Original Reporting

Help, warn, guide: How communities respond to public health

A year of online engagement with Michigan health departments found that people responded not only to what departments communicated about, but to the role they played: helping people access services, warning about risks, or acting as an authority.

The story

Health departments do much of their public communication online, where criticism can feel loud and constant. A single post can draw dozens of angry comments, making it difficult for communicators to know whether a heated comment section reflects the broader response to a message or a vocal subset of commenters.

A qualitative analysis found that topic alone did not explain how people responded to health department posts. The role a health department played in its message also mattered. A post helping people access vaccination services, for example, could generate largely positive responses, while a post from the same department taking a position on vaccine recommendations could spark significant debate.
Across 11 health topics, analysts identified three recurring roles in health department communications: helping people access services, warning about health risks, and acting as an authority on an issue. Each served a different communication purpose and was associated with different patterns of online response.
Looking at messages through these roles offers health departments another way to interpret online engagement and plan future communication. Rather than focusing only on the topic, departments can also consider how people may respond to the role they are playing: providing a service, communicating risk, or acting as an authority.
THE MESSAGE

The three roles were associated with distinct patterns of public response

Health departments communicated in three recurring roles, each serving a different purpose and drawing a different pattern of response. Select a role below to explore how each appeared in health department messaging.
The service provider role

“We can help you get or do something concrete”

In this role, health authorities communicated about the services they offer, how to access them, and how those services can help the community.

Illustrative paraphrased examples

Health Department

Hearing and vision screenings help children get ready for school. To schedule an appointment, call our clinic.

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Health Department

Used sharps? Pick up an approved sharps container at one of our clinic locations at no cost. When it is full, bring it back for safe disposal.

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Health Department

The 988 Suicide & Crisis Lifeline is available anytime. Call or text 988 to connect with support.

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Across local and state health department posts, service and risk roles appeared at nearly equal levels, accounting for 41 percent and 40 percent of posts, respectively. The authority role was less common at 19 percent and appeared primarily around key policy moments, politicized issues, or when false narratives were spreading.
The response

Public response differed across the three roles

When analysts examined how people engaged with and responded to health department messaging, distinct patterns emerged across the three roles. People appeared to judge health departments against different expectations depending on the role they were playing: whether they provided useful services, communicated risks credibly, or acted as a legitimate authority.

These patterns appeared across health topics and in both expressions of support and criticism, offering a more nuanced view of how people evaluated health departments.

Different perceptions for different roles

Select a role below to explore the underlying questions that drove public support or criticism. 

Message framing

“We can help you get or do something concrete.”

Underlying question

“Are they delivering useful, accessible services?”

Support sounds like

“They provide services that meet our needs.”

Criticism sounds like

“Their services are hard to access, unfair, or wasteful.”

“This service does not align with my values.”

The same patterns also appeared in conversations beyond health departments’ own posts, including discussions initiated by community members and responses to local media coverage of health department messaging. Across these conversations, people similarly evaluated health departments based on the role they appeared to be playing and how well they fulfilled it.

ENGAGEMENT PATTERNS

How did engagement vary by role?

Across both state and local posts, people reacted far more often than they commented, including on sensitive or politicized topics. Positive reactions were common across nearly every topic, while comment sections tended to skew more critical.
Service posts generated the least engagement of the three roles, but responses were largely positive and practical. People liked posts, tagged friends, shared information with someone who might need a service, or asked questions about how to access it.

Average engagement by role and type

Average engagements per health department post, split by engagement type.

Service provider
Risk communicator
Authority
REACTIONSCOMMENTSSHARES

Source: Infodemiology.com analysis, 2026. Note: Engagement metrics cover over 200 state and local health department posts on Facebook.

Risk posts drew more engagement than service posts. Reactions remained largely positive, while posts were also frequently shared. Unlike service posts, however, risk messages prompted more debate, questions, and personal stories in the comments.

Authority posts generated the most contentious responses. At the local level, they drew higher average engagement than service or risk posts despite being relatively rare. At the state level, risk and authority posts both drew high levels of engagement and contention, possibly reflecting the state’s role as a source of evidence and guidance during risk events.

Reaction types by role, on average

Share of all reactions on posts in each role.

Service provider
Risk communicator
Authority
LIKELOVECAREHAHAANGRYWOWSAD

Source: Infodemiology.com analysis, 2026. Note: Engagement metrics cover over 200 state and local health department posts on Facebook. Reactions are shown as a share of all reactions on posts in each role.

PUBLIC PERCEPTIONS

How did people respond to each role?

Select a role below to explore themes in public perceptions in more detail.

The service provider role

Service posts drew largely positive responses when they helped people solve concrete problems

Service posts were best received when they were concrete, local, and action-oriented. In conversations about everyday needs or concerns, people also pointed others toward health department services, especially local ones, as a source of help. Support often centered on access and affordability, particularly when health departments provided services people described as difficult or costly to obtain elsewhere.
Criticism took two forms. Some focused on how services were delivered, including concerns about access, availability, cost, or poor communication. These comments reflected expectations that departments be timely, responsive, and accountable.

More often, however, criticism focused on the service itself. Commenters questioned whether the department should provide a particular service at all, or who should receive support, shifting the conversation from service delivery to the values and priorities behind it.

Illustrative paraphrased examples

Health Department

Used sharps?

Free sharps containers are available at clinic sites. Pick one up, use it at home, and return it for safe disposal when it is full.

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“Wonderful program, I’ll bring mine in soon.”
“Can we drop off full ones that we got elsewhere?”
Local News

Crisis center closing

A community crisis center run by the Department of Health is shutting down after years of service, leaving many residents without support.

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“This place saved my life. Very disappointing.”
“Clinical settings don’t always feel safe, but this place did.”
Community member

Help for a child with lead exposure

My child tested high for lead exposure. Are there any low-income programs or support? I really need help.

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“Call the county health department first. They helped my family apply.”
“The health department was a great resource when this happened to me.”
Community member

Substance use detox help without insurance

I need detox support but do not have insurance. The cost is far more than I can pay out of pocket, and I need help finding options.

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“Contact your county health department’s community mental health crisis line.”
“They know about local resources and can help you apply.”
Takeaways

What the patterns suggest for communicators

“Trust in public health” is often discussed in broad terms. This analysis suggests a more nuanced picture: People may respond differently to the same health department depending on the role it is playing. Understanding those differences can help communicators interpret feedback and decide what, if anything, to change.
Before communicating, consider the role you are playing: providing a service, communicating a risk, or acting as an authority. Each comes with different audience expectations and patterns of response. Identifying the role upfront can help communicators anticipate those expectations and evaluate the response in context.

The same framework can help after a message goes out. Rather than responding to criticism alone, communicators can ask what the response reveals about the expectations people have for that particular role and whether there is something actionable to address. Select a takeaway below to view the full recommendation.