It’s often quite easy, but not necessarily useful or fair, to fall into the trap of blaming individuals for some of their choices in life. We continue to witness the unfair attribution of blame and stigma, often funnelled through particular types of media, on individual behaviours deemed “bad”. In the media and some political discourse, negative stereotypes tend to be attached to people undertaking a variety of “bad” behaviours, such as eating too much junk food, drinking too much alcohol, not practicing safe sex or not doing enough exercise. Parents who reject vaccinations for their children are also negatively stereotyped and constructed as bad parents and bad citizens, which simply leads to further polarisation and distrust.

Health professionals threatened with disciplinary action if they spread anti-vaxx messages Read more

Evidence shows that it is very difficult to change behaviour among parents who actively refuse vaccination. Providing the correct information on vaccines improves knowledge but does not improve intent to vaccinate, indicating that simply correcting myths about vaccines in information campaigns or public health interventions may not be effective in changing vaccination behaviours.

The assumption underpinning negative stereotyping is that bad behaviours are simply individual choices, which can be changed via health education and government policy. In other words, if people are educated that their behaviours are health damaging, and they choose to ignore the advice, they are seen as culpable for the outcomes of their behaviour.

In my field of public health, we actively aim not simply to blame people for their behaviours, but rather to understand the social, cultural, economic and cultural reasons that underpin their behaviours in the first place. This approach has been called “the causes of the causes”. We can then advocate for changes to the underlying factors which create the reasons for the behaviours, which moves the focus away from the individual and on to the social and political determinants of behaviour.

Rather than simply blaming vaccine-rejecting parents and carrying on the “anti” and “pro” vaccination stalemate, I am part of a research team trying to understand the reasons why some parents decide not to vaccinate their children, focusing on their trust or distrust in childhood vaccinations.

I am not simply trying to change what I see as the wrong decision – I seek to understand the logic and moral position of parents

The times when we were simply, even blindly, expected to trust people because they were in positions of power has gone. This is not to say that people in power should not be trusted, but simply that people are expected to question such authority, access other sources of information and perform the role of the “informed citizen”. Across many countries and cultures, this unquestioning of power has been somewhat eroded, and in some cases broken. Nevertheless, most of social life could not happen without trust – as humans, we cannot personally perform every function ourselves, and therefore we need other humans to perform those functions for us. There are all sorts of uncertainties and contingencies built into the decision to trust (or not), but trust is ultimately based on cooperation – if we trust, we believe that the other person will do their best for us, and we will cooperate in a social relationship on that basis. Trust is a judgment, not a decision based on facts. We gather as much information as we need and then use that as our guide, but it is not fail-safe. Neither is it based on full information, mainly because we are trusting something which has not happened yet.

Trust is an emotion which is based to an expectation about the future – if you trust a doctor to diagnose an illness or provide childhood vaccinations, you expect that they will be able to do this properly. Our research found that while parents tended to trust complementary and alternative practitioners, they had a distrust in doctors (in general), pharmaceutical companies (en masse) and even science as an institution. The central question for public health around ethical and effective communication with non-vaccinating parents is: if the messenger is distrusted, how do we get the message in an appropriate manner and what message will be accepted?

Anti-vaxxers are taking populism to a new, deadly level | Gaby Hinsliff Read more

All the parents in our research made a conscious and (for them) logical choice not to vaccinate, questioned the science underpinning vaccinations and undertook a number of health-promoting practices for the wellbeing of their children. Parents engaged in an ongoing search for information about how best to parent their children, which for many led to questioning of traditional scientific knowledge. Parents practised health-promoting activities which they saw as boosting the natural immunity of their children and protecting them from illness (reducing or negating the perceived need for vaccinations), including breastfeeding, eating organic and/or homegrown food, cooking from scratch to reduce preservative consumption and reducing exposure to toxins. Parents actively sought to take agency and responsibility back from the state and replace what they regarded as the negative consequences of vaccinating their children with positive consequences of health-promoting parenting.

This lens reframes the act of not vaccinating from being deficit-based (parents doing something wrong) to being assets-based (parents having a particular logic and perceiving their parenting as health promoting).

As a public health academic, I do not wish to promote the decisions of parents not to vaccinate their children, since I fully believe in population-level vaccination programs. However, I am not simply trying to change what I see as the wrong decision – I seek to understand the logic and moral position of parents so that two-way communication can occur in a socially, culturally and ethically appropriate way.

• Paul Ward is professor and head of public health at the College of Medicine and Public Health, Flinders University

• Comments on this article have been pre-moderated to ensure the discussion is on the topics that have been written about in the article