Health science popularization service has the attribute of public product
According to survey results, although Wuhan residents have higher trust in the health science popularization services provided by professional doctors or medical institutions, the proportion of community, sub-district offices, and other government departments as the main providers of health science popularization services (35.43%) is much higher than that of medical institutions (20.86%) or media (5.79%). Health science popularization aims to assist individuals and groups in preventing diseases, promoting health, improving the quality of life, and pursuing social public value. It is characterized by universality, public welfare, and fairness, and every citizen has the right to obtain health science popularization services.
According to public economics theory, public goods are the products or services that can be consumed or enjoyed by most people, are non-competitive in their consumption or use, and are not excludable in terms of benefits[9]. They are distinguished from private goods enjoyed by individual consumers and are hostile, exclusive, or divisible. Health science popularization services have the characteristics of public goods enjoyed by all, and they are clearly non-exclusive and non-competitive because they are delivered through platforms such as networks, TV, and community bulletin boards. An increase in the number of people receiving health science popularization services does not preclude others from receiving them, nor does the addition of a new audience for science popularization cause an increase in marginal costs. Concurrently, when one person receives popular health science services, it does not preclude or exclude others from obtaining the same quantity and quality of services, implying that health popular science has the property of public goods.
Between public and private goods, there exists “quasi-public goods”, which are items that include the characteristics of both public and private goods, such as medical services, non-compulsory education, and some infrastructure that requires payment for use[10]. By considering health science popularization services as an example, on the one hand, there is a certain degree of competition in the provision of health science services on-site (e.g., medical consultations, lectures, etc.), and when the number of services exceeds the limit of resource design, the number of venues, service facilities, and human resources required to provide them increases accordingly, and the marginal cost is not zero at this point. On the other hand, certain health science service channels are somewhat exclusive in terms of benefits, such as face-to-face health education in outpatient clinics and wards, where the time required for one patient to receive health education from health care staff may reduce the opportunities for other patients to receive health education. Therefore, health science services fall into the category of quasi-public goods.
As a quasi-public product, health science popularization cannot be provided entirely by the market, while the government, as the main provider, suffers from the dilemma of a single supply and limited resources[11]. To address the issue of whether the government or the market should exclusively provide public health services, Ostrom proposed polycentric governance theory, advocating a new governance model[12]. Polycentrism implies that public goods or services can and should have multiple producers, providers, and processors, producing a three-dimensional model of government, market, and society, in which citizens can make reasonable choices among various products and services according to their own needs. Their relationship is both mutual competition and cooperation. This avoids not only the limited capacity and single supply caused by the government monopoly but the "free-rider effect" caused by excessive privatization[13]. According to the questionnaire survey results, government departments, medical institutions, and media jointly provide health science services in response to the highest proportion of people’s choice, which widens the supply channels and modes of health science services, and paves a realization path to meet the growing demand for diversified health science services. During COVID-19 outbreak, health science services, led by government departments, voiced by authoritative experts, and delivered through online media, were widely recognized by the public. They assisted the public in the rational response to the sudden impact of epidemic, played a role in stabilizing people's minds, and improved the scientific response capacity of the whole society.
The government plays a crucial role in health science popularization, from management to infrastructure construction, policy formulation, and implementation, and has unique advantages in terms of resources, channels, and talents[14]. Experts and scholars play the role of opinion leaders in health science services[15], and media should cooperate with professional medical teams and adopt double-check mechanism in communication mode and content to effectively enhance their credibility and authority[16]. Concurrently, the government's policy support and effective supervision must obtain more power space to play its maximum effectiveness.
The overall supply of health science popularization services is insufficient and unbalanced
With the continuous improvement of China's economic level, people are increasingly concerned about health knowledge and pursue a healthy lifestyle, hoping to acquire a wealth of health science knowledge to guide their daily work and lives. However, according to the questionnaire survey results, only 30% of township residents can often or always obtain necessary health science knowledge in a timely manner. The contradiction between the overall shortage of health service supply and the increasing demand remains prevalent. The coordination between health development and economic and social development must be strengthened[17].
The supply level of rural public goods is an important index to measure the development of rural economy and society[18]. Although the country has recently increased its investment in rural public goods, the main force has been on the economic construction of rural areas and productivity improvement. It is difficult to see immediate returns on some public goods, such as health education and agricultural research because they require significant investment and yield slow results. Some government officials, influenced by factors such as achievement views and economic interests, lack enthusiasm for their provision[19]. In addition, farmers' demand for public goods is expressed through five levels of agency, from central government officials to provincial government officials to township government officials, which not only increases agency costs but also makes it easier for governments at all levels to perform their functions in a self-serving manner, without fully integrating the actual needs of rural people. Finally, this leads to agency failure, resulting in a disconnect or imbalance between supply and demand for rural public goods[20].
According to Health literacy Monitoring report of Chinese Residents (2018), urban residents had a health literacy level of 22.44%, while that of rural residents was 13.72%[21]. The Chinese government should prioritize health education services for rural residents, intensify health science popularization, promote equalization of basic public services in the health field, maintain basic medical and health services of public welfare, and gradually reduce the differences between urban and rural, regional, as well as basic health services and health level between urban and rural residents to achieve universal health coverage and promote social equity[22].
In recent years, under the context of "equalization of basic public health services", the supply capacity of health education directly or indirectly affects the effective performance of public health service functions and the improvement of residents' overall health literacy, and supply capacity construction is critical for overcoming the rural health science popularization service's predicament. First of all, as direct service objects and beneficiaries of rural health science popularization, rural citizens should have the right to decide their health services[23]. Governments at all levels should clarify their own responsibilities in supplying health education, investigating and analyzing the actual health needs of rural people, and creating a bottom-up mechanism for supplying public goods. In addition, the government should strengthen the development of special funds for health science, the marketing operation, the expansion of financing channels, the promotion of multidisciplinary and multisectoral collaborative innovation, the exploration of standardized health science popularization personnel training mode and channel construction mechanisms, the maintenance of a balance between urban and rural public products, and the tilt the development of health science education in rural areas in terms of policy support and financial support.
The interpersonal communication channels of health science popularization are prominent
According to survey's results, WeChat public account (Circle of friends, WeChat public account), as a media platform with a high penetration rate, was selected by the masses as the most important way of obtaining health science knowledge through the network (84.27%), similar to the way of communication with acquaintances(46.9%). Both modes of communication reflect the value of "strong interpersonal communication".
Lazarsfield's "two-stage communication theory" holds that mass communication (primary communication) is more effective in communicating broadly, but interpersonal communication (secondary communication) is more effective at communicating deeply[24]. While mass communication plays a significant role in people's access to information, it is primarily interpersonal communication that leads to changes in attitudes, values, and ultimately behavior [25]. Social media is an important source of information in people's daily lives. In the United States, nearly 81% of teens and 74% of adults use some form of social media[26]. This kind of interpersonal communication mode based on friend relationship is two-way, with timely feedback and high interaction frequency, which can better address people's social spiritual, and psychological requirements.
As mobile internet technology advances, interpersonal communication will unavoidably reconstruct a transmission power system. Using "retweeting", "following", "liking", the public gains increasing control over content selection, to the point where it influences the selection of "first-level disseminators". Such communication features are beneficial, as they encourage the media to raise their awareness of audience service and enhance pertinence and readability of popular science works. However, in the absence of improved supervision and guidance, power promotion of "secondary transmission" will also have negative consequences.
Exaggeration and disinformation can flourish as a result of the mainstream media's unbridled pandering to public tastes. According to the Crowd: A Study of the Popular Mind, "if an assertion is effectively repeated, there is no longer any objection to that repetition."[27]. Interpersonal communication has inherent drawbacks in "checking" network information. Most citizens lack professional training, and their ability to detect rumors is insufficient, making them easily misled by rumors. If a rumor is amplified through interpersonal transmission, it is likely to become general consensus of society, increasing the difficulty of refuting the rumor. In mobile media environment, interactivity and convenience have increased dramatically, and the public does not require too much thinking when making judgments, spreading, sharing, and commenting, nor does it have to bear major responsibility in particular, which has made "emotional catharsis" a widespread phenomenon in the era of mobile media, along with accompanying incidents of "online public opinion violence" events, becoming more outstanding and prone to "moral judgment".
The popularity rate of network health science popularization channel is high, and the trust rate is low
The results indicate that while online media is the most important channel for Wuhan citizens to obtain health science knowledge (85.29%), it is also the least trusted by the public.
According to the 47th Statistical Report of China's Internet Development by CNNIC, as of December 2020, the number of China's Internet users reached 989 million, an increase of 85.4 million compared with March 2020, and the Internet penetration rate reached 70.4%[28]. The structured measurement results of netizens' demands for science popularization in China Science Popularization Internet Data Report 2020 reveal that health and medical care are the largest part of netizens' popular science demand, with approximately 70% overall demand intensity and 60% overall demand width[4].
Contemporary popular science is undergoing revolutionary changes. On the one hand, with the widespread use of mobile Internet, online science popularization is accepted among more audiences due to the characteristics of more convenient information transmission and more diversified communication modes. On the other hand, in the social media era, everyone can become the subject of online communication, and opinion leaders are "ordinary people". This results in mixed content and uneven quality of health science popularization services[29]. To garner attention, some self-publishers place a greater emphasis on presentation and entertainment effect of the content than on the scientific nature of science popularization works, resulting in much popular science works through the Internet having gorgeous and interesting appearance but lacking scientific thought, scientific spirit, and scientific connotation in their essence. Due to the lack of professional knowledge and logical thinking, netizens are easily attracted by "headline party" and are prone to retweet and share false information[22]. In the absence of effective supervision and punishment mechanism, network media has become the least trusted source of health science information.
Health science popularization is a long-term activity to spread scientific and technical knowledge, scientific methods, scientific ideas, and scientific spirit in the field of health to the public through popular science, aiming at cultivating public health literacy and assisting the public in self-management of their health[30]. Its objective is not only to impart basic knowledge and skills for living a healthy life to citizens but also to assist them in developing scientific thinking and conducting health management scientifically and effectively. Critical health literacy is more important than ever in an era of information overload and advanced development, particularly regarding the outbreak of infectious diseases and people's growing expectations for health[31]. Through deductive reasoning, inductive argumentation, and other methods, critical thinking can help people see through phenomena to their essence, forming their own logical thinking and opinions on situations and events that are not easily influenced by emotion, public opinion, or others. Knowledge is constantly updated; even authoritative experts do not claim to possess the absolute truth. People should pay attention to evidence, learn to judge the credibility of different evidence, and set aside the inherent biases and existing positions to examine different opinions.
