Ritual Communication: What Can Public Health Institutions Learn from Twitch Streamers?

By Samuel R. Mendez. July 16, 2023.

Tune into Constababble’s livestreams if you’re in the mood for a variety show. Each week, they talk about science news, read letters from viewers, play recorder solos, and practice the best construction paper choreography on Twitch. If you’re lucky, her drag king persona Milton Mango may even make a guest appearance. This social approach to science communication is a good model for public health in the pandemic era.

Lee Constable, aka Constababble, is a professional science communicator and TV presenter in Australia. Their TikToks for research-based news website The Conversation include evidence and conversations with scientific experts, with the end goal of spreading accurate information online. This informational focus resembles the typical focus of communication in public health. The Indian Health Service, for example, describes health communication as “verbal and written information.” The World Health Organization’s communication framework revolves around providing information and advice. This shapes the way we respond to public health emergencies like the COVID-19 pandemic, as seen in our field’s sudden focus on misinformation.

What is ritual communication? And why does it matter?

Information isn’t the only important aspect of communication. Communication also maintains relationships, identities, habits, and power dynamics. For example, why would you need to say “Good morning!” to your neighbor every day, or tell someone you love them more than once? Through a focus on the transfer of information, these interactions make little sense. No one is sharing any new information, so what’s the point? Clearly a focus on transmission of information is not enough to understand human communication.

So, why does this matter for public health? Across various studies, researchers recommend a variety of transmission-focused ways to counteract the COVID-19 infodemic: education, government transparency, social media outreach, and clear risk communication. While we work to improve our ability to spread accurate information, it’s important to keep in mind the current limits of this approach. Many research teams studied ways to stop the spread of COVID-19 misinformation, finding a lack of evidence that these approaches work overall. This doesn’t mean we won’t find specific methods that work or specific contexts where we can succeed. And it doesn’t mean we can stop addressing inequities in access to health information. But it does mean that we should also consider the ritual aspects of communication that help build emotional and social bonds.

What could a focus on ritual communication look like in public health?

Science communication offers examples of what this might look like for public health. Story Collider is an explicitly non-educational project that highlights the role of science in society through personal storytelling. Survey research with audience members found a few different profiles of audience impact: humanizing science, feeling empowered, feeling like part of a community, and being absorbed in the stories. The science cafe model mixes educational aims and informal discussions with scientists. Evaluations of science cafes in Canada, Wisconsin, and Iowa show how participants process information through existing identities and gain confidence in scientific literacy skills.

Live streaming is an emerging method of science communication that blends education and entertainment with community building. We can look at Lee Constable’s livestreams as a fruitful example. They will stop what they are doing to answer questions from their audience, analyze suggested social media content, and get to know the people watching them. They have special rewards and intermissions people can request via channel points. And they will consider the expertise from people in the audience. They follow a regular schedule and commit to showing up over time. We can contrast this with the approach we saw from Anthony Fauci and Vivek Murthy during the pandemic, which focused on transmission of information, and thus looked more like a typical webinar rather than a typical Twitch stream.

Sure, but what about misinformation?

Through a transmission lens, we might wonder how public health officials will reach people with accurate information in an ever-shifting media environment. Sure enough, public health scholars have been interested in how to create successful health communication in a crowded media environment since before social media entered our lives. Issues in maximizing exposure and assessing the broader information environment were difficult even when access to mass communication was severely limited. How much harder is it today, when 500 hours of video are uploaded to YouTube and 231 million emails are sent each minute? And when millions of social media accounts are sending out automated messages? And when trust in news media is politically polarized?  And when decentralized platforms like Mastodon and BlueSky gain prominence, limiting the reach of information in the face of server- and user-specific content moderation?

It’s important for those of us in public health to remember that we don’t have the marketing budget of Coca Cola or the ability to try to shape communication like a social media company. Through a ritual lens, however, we might instead focus on the strengths of public health professionals and institutions beyond the transfer of information. People don’t just exist online. Communities already benefit from public health institutions. Our response to the problem of misinformation should involve more equitable benefits and more community touchpoints that can build relationships of trust and mutual support.

Where do we go from here?

More than adopting innovations from science communicators, ritual communication in public health might very well rely on tried and true efforts from public health. Community health workers, for example, have shown to improve health management while also working to protect their communities from harm via health institutions. PhotoVoice has proven a useful tool for community advocacy and research and to speak back to health professionals in the face of discrimination. It is important that our field’s response to misinformation does not just involve paying social media companies and marketing firms. The ritual lens of communication reminds us that it should also involve investing resources into communities directly, creating many sustainable touchpoints and interactions over time. It should involve showing up where we can be of service, online and in-person.

Public Health Communication Action Items

Public Health Communication Action Items

Public health institutions focus largely on the transfer of information. But a focus on the ritual aspects of communication can help us build more trustworthy relationships with communities that can withstand future health emergencies.

  • Individuals: Practice having conversations about health topics that focus on understanding other people’s viewpoints and building emotional connections. Engage with media creators in fields outside of public health.
  • Organizations: Create more touch points with communities beyond the scope of education, data collection, or research recruitment. Create an institutional culture of community service, and allow more staff and student time to go towards these purposes.
  • Policy: Create more long-term funding opportunities for patient navigators and community health workers.

Key References

This blog post draws on James Carey’s concept of ritual and transmission lenses of communication.

  • Carey, JW. (1989). “A cultural approach to communication.” Communication as Culture (p. 13-36). Winchester, MA: Unwin Hyman.
  • Pian W, Chi J, and Ma F. (2021). “The causes, impacts and countermeasures of COVID-19 “Infodemic”: A systematic review using narrative synthesis.” Information Processing & Management, 58(6).
  • Janmohamed K, Walter N, Nyhan K, Khoshnood K, Tucker JD, et al. (2021). Interventions to Mitigate COVID-19 Misinformation: A Systematic Review and Meta-Analysis. Journal of Health Communication, 26(12): 846-857.

Stay in Touch with Samuel

You can find Samuel talking about health communication, health equity, and video games: @samuelanimates on Twitter, Twitch, YouTube, Tiktok, BlueSky, and on the scicomm.xyz Mastodon server. 

Samuel Mendez


The mission of the Boston Congress of Public Health Thought Leadership for Public Health Fellowship (BCPH Fellowship) seeks to: 

  • Incubate the next generation of thought leaders in public health;
  • Advance collective impact for health equity through public health advocacy; and
  • Diversify, democratize, and broaden evidence-based public health dialogue and expression.

It is guided by an overall vision to provide a platform, training, and support network for the next generation of public health thought leaders and public scholars to explore and grow their voice.