The five communication failures that undermine every health system — and the US is facing them all at once

When I was teaching infodemic management at the World Health Organization during the pandemic, one principle was repeatedly discussed and validated across contexts: health communication failures are operational threats to health programs and services. They weaken health programs, corrode trust, and compound harm.

There are five key communication failures that undermine operational success, taken from the CDC’s very own Crisis and Emergency Risk Communications manual and training:

1. Mixed messages from multiple experts

2. Information released late

3. Paternalistic attitudes

4. Failing to counter rumors and myths in real time

5. Public power struggles and confusion

These failures accumulate over time. And what we’re witnessing now in the United States is a case study in what happens when all five occur simultaneously, in one of the most powerful and resource-rich countries in the world.

You can see it clearly today:

• The health system is issuing mixed messages, revising guidance post-fact, and grappling with overt political interference.

• The information ecosystem is polluted with sensationalism, outdated science, influencer myths, and increasingly, generative AI errors.

• The public is overwhelmed, navigating confusion, avoiding information altogether, or sourcing guidance from whichever outlet aligns with their values or fears.

In the US, we are watching a profound shift not only in what to trust, but in how people decide what to trust at all.

The New York Times’ useful guide, with a warning

A couple of days ago, the New York Times published a helpful list of where people can go in the US to find trustworthy health information, highlighting resources like the Vaccine Education Center at CHOP, The American College of Obstetricians and Gynecologists, Cleveland Clinic’s Health Library, HealthyChildren.org, and Brown University’s The Tracking Report. The list was timely and I’ve received a link to it several times via different networks. But the most revealing part for me are the comments by the readers, underneath the article.

Hundreds of readers responded, with gratitude for the list, and also with grief, scepticism, and defiance. Here’s what they’ve said:

1. Deep distrust in federal institutions

Many commenters expressed disillusionment with once-trusted sources like the CDC, FDA, and NIH. These concerns were concrete and  informed by specific political developments and personal experiences:

• “Unfortunately, we can no longer rely on our government for reliable, up-to-date health information.”

• “It is appalling that we must view government medical and health sites with suspicion.”

• “Cuts to these programs could affect your day-to-day medical care.”

Some even described the situation as a travesty, linking the deletion and alteration of health data to broader political agendas, including Project 2025 and perceived authoritarian drift.

Implication: Trust has shifted from institutional affiliation (.gov) to perceived integrity and independence. This is a textbook example of "crisis of legitimacy" in health ecosystems that I discussed recently at the Society for Public Health Education (SOPHE) annual meeting.

2. Rise of federated trust networks

Instead of using government sites, commenters described building their own patchwork of trusted sources:

• Cleveland Clinic and Mayo Clinic were the most frequently mentioned.

• Wikipedia came up repeatedly as a go-to starting point, even endorsed by multiple physicians.

• CIDRAP, UpToDate, Science Based Medicine, and Johns Hopkins were highly valued.

• International sources, especially the UK’s NHS and Australia’s health portals, were praised for clarity and neutrality.

This is a real-world validation of a decentralized, federated health information model. People are triangulating across institutions to build personal epistemic ecosystems, a model public health leaders should study and support.

3. Sophisticated scepticism and media literacy

The comments revealed a surprisingly high level of discernment:

• People cross-check PubMed, UpToDate, Wikipedia, and Mayo Clinic, often noting when one source may be biased, incomplete, or outdated.

• Many avoid commercial sites like WebMD due to ad saturation and industry influence.

• Several health professionals (MDs, PhDs, pharmacists) joined the discussion, echoing lay concerns about .gov trustworthiness.

One retired health librarian summed it up: “I used to give workshops about how to select reliable health information… I’m appalled and saddened to realize .gov sites are no longer reliable.”

Others noted how they teach students to use critical thinking instead of relying on domain names like .gov or .edu, This is an example that information equity now includes cognitive agency.

4. Cautious experimentation with AI

AI was a divisive topic. Some were enthusiastic:

• “I turn to ChatGPT for medical information… It’s far more knowledgeable than any doctor.”

Others were cautious or outright alarmed:

• “Using AI as a shortcut replacement is stupid and lazy.”

• “I caught Google AI in a couple of ridiculous errors…”

There’s a pattern here: people are using AI as a first pass, not a final authority. AI is replacing search engines for many, but not replacing evidence-based judgment - yet. Still, the KFF Health Poll confirms that 56% of Americans doubt AI health info accuracy, even while using it.

5. A call for tools, not just sources

Multiple comments proposed practical interventions:

• Print-friendly health info summaries for refrigerators.

• Trust rating systems for health sites.

• More transparent funding disclosures.

• Better AI curation tools—with examples like Perplexity or Gemini for simplifying medical language.

Many noted that while the NYT article was helpful, "this list shouldn't have to exist". That it does is a measure of the scale of institutional collapse and the demand for credible, self-directed navigation tools.

To be sure, NYT readers are not a representative sample of the US public. They tend to be more highly educated, more politically liberal, and more accustomed to seeking out structured information. Yet even within this relatively information-savvy group, we see profound anxiety, disillusionment, and a willingness to turn to non-traditional sources for health information.

This should make us pause.

Because when we overlay this pattern with what we know about how the MAGA movement has reshaped a large segment of the American public’s relationship with health information, casting public health guidance as suspect, expertise as elitism, and science as partisan narrative, the challenges ahead become even more stark.

The US information ecosystem is being rewired for health information,  and the ripple effects will be global

The comments under the NYT article show that people are already adapting amidst the breakdown of trust in the health information ecosystem. They are weaving federated, multi-source, often crowdsourced systems of health knowledge to replace what they no longer trust.

When all five communication failures hit at once (mixed messaging, delays, paternalism, unchecked rumors, and public power struggles) what's left is confusion, but also a starting point. From there, we have the opportunity to build something better, even amid commercial and political forces that disincentivize doing so.

What we need now is a bold reimagining of how health knowledge is produced, verified, communicated, understood, and used. And also what the relationship between public health systems and different communities can be.

Public health leaders must meet this moment, and not by trying to restore broken systems, but by imagining and building infrastructures for health information that support:

• Transparent, independent curation of health information

• Tools for triangulation and critical analysis of health claims

• International and multilingual, but – critically - localized, resource hubs

• Responsible AI-assisted navigation of health information

• Community-led models of health literacy and education

Yet, every bullet point above carries major ethical, evidentiary, and equity challenges. These cannot be addressed easily or uniformly. Implementation will require balancing global connections with deeply rooted local relevance, maintaining public trust across contexts.

The erosion and distortion of health information we are seeing in the US is already beginning to spill over into other parts of the world, even into countries where health information systems and public health authorities have so far remained relatively intact.

We face several interconnected challenges:

• Even in countries with strong health communication infrastructure, crises and emergencies expose weaknesses: when guidance must change rapidly, the cracks in trust and coordination become visible.

• US-based users are already beginning to turn routinely to the UK’s NHS, Canada’s Health Canada, and other international sources for credible health information. This works for general questions, but health guidance will differ between countries, especially during emergencies, because local epidemiological realities, healthcare capacity, and crisis contexts are different.

• In an emergency, guidance must be localized, not imported wholesale. An American relying on NHS pandemic advice, for example, may be dangerously mismatched to their local situation.

Public health and healthcare services must make themselves relevant in these profound changes to the relationship people now have with health information, health systems, and the public health system.

This means public health can't just "push information" anymore. It must build partnerships with communities, co-create trust ecosystems, and show up where people are already seeking information, whether that’s on digital platforms, in local clinics, on Wikipedia, through AI tools, or in new digital community hubs.

The way forward will demand that we think big picture and hyper-localized at the same time.

What could bold ideas for this transformation look like? I don't have all the answers. But we urgently need to start coming together, across disciplines and across borders, to build a health information ecosystem fit for a fragmented, globalized, and crisis-prone world.