Poor Communication Risks Lives: COVID-19 Lessons Learned in England & Scotland

Public health practitioners have long known that poor communication during health crises risks lives. This is why the WHO and most national public health agencies invest in risk and crisis communication. However, that does not mean it always is effective. In fact, COVID-19 has provided the opportunity to better understand what can go right and wrong in strategic communication efforts to prevent avoidable deaths and illnesses. This case study explores the relative communication failures in England and relative communication successes in Scotland by comparing the social media engagement approaches from each country throughout the pandemic. This research with my co-authors Grace Omondi and Sophie Hillier has been published in a special issue of the Journal of Visual Political Communication. These findings were also presented at a WHO workshop for the Western Balkans in Tirana, Albania.

Though it is not always apparent outside of the United Kingdom, the UK is comprised of four separate nations – England, Northern Ireland, Scotland, and Wales—and a number of policy areas, like health, are devolved to each of the member nations. Throughout the COVID-19 pandemic, though both English and Scottish COVID-19 death rates were higher compared to Europe; however, England’s were significantly worse than Scotland’s despite sharing the island and a similar set of COVID-19 policies. One of the notable differences was how the two governments communicated with the public throughout the pandemic. While English and Scottish politicians and health experts communicated on a daily basis, both campaigns relied the visual messages available in the media, during press briefings, and online making the campaigns visual arguments for self-protective behaviors.

The bottom line is that we know how this story ends England had significantly more deaths per capita compared to Scotland – but we don’t know how we got there. One of the challenges in comparing different national health campaigns can be dissimilarity in culture, language, social, and political systems. Additionally, within the context of the COVID-19 pandemic, there are challenges in comparing radically different material responses to the pandemic (e.g., health policy implemented).

However, given England and Scotland share a three-century national history, language, an overarching political structure in the British government, and had similar devolved policy approaches to the pandemic, they provide the opportunity to directly and meaningfully compare divergent communication strategies. Therefore, we use this comparison between English and Scottish government response to COVID on social media to directly evaluate the impact and importance of political and health communication during pandemics focusing on the combined use of visual and textual information to communicate.

So, what can we say about this? We started with the conclusion of the story because we know that in a per-capita comparison Scotland has simply performed better not only with a comparative death rate but also daily case rate comparisons and hospitalizations.

There are a lot of possible factors contributing to this; however, when we look at the role of communication and visual communication – previous research very clearly indicates that effective communication saves lives and ineffective communication can cost them.

After reviewing the communication in this project and living in England during the pandemic – it seems clear that the poor messaging, themes, and approach in England contributed to its death toll and by comparison we see a different story emerge in Scotland, so there are four insights we can take from this comparison.

First, governments need to think about visual branding to create familiarity, consistency, and trust in the messaging. Scotland’s messaging may not have always been as visually dynamic as some of the messages from England, but the consistency and simplicity in the visuals made it easier to focus on the content. Part of the branding is also using and re-using messages. Scotland tweeted about 600 more health-related messages across the pandemic, but England had a meaningfully larger number of individual images. Branding isn’t just about the consistency of look and feel but ensuring each message used has optimal effectiveness, which in social media means that one-shot at being seen isn’t enough.

Second, both good visuals and good text are needed. One of the core weaknesses in England’s self-protective messaging was the utter lack of contextualization or explanation of the visual message recommendations and lack of follow up information with a link. Moreover, the comparative use of images rather than short video clips means that less information was being communicated by England in almost every message.

Third, the negativity in England’s messaging was astounding during the second wave. The focus on fear-based messaging when we were months into a pandemic which had claimed 100,000 lives in the UK would have suggested that people were already aware of risk and fear. But it wasn’t just the fear – it was the negativity from the compliance messaging that seemed to create the conditions for psychological reactance. Even though not all of the messages were negative, the positive ones were drowned out by volume. Scotland’s messaging remained positive, supportive, and like the government was having a conversation with its people and not admonishing them or trying to make them more afraid.

And we come back to the final insight which is to remind that there is significant documentation to suggest that negative messaging costs lives. This study doesn’t provide direct evidence but it provides a pretty good clue.