of content are also available on request by contacting the NHS service help desk via
Analysis and Discussion
In this section, we consider the intersectional connections between gender, race, age, and sex to interpret the nuanced complexity of marginalized and disenfranchised communities (Crenshaw, 2017). We deem this vantage point to be critical to observing and analyzing the positive and negative effects of government communication as this position enables us to regard the multifarious components leading to the contemporary lack of health infrastructure. As stated in our introduction, we find that an intersectional lens allows us to understand these limitations of health infrastructure on the disenfranchised citizens and begs the consideration for further research into the impact of reconstructive governmental health communications.
Having presented the three organizations that we have evaluated in terms of their roles as institutions that communicate and promote health, we now address what we consider to be their positive and negative features, which impact the pipeline of information from the organization to the user.
The obligation that these three organizations share in common is the responsibility to preserve the health of citizens by using their vast resources to combat any health risks and threats before they reach the public. The NIH’s interest in providing for medical institutes and medical schools aids citizens by supplying a diverse range of perspectives and advice to favor affected populations and environments. The research that is organized by specific institutions and centers associated with the NIH carries a responsibility of providing expert medical and public health comprehension that is improving the present and future health vulnerabilities among U.S. citizens. The use of public feedback from specific NIH institution digital platforms provides a way to connect with citizens impacted by certain health threats and gain qualitative insight into their real-time experiences, gaining first-person observations to assist researchers with studies to improve U.S. health infrastructure.
The CDC’s role is imperative in providing updated health information to the public. It creates official health policies for state and local governments to adopt in order to ensure the safety of American citizens in their communities. With the abundance of conflicting information from different commercial institutions and agencies through different privatized digital platforms, the CDC maintains federally regulated standards of integrity and accuracy to ensure information prioritizes the best interest of its citizens.
As federal institutions are required by law to abide by Section 508 of the FOIA, their benchmarks for information adaptability provide disabled individuals with alternative methods of access to public records that best fit their communication needs. With an increase in user engagement on online platforms, the NIH and CDC have broad opportunities for gaining users’ trust to be a preferred reliable source to find vital information regarding disease prevention and illness in the United States.
The NHS provides a thorough explanation of how citizens in the U.K. gain access to records and information provided by NHS research. With over 2,000 partnered organizations or digital platforms that supply NHS information to the public, citizens in the United Kingdom have access and exposure to a substantial body of health and medical information about ongoing disease, illness, and illness prevention and treatment. The incorporation of professional insights and correspondence with valuable stakeholders, such as those working with medical care, essential workers, and patients, ensures that U.K. citizens are receiving accurate and ethical information from the NHS. This access enhances consideration of new and ongoing health issues that deserve more investigation and attention if there is a suggested threat to the citizens in the United Kingdom.
Limitations
While reviewing the groundwork that helps each of these organizations carry on their tasks, we found that there were varying differences in how the institution ran in the United States versus the United Kingdom. Additionally in our analysis, we found some actions that were contradictory to the commitment in their mission statements to ensure that the institutions were prioritizing the interest of its citizens.
A main difference we found through analyzing the privacy policies of each nation was the ease of navigating how each organization obtains and uses data. The NHS site provides a minimal number of links and subsections where users can find out why and how the NHS uses cookie analytics, how users can opt-out, and how third-party services use data to improve the NHS sites for its users. The CDC and NIH provide thorough sections on their privacy and data policies, but the details regarding how they use user data to improve their and third-party sites are not designed in a way that is inclusive and easy for users to obtain. There is not an easy way to opt-out of cookie analytics: users are agreeing to the use of their cookie analytics when entering the official NIH and CDC websites. There are plenty of separate links that send users to the websites of other federal agencies (e.g., HHS website) that provide another subset of links and subsections to find comprehensive information about how user data are being obtained and used for the purpose of improving the CDC and NIH websites. If one tries to contact the U.S. federal organizations to ask any further questions about how user data are being used or how to opt-out of cookie analytics, this results in a message that there is currently a higher than usual volume of inquiries and it may take longer than expected to receive a response from these organizations about the matter. Although the information is provided for users by the NHS, CDC, and NIH, they are not adequately complying with their mission statements to ensure that the information provided on their sites is considering their users’ best interests of transparency.
The clear and straightforward layout of the official NHS websites and the thoroughness of search applications allow convenient and easy access to information. The NHS website also provides external links to any regulations or systems put in place that may have similar yet different regulations depending on the country in which a U.K. citizen lives: England, Wales, Scotland, or Northern Ireland. The NHS is an independent government organization that is not regulated by central government officials. This provides citizens of the United Kingdom equality of opportunity to benefits and information provided by the NHS because of their regulated partnership among healthcare and medical providers across the United Kingdom, regardless of geographic region or affected populations.
Differing from the web tracking analytics the CDC and NIH obtain from their web users that do not individually identify any persons, the NHS provides a header asking whether you would or would not like the NHS.gov official website to use analytics cookies. With every new hyperlink that transfers the user to a different page, the user will be asked again if they would or not like the site to use analytic cookies. The cookies the NHS uses are very similar to the ones the CDC and NIH use that do not individually identify any persons, unless the user has consented to give the NHS access to their data to improve NHS sites and communication practices.
The language and vocabulary regarding the organizational mission and content policy, when compared between the U.S. and U.K. institutions, are varied in a couple of ways. The CDC and NIH use vocabulary that conveys the impression of being an abrasive language when promoting their mission statement and purpose as a leading government health agency. The inflection of communication that is preached to their audience is about how they want to protect their citizens from disease in national and foreign waters and is assigning responsibility on U.S. citizens. Being massive and influential organizations like the CDC and NIH, putting immediate attention on how citizens should act to prevent the spread of disease poses its own set of complexities, affecting different sections of U.S. communities across the country in ways: beneficial to some and detrimental to others. This language imposes the idea that there is an equal responsibility that is held by these government health organizations and U.S. citizens to protect the country from current and future health dangers. Although we recognize that it is important and valid that citizens should definitely be following guidelines enforced by these leading health organizations, this is putting an inherent higher responsibility on the individual citizen when there are many communities that lack the resources to properly enforce the safety precautions stated by the CDC guidelines.
Differences between the CDC and NIH compared to the NHS are apparent when facilitating accurate information and funding. The NHS is committed to regulating the information published on their digital platforms to the highest ethical standards to ensure the information being issued is evidence based and benefits the needs of the public. The NHS uses their Digital clinical assurance team which abides by rigorous terms to guarantee its suitability is administered through the seven main NHS principles and maintain peer-reviewed scientific research so that it follows NHS content policies.
The CDC and NIH have similar policies to ensure their digital content and research records are following rigorous content policy to maintain the accuracy of the information they are providing for their citizens. The CDC has 19 different FAC that oversee all research and information being published by the CDC about disease prevention and health care. Nominated individuals must be qualified in their field with experience in preventing human disease, disability, and injury, or if from the general public, nominees must have qualifications contributing to social, community, consumer, or affected populations. This creates an increased risk for bias in the information being published for the public that relies on this information. Qualified advisory committee members may have a greater disconnection with socioeconomic inequities that impacts the health infrastructure of low-income and marginalized communities across the United States. Candidates for FAC are appointed and overseen at high levels of government such as congress, the President of the United States and the General Services Administrator (delegated by the President), as well as actively being overseen by the SBI FAC Management Program. This contradicts some of the requirements to be nominated onto a FAC when there are central government and SBI officials that may not have any expertise in preventing human disease, disability, injury, social, community, consumer, or affected population perspectives when evaluating the running candidates. The ambiguity surrounding the requirements of “fairly balanced in terms of point of view” ostracizes the commitment to prioritize the best interest of the public.
The U.S. organizations claim to use, “critical science methods and provide health information that protects the US against expensive and dangerous health threats, and responds when these arise.” This can cause a routine of unconscious bias based on the resources that are prioritized over others based on the population demographic of citizens, rather than the populations of individuals that are higher risk targets for dangerous health threats. This situation also refrains from putting the emphasis on benefitting their citizens, which would result if the needs of citizens were positioned first. The language being used portrays an interesting power dynamic that emphasizes a great deal of what strategic and scientific tactics are being used to protect U.S. citizens from diseases that arise, and places less emphasis on educating, informing, and providing resources for their citizens to implement impactful behaviors that would lower spread of diseases.
Conclusion
We have discovered that the communication methods that the official NHS, CDC, and NIH platforms offer show a great deal of variation between the U.S. and U.K. institutions. Specifically, in terms of their internal structures and the online presence of abundant health-related, diagnostic, and treatment information. We noted that such offerings are related to how the three institutions attempt to fulfill their roles as health protection agencies with the best interest of their citizens as their first concern.
We identified differences between the stated missions of the institutions and how legislation and governmental controls differ between the United Kingdom and United States. The variations in the substantive content and how the United States and the United Kingdom state health organizations make their content available for their citizens may have a significant impact upon how the public responds to these communication efforts. These differences may also impact how the two countries have succeeded and failed in their attempts to communicate the dangers and compulsory health safety measures to its citizens.
Understanding these discrepancies in the institutions communication methods rationalizes the behavior that certain actions committed by the CDC, NIH, and NHS are not led with the best interest of their citizens at heart. This situation may put innocent citizens, marginalized and disenfranchised communities at greater risk of receiving accurate health resources because of the lack of equitable updated infrastructure by government health organizations. To provide more information on the inequitable results of the antiquated government health communication methods, we propose that further quantitative, psychosomatic, and environmental research be made through an intersectional lens to open the discussion for equitable opportunities for health information comprehension and access to health provisions.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.