An Illinois Case Study of Local Health Department Officials’ Reliance on Facebook

By: Nikki Usher, CJL senior fellow, with CJL director Jody Brannon

FINDINGS IN BRIEF

In the growing number of communities that now have little, if any, newspaper, radio, or TV coverage, Facebook has become the dominant means of disseminating local news and public messages. This leaves local public health officials with little choice but to rely on Facebook to communicate with their communities.

To study how dependence on Facebook has affected public health messaging during the COVID-19 pandemic, researchers at the University of Illinois, Champaign-Urbana, in collaboration with the Open Markets Institute, conducted 18 interviews with public health officials representing 29 nonurban Illinois counties [1] during the summer of 2021. The names of those interviewed have been omitted to adhere to university requirements and encourage candor from frontline public servants.

Overall, we found that every public health official interviewed considered Facebook the primary method for disseminating COVID-19 information across their county, largely because of three factors: ease of updates, speed, and reach. Reliance on Facebook, however, created deeply problematic challenges. These included technical difficulties in posting, message filtering by Facebook itself, and dealing with user comments that are often rife with misinformation about the pandemic and online harassment targeted at public health officials.

The interviews raise questions about overreliance on a private, largely unregulated for-profit corporation to deliver essential health messages. Fortunately, state and local officials can take measures to mitigate the damage done to the public interest.

Factors Influencing Efforts to Distribute Accurate Health Information Across Illinois

THE 29 COUNTIES IN THIS ILLINOIS STUDY

Local health officials could once rely on local newspapers, radio stations, and other legacy media to reach their communities. As recently as 2002, Illinois was home to approximately 546 newspapers, including not just large, prominent metro dailies in Chicago, but a rich fabric of small-town publications, according to the Illinois Press Association. Today, the number of newspapers in the state has fallen by nearly half, with rural downstate areas particularly affected. Only 12% of the state outside of the Chicago metro area has access to daily, geographically specific newspaper journalism, analysis of IPA data shows.

Local television coverage of rural communities in the state is also sparse, though a small population center might hear an early morning DJ read headlines, often on a country radio station. Many downstate residents have access only to television news broadcasts coming from distant, often out-of-state population centers.

In Illinois, as elsewhere, remaining local news outlets have typically been stripped to skeletal staffs. Penny Abernathy, a visiting professor at Northwestern University’s Medill School, said even the largest remaining news organizations no longer have reporters who specialize in healthcare coverage. “You hear stories all the time of major state outlets that once had 400 in a newsroom and now are down to 50,”she toldThe Guardian in 2021.[2] “There used to be three people responsible for covering health, and now there’s just one person who’s responsible for covering ­­— if you’re lucky — not only health but a range of other things.”

The arrival of COVID rapidly accelerated the decline of local journalism. Illinois’ 22nd Century Media, publisher of 14 suburban and exurban Illinois publications, closed on March 31, 2020, attributing its demise to “the economic impact of the coronavirus on all small businesses, from which we earn a large majority of our advertising base.” [3] Smaller community newspapers have seen their circulations decline and weekly publishing schedules have made it hard for them to keep up with the fast-moving pace of the pandemic. As local media has declined, Facebook has become the stopgap tool health officials use to reach the public.

Public Health Officials at the Crossroads

 Of the 18 public health administrators interviewed (most employed as public information officers)[4] all said that Facebook was their primary public outreach strategy in the 29 counties covered by their collective offices. The conversations with officials revealed a threefold rationale for using Facebook:

• It’s easier to create and distribute Facebook posts than update county websites.

• Facebook’s collective reach is wider than individual news outlets.

• Posting via Facebook is an expedient way to reach residents when local news cannot keep up with developments in the fast-moving pandemic.

 Public health officials no longer found local news adequate to efficiently inform people in their communities. As one official in an eastern Illinois county said, “Twenty years ago, I’d [have] a good relationship with the radio, TV, and newspaper. Right now, I can’t count on them to get the message out  in timely manner.”

Some communities only get local television and radio news from stations in surrounding states, which can  confuse residents about Illinois’ guidelines. “The dissemination of information is very fractured,” remarked a public health official from the Southern Seven health department, located in the southern tip of Illinois, where the Mississippi and Ohio rivers meet. Residents in that region, about the size of Delaware and which includes Alexander County, an economically distressed area that has lost more residents than any other county in the U.S. in the past 10 years, can receive TV news from Kentucky, Missouri, and Illinois. [5]

Some public health officials also believe that a substantial share of residents in their communities discount some messages conveyed through mainstream media. They point to deep levels of distrust in journalism.  “We tried to avoid news sources all together, just because of the polarization we were dealing with,” a central Illinois public health official explained. “Looking at the demographics and makeup of [the] counties, news sources aren’t always trusted in this region.”

Reliance on Facebook brings substantial challenges to public health officials, however. Unlike a newspaper, Facebook’s algorithm curates content based on predictions about what people want to see, reducing chances for incidental exposure to information and preemptively de-emphasizing critical local information. Thanks to Facebook’s black-box algorithmic filtering, public health messages about masking and the importance of vaccines might show up on someone’s news feed adjacent to anti-vaccination and COVID-denier propaganda.

Some public health officials also report having trouble with Facebook’s settings and the platform’s uneven efforts to halt misinformation. A health department official from a rural northwestern Illinois county recalled how Facebook had marked one of its posts announcing a vaccine clinic as “misinformation.” She said, “Facebook denied us — they said it violated their COVID policy … but how could it?”

In one rural southwest Illinois county, the public health department’s Facebook presence was set up as a “profile,” as if it were an individual person, rather than as a “page.” During the early days of the pandemic, the department landed in what a public health official called “Facebook jail,” and the site went down for about a week, likely because Facebook flagged the public health department’s page as misclassified according to Facebook’s categories. To restore the health department’s Facebook presence, the team had to create a new page. Facebook would not let the department keep or transfer existing followers from its original profile. “We kind of pleaded with them — we already had followers. [We asked], ‘Can we just maintain what was going on?’” But, according to the official, Facebook didn’t care that the department would lose followers in the vortex of the pandemic. “It didn’t matter,” she said. “They wanted the page to be set up appropriately.”

In other cases, departmental turnover has meant that access to passwords and the ability to change a page’s settings are no longer available to the department — particularly if there’s no knowledge about who set up the page in the first place. In Champaign County, the public health administrator and her team did not have full access to their page’s analytics because they did not have administrator privileges. They’ve been unable to get the attention of anyone at Facebook to help them address their limitations. This means that the staff does not have data on the performance or reach of their posts, so it’s hard to know if they need to tweak a message or do additional outreach.

Others have struggled with various settings to moderate comments, including screening out profanity or simply disallowing commenting. One official felt fortunate to know how to adjust Facebook’s page settings to close commenting — no easy task. She explained that others with less facility with Facebook’s back-end controls might not be able to do so easily, if at all. Still others have had to figure out how to add to the growing list of new COVID-inspired profanity to Facebook’s automated blocker; one public health official in central Illinois said she categorized as many as 250 terms as derogatory or profane.

Misinformation and Hatemongering

Another aspect of Facebook that public health officials find somewhat confounding is clarity and adherence to state-level Freedom of Information Act (FOIA) regulations. What types of communication on social media need to be recorded? Are posts and comments covered by the state’s FOIA“electronic data processing records, electronic communications” provision? Do transparency regulations mean that even the most damaging and misinformation-filled comments need to remain visible on public health pages? These kinds of questions, relevant for a relatively new platform still being adopted by public agencies, can stymie administrators.

One county official worried that even hiding misinformation and profanity would be counter to the state’s FOIA requirement. In this case, the official retained everything on the page: hate directed at public health officials; misinformation contributed by COVID deniers and those opposed to vaccinations; profanity; and derogatory attacks on elected lawmakers.

The implication is that in many cases, misinformation is left to fester on the very pages designed to provide the most accurate information to a geographically specific community about its local COVID context and mitigation strategies.

Some public health officials also found themselves under personal attack on their own pages and from community members, both online and offline. As one official in the Peoria region shared:           

“In the height of the pandemic, it got really ugly. People were downright brutal, and I had a lot of haters in the community. My name was thrown out there quite a lot. It was pretty stressful, stressful for my family. ... At that time, the big issue was that restaurants were closed, and there was a local attorney who was representing people very inexpensively and basically saying [the Illinois Department of Public Health] did not have the authority to do what it was doing, nor did local health departments. He really helped to stir up the dissension. He would do Facebook Live periodically, and all his followers would get on there, and I would watch the comments constantly streaming, and it was very negative.”

Another official from the same region relayed her experience:

“You could call them local social media influencers: They would go to their minions and their followers to threaten us, and yes, I truly believe this was stoked … federally, by the person in the presidency [Trump], stoked by Fox News, but we had a local element that played on that … and they took it out on public servants.”

Conclusion

This collection of interviews revealed challenges to the effective communication of public health messages brought on by the decline of traditional local media and the reliance on Facebook as a replacement. Fixing Facebook’s shortfalls is beyond the scope of this paper, but some immediate changes should be implemented to make it easier for public health services  to reach residents in their community:

1. Facebook should create public service announcements that allow state and local officials to bypass algorithmic curation and geotarget local residents for critical lifesaving information and in emergencies.

2. The state of Illinois must change its public records requirements and clarify how public officials should deal with misinformation and abusive comments.

3. Illinois and other states should create a reporting process for online and offline harassment to ensure that public health officials and other civil service employees feel safe in performing their duties.

4. State agencies must provide support for social media outreach, setting clear and consistent standards to mitigate Facebook’s unanticipated idiosyncrasies, which may hinder public outreach.

5. Local newspapers could partner with community members and institutions, such as libraries, community colleges, and religious organizations, to help maintain their websites and digital outreach.

Footnotes

[1] Illinois has 102 counties, the largest of which is Cook County, the nation’s second-most populous at 5.1 million and encompassing the greater Chicago area. Of the 29 counties in this study, the average population is 46,700, according to census data compiled by Esri Demographics and organized by counties per state by HTL Inc.

[2] Robins-Early, Nick, “How anti-vaxxers and ivermectin advocates have co-opted US local news,” The Guardian, Nov. 3, 2021.

[3] Feder, Robert, “Citing coronavirus impact, 22nd Century Media goes out of business,” Daily Herald, April 1, 2020.

[4] Surveyed officials oversaw health communication in these counties: Adams; Bond; Boone; Bureau; Champaign; Clay; Clinton; Cumberland; Douglas; Ford; Greene; Grundy; Henry; LaSalle; Macon; Macoupin; Menard; Sangamon; Stark; Southern Seven (comprising Alexander, Hardin, Johnson, Massac, Pope, Pulaski, and Union counties); Tazewell; Vermillion; and Wayne.

[5] McCormick, John, and Chad Day, “This Illinois County Is Losing People Faster Than Anywhere in the U.S.,” The Wall Street Journal, Aug. 25, 2021. 

ABOUT THIS PAPER

Nikki Usher, a senior adviser at the Center of Journalism, founded the Platforms, Politics and Local News in Illinois project in 2021 while an associate professor at the University of Illinois, Champaign-Urbana. The PPLN-IL initiative. CJL director Jody Brannon contributed research and reporting. Open Markets policy director Phillip Longman edited this paper.

ABOUT THIS research

This paper is part of an alliance between the Center for Journalism & Liberty and the University of Illinois, Champaign-Urbana. In the summer of 2021, students from the communications and political science departments, at the height of the COVID-19 pandemic, explored the impact of social media in Illinois. This Platforms, Politics and Local News in Illinois project is made possible through a Knight Foundation grant to the Center for Journalism & Liberty, which is part of the Open Markets Institute. The center has been a part of the Knight Research Network since August 2019.