The COVID-19 pandemic, along with other recent health crises, has highlighted the detrimental impact of misinformation and mistrust of health information on health systems. Studies have underscored the negative associations between mistrust and various aspects associated to a health response, including health outcomes, utilization of preventive health services, willingness to receive care (including vaccination), mortality rates during an emergency, perceptions of risks, and overall acceptance of health measures (Lee & Lin 2011, Musa et al. 2009,
Ahorsu 2021, Reiersen et al. 2022, Bollyky 2022, Pian et al. 2021). Understanding what drives mistrust in health information and what possible actions can mitigate or address the impact that this mistrust has on the effectiveness of health emergency response is critical (Mulukom 2022). Given the significant role that trust plays during a health response, it becomes paramount to take a deeper look at what the main drivers of trust in health information are during a health crisis. This research is situated as part of the Rooted in Trust (RiT) project at Internews, which since 2020 has partnered with over 41 local organizations in 15 different humanitarian settings to respond to the unprecedented scale and speed of health-related rumors and misinformation. As part of our project, we have identified that inequity is an important driver of mistrust, particularly for at-risk communities in humanitarian settings.
Inequity has also proven to be an important social determinant of health that can have an impact on health outcomes (WHO, 2008).
A recount of the existing literature shows a significant gap, which this paper aims to begin to address. Some studies have conceptualized information inequality as the lack of access to factual and scientific information and emphasized how it contributes to the rise of misinformation (Mostagir & Siderius , 2022). However, “infodemic”1 management has shown that access to scientific evidence alone does not necessarily curb the spread of health misinformation (Internews, 2020). Consequently, other studies have increasingly focused on structural inequalities and their role as social determinants of health to understand their influence on inequity-driven mistrust and misinformation. These studies have emphasized how societal issues such as structural racism, vulnerability, and discrimination influence marginalized communities’ mistrust of health-related information with impacts on health outcomes (Musa et al., 2009; Jaiswal et al., 2020; Bazargan et al 2021, Rasheeta 2020, Da Silva Et al 2021, Smith 2021).
However, many of these studies have primarily focused on at-risk communities in high-income settings, particularly in the United States. As a result, there is a literature gap when it comes to understanding how inequity-driven mistrust operates for at-risk communities in low-income settings, specifically in humanitarian contexts.
Factors such as unreliable health care systems, widespread poverty and inequality, geopolitical conflicts, post-colonial tensions, and weak institutions may alter the ways in which inequity-driven mistrust operates in those contexts.
Furthermore, existing studies have primarily examined how inequity-driven mistrust influences health behavior, without adequately addressing its impact on “infodemic” management, health emergency response, or humanitarian response.
This paper aims to address these gaps by investigating the ways in which inequity can contribute to mistrust in information among at-risk communities in humanitarian contexts. The goal is to shed light on the potential impacts of this mistrust on health emergency response and “infodemic” management.
To achieve this, the paper provides an empirical account through case studies conducted with internally displaced communities in northern Iraq and indigenous communities in the Colombian and Brazilian Amazon regions.