Combating Xenophobia in the Covid-19 Pandemic: The Importance of Health Literacy

The emergence of the novel coronavirus, SARS-CoV-2, has caused a global pandemic of the coronavirus disease, COVID-19. Delaying the spread of the virus quickly gained international prioritization; however, the growing cases of xenophobia –– the dislike, prejudice, or fear of people from other countries (Oxford Learner’s Dictionaries, n.d.) –– did not. The prevalence of the virus has been coupled with increased reports of xenophobia in the United States, targeting Asian and Asian-American communities due to the virus’ reported origins in Wuhan, China. Although this particular type of targeting has occurred in the past, its prevalence is heightened at growing speeds, driven by fear, panic, and embedded historical roots. The increased reliance and use of technology has also allowed misinformation, pseudoscience, and xenophobic ideologies to spread at exponential rates, adding to the plethora of information available for the public to use to draw their own conclusions. Although these issues can be overwhelming, one’s own understanding of health science –– one’s health literacy –– can help mitigate misconceptions and give people the tools they need to navigate and correctly interpret information. An increase in health literacy can ultimately create a downstream effect that combats xenophobia. This consequence is explored further in this paper, which is divided into three primary sections: 1) an independent exploration of health literacy (“Health Literacy”); 2) the importance of rhetoric when discussing coronavirus (“The Rhetoric of Coronavirus Disease 2019”); and 3) a discussion on the interconnectedness of these topics, as well as proposed courses of action for individuals and larger groups (“Discussion”).

Background

The coronavirus pandemic has targeted Asians and Asian-Americans, resurging historical roots of Asian xenophobia in the United States. In 19th-century America, Asian and Asian-American xenophobia was exemplified through the Chinese Exclusion Act of 1882, Immigration Act of 1924, and Japanese Internment during World War II. In a larger context, this highlights the undertones of systemic and institutional racism in the United States (Wardell-Ghirarduzzi, 2020). In the context of a global health threat, a lack of health literacy makes people more vulnerable to xenophobic ideologies, since they lack the knowledge and tools needed to navigate and interpret different sources of information in a science-based context. Additionally, the implications of language become more profound when used against a seemingly unknown threat, making it easy to put fault on a particular population or group of people. Thus, actions can and should be taken in order to minimize the impact of these ideologies. The interplay between the overarching concept of this paper –– health literacy as a mitigation of xenophobia –– is best understood against the historical backdrop of Asian xenophobia in the United States, coupled with a sufficient understanding of the nature of health literacy and rhetoric regarding the coronavirus responsible for the COVID-19 pandemic.

Health Literacy

Health literacy, a social determinant of health, is defined as “the degree to which individuals have the capacity to obtain, process, and understand basic health information services needed to make appropriate health decisions” (Centers for Disease Control and Prevention [CDC], 2019, para. 1). These decisions emerge in a variety of contexts, ranging from food purchases to the ability to discuss health topics with a healthcare provider. In fact, a proficient demonstration of health literacy can manifest itself in simple forms such as “understanding how to contact a nurse practitioner, when to call an ambulance, and how to read a prescription label” (Flynn, 2017). Despite its prevalence and importance, nine out of ten adults in the United States lack the skills necessary to manage their own health and prevent disease (Cutilli & Bennett, 2009). Thus, a large portion of the population is easily vulnerable to falsely rooted or incorrect health claims made in the media, which can ultimately lead to misinformed and otherwise dangerous practices. In the coronavirus pandemic specifically, inaccurate or outright wrong attempts to prevent and treat coronavirus such as swallowing or gargling bleach (Johns Hopkins Medicine, 2020), spraying alcohol or chlorine all over the body, and taking antibiotics (World Health Organization [WHO], 2020) have been concerns vehemently discouraged by public health officials and major global industry leaders (Rogers, Hauser, Yuhas, & Haberman, 2020). During the pandemic’s early stages, when minimal information about the virus was known, people were left drowning in a sea of mixed information, unable to keep themselves afloat because they lacked the tools to discern accurate and inaccurate information. The COVID-19 pandemic has illuminated the shocking gap in health literacy and the subsequent consequences that can emerge. In such a case, however, it is important to remember that minimal information is not equivalent to no information at all. An elementary understanding of microbiology and human anatomy/physiology, for instance, can be instrumental in guiding people away from false claims rooted in vague scientific fact or outright incorrect information.

Furthermore, a lack of health literacy can instill fear and panic, particularly among people that are unfamiliar with the scientific origins and trends of such occurrences. Such individuals are especially susceptible to the consequences of “fear mongering,” the intentional spread of exaggerated information designed to arouse public fear (Somvichian-Clausen, 2020). In such cases, which has been historically consistent with the 2014 Ebola crisis and 2009 Swine Flu outbreak, it is evident that the cultivation of public fear can create biases that have long-term consequences. In the coronavirus case, the initial association between coronavirus and China has placed a discriminatory light on them and the greater Asian population in the United States and around the globe. The propagation of fear can be slowed with an improvement in health literacy, which would give people better context and understanding in order to reject or accept what is presented in the media.

Misinformation and telecommunication. The ability for information to rapidly spread over the internet, however, presents challenges when dealing with surges of misinformation. With sharing capabilities streamlined through social media, websites, apps, etc., it has become much easier for rumors to spread quicker and to wider audiences compared to any era prior (Somvichian-Clausen, 2020). Although such misinformation includes inaccurate health claims, false rumors and assumptions about racial populations can emerge as well. Consequently, such presence in the media can be so persistent that it becomes too late and far too difficult to remove from national consciousness.

The most striking example of the lingering effects that comes with the spread of false information is the notion that the coronavirus was spread by the consumption of bats in China. When the virus began to gain international attention in January 2020, a viral video of a young Chinese woman –– allegedly in Wuhan, China –– eating a bat with chopsticks began to circulate across the internet. Aided by promotion from popular bloggers and media outlets such as Daily Mail and RT, as well as reshares over numerous social media outlets, the video went viral and rekindled previous narratives about “the supposedly disgusting eating habits of foreigners, especially Asians” (Palmer, 2020). In response to the video, thousands of users began to criticize and blame “dirty” Chinese eating habits for the spread of the virus. In fact, the assumptions made about the video were false, as it actually depicted the host of an online travel show eating a dish in the Pacific island nation of Palau in 2016 (Palmer, 2020). In the following months, as scientists began to gather more accurate information about the virus, the lingering bias that Chinese food practices caused the coronavirus continues to persist. In the United States, where discrimination and prejudice is historically common, the quick rekindling of these ideologies during the coronavirus outbreak illuminates the fact that such ideals continue to persist.

A better understanding of health –– that is, an improved sense of health literacy –– equips an individual with the ability to effectively analyze and discern information. Although this skill has the best application in the direct context of health-related decisions, it can also be used when navigating through other media sources. The ability to critically assess information not only helps an individual mitigate the spread of false information but can subsequently suppress persistent xenophobic ideologies as well.

The Rhetoric of Coronavirus Disease 2019

In the context of the coronavirus pandemic, one of the most applicable forms of health literacy comes with a basic understanding of coronavirus itself and utilization of appropriate language in reference to it. The novel coronavirus, SARS-CoV-2, is part of a larger family of coronaviruses known to cause respiratory infections, including the common cold, Middle East Respiratory Syndrome (MERS), and Severe Acute Respiratory Syndrome (SARS). SARS-CoV-2 is related to its predecessor SARS and causes the coronavirus disease known as COVID-19 (WHO, 2020). The pathophysiological components of the virus have similarities to its viral precursors, prompting a wide range of discussion as additional information is discovered in such a rapidly-changing situation. The nature of discussion, which ranges from everyday conversation to national press, sheds light on the importance of utilizing correct vernacular when referring to the virus. The conventions used to name viruses and diseases are intentional, and referring to SARS-CoV-2 and COVID-19 is no different. These endeavors act as a continuous effort to comply with WHO nomenclature regulations, which are set in place in order “to prevent the use of other names that can be inaccurate or stigmatizing” (Healio, 2020).

Furthermore, language can affect the way in which stereotypes, biases, and xenophobia are propagated and maintained. It is the primary mode for expression and communication, and even subtle changes can influence the way in which socio-cultural constructs are presented and perceived (Stanford News, 2019). Thus, the rhetoric involved in communicating information about the virus has the potential to perpetuate and prevent xenophobic behaviors. When referring to SARS-CoV-2, terms such as “China virus,” “Kung-Flu,” “Chinese coronavirus,” and “Wuhan virus” have been used by individuals and national leadership in the United States, enabling legitimization of negative treatment and stigmatization towards Asian communities (Wardell-Ghirarduzzi, 2020). Numerous reports of racist actions directed at Asians and the Asian-American community have been documented in conjunction with the growing reports of coronavirus cases (Yan, Chen & Naresh, 2020). However, an understanding of the nature of viruses supports the fact that anyone ––regardless of race, ethnicity, or nationality –– can be affected, yet the outbreak’s initial association has created a deep-rooted bias that keeps Asian populations vulnerable to verbal and physical abuse. Consequently, this has allowed xenophobia to flourish, instigating racism and racist actions against Asian and Asian-American communities on the local and national scale.

Local and National Impact. Incidents of verbal and physical assault have been experienced by Asian and Asian-American communities across the United States both locally and nationally. In a Los Angeles subway, for example, a man singled out a Thai-American passenger by verbally abusing him with inappropriate comments and assertions that “every disease has ever come from China… because they’re [expletive] disgusting” (Yan, et al., 2020). Similarly, in New York, a woman was attacked and hit on the head in the subway station, with reports stating that the victim was called a “diseased [expletive]” during the incident of physical abuse. On a national level, inappropriate language has been used by government leaders, creating growing tensions between national leadership and the general public. A particular example comes from President Donald Trump's consistent use of the term “Chinese Virus” in national press conferences. Although the World Health Organization officially named coronavirus and coronavirus disease SARS-CoV-2 and COVID-19 respectively, Trump continued to use the term, defending its use in a press conference by simply stating that “it comes from China.” (Los Angeles Times [LA Times], 2020). Despite the seemingly innocent claims, the continuation of such language is indicative of “renaming [that] is highly politically charged and motivated” (Samuels, 2020). Furthermore, this type of rhetoric can illuminate the lack of cultural awareness that is surging in such a situation. When Trump was questioned on whether he thought a White House official’s use of the term “Kung-Flu” in reference to COVID-19 put Asian-Americans at risk of various verbal, physical, and socio-cultural threats, Trump claimed that Asians would likely agree with its use (The Hill, 2020). Clearly, a cultural divide becomes more apparent, evidently shaped by the simple use in language.

Despite Trump's insistence on the term, however, some White House officials have spoken up and publicly disagreed with such sentiments. Shortly after Trump’s defense of the term, the chairwoman of the Congressional Asian Pacific American caucus stated that Trump’s continued use of language is dangerous to Asian Americans, especially in times of heightened xenophobia (Stracqualursi, 2020). Furthermore, the CDC (2020) has actively encouraged the reduction of stigma, pointing out that targeted groups may be subject to social avoidance/rejection, physical violence, and denials of healthcare, housing, or employment. Such cases have put the mental and physical health of Asian communities at risk, especially as fear and misinformation significantly increased the reports of racist acts directed towards Asian communities (Li, 2020). However, being cognizant of the wider consequences of language’s use can help increase awareness of the importance of health literacy, ultimately influencing the way in which such situations are perceived.

Discussion

It is clear that health literacy is a major theme when it comes to the understanding, discussion, and overall consequences in the context of a pandemic. Misinformation, the carrier of xenophobic ideologies spreading in conjunction with coronavirus, can be inoculated with an improvement in health literacy. Such an improvement consequently equips individuals with the ability to identify and discern sources of media, which can help mitigate the spread of information tied to and associated with xenophobic beliefs. If left unchallenged, individuals will engage in activities –– both intentionally and unintentionally –– that can ultimately put themselves and others at risk by supporting the spread of misinformation and negative socio-cultural ideologies. Thus, various individual and collective actions can ultimately mitigate the spread of xenophobia.

One of the best ways to help reduce the consequences of xenophobia is to reduce the spread of misinformation, especially in a situation that scientifically supersedes race, ethnicity, and nationality. By using approved and accurate descriptors, as well as sharing information from credible sources, people can help suppress the perpetuation of xenophobic ideologies. Such credible and verified organizations include the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), and National Institutes of Health (NIH), trusted by international and local governments set in place in order to study, track, and treat infectious diseases. Identifying trusted sources can easily eliminate websites, blogs, and social media sites that can otherwise spread misinformation. In addition, it supports the credibility of these organizations and prevents the “echo chamber effect,” characterized by the viral spread of opinionated and polarized sources (Törnberg, 2018). However, reducing the spread of misinformation is only as effective as the ability to identify it first. The use of technological platforms has allowed people to receive a variety of information, and thus shifts the challenge to discern, rather than access, information. Health literacy becomes especially important in this context, as a basic understanding of science and health education can help cultivate critical thinking and awareness.

In addition, mitigating the spread of xenophobia during the coronavirus pandemic can be accomplished by taking actions that stand in solidarity with affected populations. On an individual level, this can come in the form of standing up for people being harassed, offering a safe ear for open discussion, and calling out bigotry and hate speech. A prominent example of advocacy on the individual level is the #IamNotaVirus campaign trend on Twitter, which harnesses the internet’s breadth to reclaim Asians’ place in the socio-cultural landscape of America. This campaign shifts the focus back to the common goal of slowing the virus’ spread while emphasizing the shared humanity between Asians and non-targeted populations (I Am Not A Virus, 2020). Furthermore, organizations on a national and local level can release statements that oppose xenophobia while providing members with a safe space to speak about these issues. Numerous Asian-Pacific Islander organizations in local counties have publicly denounced language and actions that perpetuate targeted and stigmatization among the Asian-American community (Lopez-Villafaña, 2020). In addition, nationally recognized organizations such as the National Association for the Advancement of Colored People (NAACP) have also released public statements denouncing the treatment of Asian Americans in the United States, thus urging and demonstrating cross-cultural solidarity (National Association for the Advancement of Colored People [NAACP], 2020). Regardless of the means used –– individual or collective –– it becomes important to take action that works to understand and acknowledge the experiences of affected populations. Doing so provides a sense of strength and solidarity while helping to preserve the health and dignity of those affected.

With health literacy, individuals are able to gain a clearer and more effective understanding of the situation affecting Asian populations across the nation. This can be cultivated through a variety of means. On a personal level, steps such as asking questions, understanding personal medical history, and being honest with a healthcare provider can help increase one’s individual awareness and understanding of their own health condition (Feintuch, 2018). In a wider context, understanding what steps to take in order to navigate health information can help an individual control their exposure to information. When searching online, for instance, proper evaluation of a health website can occur by considering features of the site such as its purpose, original sources of information, and chronological relevance of the material (National Institutes of Health, 2011). Thus, by engaging in the active improvement of health literacy, one can expedite one’s own ability to discern, interpret, and apply health information.

Conclusion

In the context of a global health pandemic such as COVID-19, sufficient understanding of its origins emerges as one of the best ways to take action against its health-related and socio-cultural consequences. Such an understanding manifests itself as health literacy, and acts as a common thread between the ability to discern information, utilization of accurate rhetoric, and effectiveness of standing in solidarity with targeted communities, ultimately mitigating the xenophobic ideologies emblematic of the United States. Health literacy can be cultivated through a variety of achievable practices that lie on a personal and collective scale; however, the coronavirus outbreak has made the United States’ poor health literacy –– and consequences thereof –– strikingly clear. Moving forward, prioritization must be made in order to improve and encourage health literacy. Although such action can appear miniscule alone, collective action to improve health literacy has the potential to create a multiplier effect that combats xenophobia.

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Author's Note

This paper was supported by the USF Asia Bridge Junior Fellowship Program under the mentorship of Dr. Christopher Laurent.

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References

Bai, N. (2020). Why experts are urging social distancing to combat coronavirus outbreak. Retrieved from https://www.ucsf.edu/news/2020/03/416906/why-experts-are-urging-social-distancing-combat-coronavirus-outbreak.

Centers for Disease Control and Prevention. (2020). Reducing stigma. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/reducing-stigma.html#t1.

Centers for Disease Control and Prevention. (2019). What is health literacy?. Retrieved from https://www.cdc.gov/healthliteracy/learn/index.html.

Cutilli, C. C., & Bennett, I. M. (2009). Understanding the health literacy of America: Results of the National Assessment of Adult Literacy. Orthopedic nursing, 28(1), 27–34. https://doi.org/10.1097/01.NOR.0000345852.22122.d6.

Elassar, A. (2020). One dangerous ‘self-check test’ is circulating on social media. Here’s why you would avoid it. Retrieved from https://www.cnn.com/2020/03/16/us/coronavirus-myths-debunking-holding-breath-10-seconds-trnd/index.html.

Feintuch, S. (2018). Improve your health literacy with these steps. Retrieved from https://www.healthywomen.org/content/article/improve-your-health-literacy-these-steps.

Flynn, H. (2017). Racism as a public health threat. Retrieved from https://medicalxpress.com/news/2017-03-racism-health-threat.html.

Healio. (2020). COVID-19: WHO names disease caused by novel coronavirus. Retrieved from https://www.healio.com/infectious-disease/emerging-diseases/news/online/%7B1cca9ae9-7191-498b-9758-637eab141b71%7D/covid-19-who-names-disease-caused-by-novel-coronavirus.

I Am Not A Virus. (2020). Our story. Retrieved from https://www.iamnotavirus.info.

Johns Hopkins Medicine. (2020). Coronavirus disease 2019: Myth vs. fact. Retrieved from

https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/2019-novel-coronavirus-myth-versus-fact.

Li, S. (2020). “I don’t scare easily, but I am afraid”: The dangers of being Asian American right now. Retrieved from https://www.cosmopolitan.com/politics/a31810912/anti-asian-racism-coronavirus/.

Lopez-Villafaña, A. (2020). Asia Pacific Islander organizations issue statement against hate, discrimination, amid COVID-19. Retrieved from https://www.sandiegouniontribune.com/communities/san-diego/story/2020-04-09/asian-pacific-islander-organizations-issue-statement-against-hate-discrimination-amid-covid-19.

Los Angeles Times. (2020, March 18). Trump calls coronavirus ‘the Chinese virus’ [Video file]. Retrieved from https://www.youtube.com/watch?v=0pjsx94m8qA.

National Association for the Advancement of Colored People. (2020). Civil rights and racial justice organizations denounce discrimination against Asian Americans and urge unity in response to coronavirus pandemic. Retrieved from https://www.naacp.org/latest/civil-rights-racial-justice-organizations-denounce-discrimination-asian-americans-urge-unity-responding-coronavirus-pandemic/.

National Institutes of Health. (2011). How to evaluate health information on the internet: Questions and answers. Retrieved from https://ods.od.nih.gov/Health_Information/How_To_Evaluate_Health_Information_on_the_Internet_Questions_and_Answers.aspx.

Oxford Learner’s Dictionaries. (n.d.). Retrieved from https://www.oxfordlearnersdictionaries.com/us/definition/american_english/xenophobia.

Palmer, J. (2020). Don’t blame bat soup for the coronavirus. Retrieved from https://foreignpolicy.com/2020/01/27/coronavirus-covid19-dont-blame-bat-soup-for-the-virus/.

Rogers, K., Hauser, C., Yuhas, A., & Habernam, M. (2020). Trump’s suggestion that disinfectants could be used to treat coronavirus prompts aggressive pushback. Retrieved from https://www.nytimes.com/2020/04/24/us/politics/trump-inject-disinfectant-bleach-coronavirus.html.

Samuels, A. (2020). As coronavirus spread, some Asian Americans worry their leaders’ language stokes a stigma. Retrieved from https://www.texastribune.org/2020/03/23/texas-politicians-coronavirus-language-could-stoke-stigma/.

Somvichian-Clausen. (2020). The coronavirus is causing an outbreak in America –– of anti-Asian racism. Retrieved from https://thehill.com/changing-america/respect/diversity-inclusion/480749-the-coronavirus-is-causing-an-outbreak-in-anti.

Stracqualursi, V. (2020). Congress’ Asian Pacific American caucus chair: It’s dangerous for Trump to call coronavirus ‘the Chinese virus’. Retrieved from https://www.cnn.com/2020/03/21/politics/judy-chu-coronavirus-trump-china/index.html.

Stanford News. (2019). The power of language: How words shape people, culture. Retrieved from https://news.stanford.edu/2019/08/22/the-power-of-language-how-words-shape-people-culture/.

The Hill. (2020, March 18). Trump again defends saying ‘Chinese virus,’ is asked about WH official using term ‘Kung Flu’ [Video file]. Retrieved fromhttps://www.youtube.com/watch?v=CkcxlYYad6o.

Törnberg, P. (2018). Echo chambers and viral misinformation: Modeling fake news as complex contagion. PloS one, 13(9), e0203958. https://doi.org/10.1371/journal.pone.0203958.

Wardell-Ghirarduzzi, M.J. (2020). Racism against Asians during COVID-19 [Google Slides]. Retrieved from https://docs.google.com/presentation/d/11xnFP4aUAbHTw31ZOuLRMBJkf6sMWS2o0GoMuqFbZ9Y/edit#slide=id.g83fd3d91b9_0_24.

World Health Organization. (n.d.). Coronavirus disease (COVID-19) advice for the public: Myth busters. Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters.

World Health Organization. (2020). Q&A on coronaviruses (COVID-19). Retrieved from https://www.who.int/news-room/q-a-detail/q-a-coronaviruses.

Yan, H., Chen, N., and Naresh, D. (2020). What’s spreading faster than coronavirus in the US? Racist assaults and ignorant attacks against Asians. Retrieved from https://www.cnn.com/2020/02/20/us/coronavirus-racist-attacks-against-asian-americans/index.html.