How to trust public media again with Jessica Malaty Rivera

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2:13This is TEDHealth, a podcast from TED. I'm Dr. Shoshana Ungerleiter. I'm a board-certified practicing internal medicine physician, and I'm your host for today's show. Most of us make dozens of decisions every day based on information that we didn't gather ourselves. We rely on other people to interpret the world for us, especially when the subject is complicated, uncertain, or personal. Health is full of those moments. Today, I'm sharing a conversation I had with epidemiologist and science communicator Jessica Malati Rivera at Aspen Ideas. We talked about how trust gets built, how it breaks down, and what happens when the systems delivering information make it harder to know whom or what to believe.

3:01Jessica helped policymakers and the public make sense of COVID-19, and today she studies how information itself can shape health. Then after our conversation, we'll hear a TED Talk from Substack co-founder Hamish McKenzie, who looks at the same question from another angle, how the structure of our media ecosystem can reward attention over trust, and what a different model might look like. Here's my conversation with Jessica Malati Rivera, recorded at Aspen Ideas Health. A quick note to say that we recorded this conversation in an outdoor pop-up podcast studio, so you may hear the buzz of insects or the sound of a plane passing overhead in the recording.

3:41It's the magic of live audio. Jessica, hi. Hi. So we're here at Aspen Ideas, a place where people really come to think out loud about problems that can feel too big to solve alone. I can't think of a better place to tackle the topic of public trust in public health. And you have spent years inside this story. Was there a moment in your life or your career that initially drew you to this topic? You know, I think I, from a very young age, loved knowing things, understanding complex topics. I remember at age nine, just being absolutely committed to my parents explaining like where babies came from, you know, just had to understand systems and how to explain it simply.

4:31So sense-making has always been something that I enjoyed receiving and then learned to do over time. And I think trust is inextricably linked with people's ability to understand complex topics with the nuance and the cultural competence and the historical relevance and everything in between for them to make informed choices for themselves. Yeah. So it sounds like the professional mission came later, but the roots of it may have started much earlier for you. What was your childhood like in your Egyptian-American family in LA? And what did the world teach you before you had the language for it? Yeah, I am very much a third culture kid.

5:07My parents are immigrants from Egypt, and I grew up in Los Angeles, born and raised. So had a very kind of unique amalgamation of cultures. English was my second language. And I have this like funny story of my parents not really knowing my full grasp of the English language until I had translated a private Arabic conversation to a curious neighbor wondering what my parents were talking about. And so the gift of translation and the gift of like explanation, I think was perhaps like an early seed planted in my mind. But it was interesting. There were so many things that were lost in literal translation and lost in cultural incongruence in my household.

5:47I had to explain a lot of things from dating to, you know, not living at home for college. It took me a long time to turn what I observed into empathy for their experience because I felt 100 % like an outsider and 100 % like I was from here too. And it wasn't until I had that kind of understanding of this is a very different world for them, a very different system for them. And they are doing a lot of comparing and contrasting from what it was like back home to what it is here. And so much of it had to do with community. And trust was very, very strong in community. Trust was very strong in people who spoke the same language and who had the same faith and who made personal recommendations for things, whether about health or whether about where to get your groceries.

6:35Yeah. Do you think being the daughter of immigrants shaped the way you communicate science now? Absolutely. I very much am aware of what I look like, that I am not a white male doing this type of work. And I think that has endeared me to a very diverse audience that understands that people who do this type of work don't look all the same and can have different backgrounds. And I lean into that because I think it gives me a type of connection point with an audience that a lot of them do look like me. Yeah. Yeah. I think it certainly does. That idea of trust shaping outcomes seems to show up throughout your own journey.

7:10You started at USC, pre-med, path I know quite well. And then you took a class on public health and human rights. Yeah. And something shifted for you. Yeah. Do you remember the moment when medicine no longer felt like the only answer for you? There were several moments in my senior year at USC. I mean, my parents said that I was pre-med since the first grade. And I really was because I was the first born kid who was really good at math and science. And all science pointed to, well, you're going to medical school. And I certainly could have, but I was so interested in harm reduction and in disease prevention.

7:42And actually, I switched my major from biology. I made my biology my minor to a really new degree there that was a public health degree called health promotion and disease prevention. And I loved the idea of the before illness and the systems that existed that could have made conditions for illness. And I also realized in doing multiple hospital rotations with doctors at the hospital that was adjacent to my high school and volunteer shifts in college that I was very sensitive to people's suffering and pain. And I just didn't think that clinical work would be the right thing for my mind mentally.

8:17I think I could have done it academically, but I just felt emotionally probably would have been too difficult. I remember understanding kind of the social determinants of health and lots of issues in global health and geopolitics that determine outcomes just really, really gripped me. And I wanted to lean into that. Yeah. So I know that you worked at a human rights firm. That is not the obvious step to the weight of becoming an epidemiologist. What did that work teach you about health that you could not have learned, maybe in a textbook or in a lab? I had a very unique job, a job that was unbelievable to a 21-year-old.

8:54And it was essentially an opportunity to go and visit over 20 countries all over Sub-Saharan Africa and Southeast Asia and South Asia, Latin America, to do public health and first aid and CPR training for offices that were working in the field doing things like preventing sex trafficking, preventing bonded labor, preventing all kinds of terrible social injustices, human rights abuses. And I was working with those field staff who had limited access to health care and who perhaps needed to understand ways in which to prioritize things like clean water and vaccination and sanitation and first aid and CPR.

9:32And that field work really, again, reinforced the fact that I was so interested in the systems that create conditions for health. And the data behind it all, too, was something that I really loved learning about. Yeah, what an incredible experience. Wow. So when you look back now, do you see that period as a detour or as part of the foundation? And, like, how did it inform the work that you do today? I think in isolation it seems like a detour. But when I look with a zoomed out lens, it feels like a nonlinear path to the most fulfilling career I could have ever dreamed of. I think that it absolutely made me who I am today.

10:07And I, in hindsight, would never say, oh, that's the way you should do it. But I'm so glad I did it that way. And then almost suddenly, the world handed you a test of many of those lessons that you've learned in real time, right? And so in early 2020, you became part of what turned into one of the most trusted COVID data sources in the country, probably in the world, the COVID tracking project. It was volunteer run. It was urgent, certainly. It was filling a gap that really should not have existed. How did you get involved and how did you realize the importance of this work? So I remember getting the first email in December of 2019 of an undiagnosed respiratory virus in Wuhan, China.

10:47And then in early 2020, there was a tweet from Alexis Madrigal, who was at The Atlantic at the time, basically crowdsourcing experts and people who wanted to help collect the data and make sense of the data. So I DM'd him and put on my hat and said, you know, I have a lot of experience in biosurveillance and in data reporting, and I'd love to help you make sense of it all. And so I got thrown into a slack and very shortly after became the science communication lead, and then the rest is history. Oh, my goodness. Yeah. The power of social media. Truly. It's just incredible. And for so many of us throughout that whole period was so enormous.

11:19What stands out to me is that behind all the data and the decision-making, we're still very human beings carrying an enormous weight. And so COVID was such a difficult time, right, on every level. You became a calm voice for a lot of people, including me, who were scared. And who did you call when you were scared? That's a good question. I called my colleagues. We were all trying to make sense of it all, right? I mean, I think that I might perhaps, and my colleagues included, might have a higher tolerance for how destabilizing and disorienting a pandemic might be because I had been preparing my whole career for this moment, right?

12:02We were working on identifying early indicators and warnings of the next emerging pandemic. And so the friends who were like, weren't you talking about this a long time ago? There was some camaraderie in folks who had been in this space and some mutual understanding of, okay, well, now this is, for lack of a better term, like our Super Bowl. This is our time to like, you know, jump in the field. And, you know, there is a lot of uncertainty. And I think sitting with uncertainty is something that I'm familiar with. And doing that in community with people who have been in that space too was a stabilizing source for me.

12:37We'll be back with more of my interview with Jessica Malati Rivera after a quick break.

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14:31You're known as a data person and for good reason. But I want to ask you about the limits of data. What can numbers help us see clearly? And what do they still miss? They are an incredible tool, but they are not the tool. Humans are still very driven by stories, by anecdotes, by personal experience, by history, by culture, by a variety of other influences. And if we over-rely on numbers, I mean, there is a point in which even data scientists themselves can become a little chart blind and numb to the numbers. because the numbers became so big during COVID that there were moments where you'd have to have this kind of check-in and say, these aren't just numbers.

15:13These are human beings. These are people who are no longer at dinner tables and no longer at family celebrations. And normalizing that, using human language to describe data was incredibly essential because there was a time when it just became too big. I mean, there's a terrible quote about, you know, one person is a tragedy, a million people is a statistic. And you have to bring the human into that story. Otherwise it gets lost on everybody. Yeah. I remember, I think reading, it was in New York Times in the midst of COVID and seeing that million lives lost. And it was just such a heaviness, but it was hard to even wrap your head around.

15:52Truly. That big. And so you now lead work on infodemiology, which is essentially the study of how information spreads and harms health. I want to get underneath the phrase misinformation. We use it a lot. When someone holds on to something false, even something dangerous, what might they be protecting? In a word identity, there is a lot of research that shows that so much of what we believe and who we believe and why we believe these people has to do with the community that we are involved in and the identity in which we use to describe ourselves. And when you start to chip at that or question it, it can be very destabilizing to a person as a whole.

16:39And so there is a lot of emotion and deep personal identity connected to the strongly held beliefs. The stronger that belief, the harder it is to shake that identity question. And unfortunately, if there is a strong grip on one piece of misinformation, There's a very likely strong grip on others, but it's usually because they're part of some sort of community or connection. And we spend so much of our time in echo chambers. Totally. And communities of people that are just like us. What have you learned from listening to people that change the way that you think about false beliefs? That people do change their minds.

17:16I think that there is an incredible amount of learning that scientists can gain in understanding that these groups that may seem obstinate, that may seem anti, are actually an incredibly diverse, wide spectrum of people with very wide personal experiences and beliefs. And we're missing an opportunity when we try to communicate to them or treat them like a monolith. There are so many diverse opinions and legitimate reasons for somebody who might be obstinate or doubtful or skeptical. And I think sometimes what looks like misinformation on the surface is connected to much longer histories underneath.

17:54Totally. And misinformation is an insufficient word to describe so many of the things that we identify as against evidence-based science or against consensus. I mean, sometimes it's revealing an information gap. Sometimes it's revealing curiosity. Sometimes it reveals disinformation, which was targeted to intentionally cause harm and deceive. And so I'm very judicious about my use of that word now because I do think it's almost lost part of its meaning. It feels a bit like a slur or a way to virtue signal about which team you're on. And yes, there is a time and a place and a technical definition for misinformation, but it's not a catch-all as we've used it.

18:34I blame myself, too, in perhaps being too loose with the term in the past. I'm much more precise with it now. Yeah, thank you for that. I think we often talk about rebuilding trust in science, and that's part of this conversation. But trust was not lost in a vacuum. Institutions have lied, excluded people, they've caused harm, sometimes in the name of science. So how do we talk openly and honestly about that history, especially its disparate impacts on diverse communities and still help people make decisions that protect their health today? So much of it is about language. And that's a perfect example of being very precise about how and when you use certain words.

19:13The public health lexicon has been weaponized on both sides as a way to shame and otherize different communities. And I think that a lot of phrases that have perhaps in the past meant something have lost their meaning too. trust the science, trust the experts, vaccines work, vaccines are safe and effective. They're basically word salads at this point with not a lot of weight to them. It requires so much more nuance and explanation to get that message across. And I think that trust is an incredible currency in society that really is the reason why we can do anything. It's the reason why we can sit on these chairs and have confidence that they won't fall down.

19:52It's the reason why we can drink water and not worry that something's going to be harmful in it. It is the undertone of so much of life. And we've taken advantage of it by, I think, exercising way too much authority from fallible people. Humans are deeply fallible. Data doesn't just exist in the natural world. It's all human made. And so when we think about the way in which we present expertise, it's sadly sometimes conflated with authority, infallibility, and absolute certainty. And those things are not why we became scientists. I became a scientist because I was endlessly curious and because there was so much uncertainty and there are more answers to be found.

20:34And yeah, there can be growing bodies of evidence that make it pretty clear that this is like certain science, but I don't operate with certainty as my goal. And I don't think anybody in science should. Agree. So perhaps the challenge isn't just restoring trust, but rethinking what trustworthiness actually requires. And you've said that you're trying to rebuild trust. But I wonder if the deeper question is whether trust needs to be redesigned. What would a truly trustworthy public health system actually look like to you? And what would feel different for a patient or a parent or a community health worker?

21:10I think the way you phrased that is exactly why I'm doing what I'm doing. It's that it's instead of assigning the work to the people who we are expecting to trust, it is putting the responsibility on us to be worthy of that. And a lot of that is doing the emotional work of repair. I think apology is necessary. I think saying what you know and what you don't know is necessary. I think saying we got this wrong is necessary. I don't know how humans can exist in relationship without repair. And there is a relationship between people and science and people and scientists. And unless we are doing that type of work to recognize that it wasn't perfect, we made mistakes, and there probably will be more mistakes in the past or in the future.

21:54But to include people in that journey of learning is going to do a lot more to make us worthy of that trust than to just say, well, trust us because we're smart. Trust us because we know what we're doing. Yeah. I think that idea feels right to me and very ambitious, but also grounded in choices that people make every day. And what is one habit that you wish more of us practiced before we shared or dismissed or believed something? I think about this a lot because I have young kids, and I want to train them to exercise this type of restraint to an emotional regulation. But it's asking, how does this make you feel?

22:32If there is content that is agitating you, that is activating you, that is making you feel fearful, angry, that there was some hidden truth that you don't have access to, it makes you hate a group more or love a group more. Those are all feelings I want you to check in with yourself on first before you react. Because we live in an attention economy with algorithms that incentivize clicks, eyeballs, and strong reactions. And so it forces people to not get past the lead because they see a headline that's triggering. They see a headline and perhaps a lead that makes them feel like they understand the full story and they're quick to share.

23:10They're quick to like. They're quick to send it to somebody else. And I want people to take a beat, to check in with yourself and see, is this making me feel more informed, more curious, or is it making me feel very dysregulated? because you don't want to be sharing information from a dysregulated place in any topic, you know, politics or science. Great advice. And that's maybe a fitting place to end because individual habits matter, but certainly systems and leadership are a big part of the equation. And as I mentioned at the beginning of our conversation, we're sitting at Aspen Ideas in this beautiful space surrounded by people with real influence and resources.

23:46And so as we wrap up, I want to end with this. What is one uncomfortable truth about public health that this audience may need to hear? The uncomfortable truth is that there will always be risk. And I think that humans are really bad at understanding risk. I am also not always good at understanding risk because risk is so personal and it's so subjective. And our work is never to eliminate it. It's to reduce it and to help people live with that discomfort of there will always be a ratio of risk and benefit. And I think sometimes people want to just blow through the risk and say, we've got these panaceas, these silver bullets, whether it be a new drug development, whether it be AI.

24:34And I just think that for as long as we are humans on this planet, risk will always be an underlying consideration. And I don't want people to live in a world where that is ignored or deceivingly washed over because of some innovation. Yeah. And ask all of us to be thinking in more nuanced ways. Yeah. Right. And that's hard. Jessica, thank you. This was such a wonderful conversation. And in a moment, I think when trust can feel so fragile, you reminded us that trust isn't just something we demand. It's something that we earn. So I so appreciate your time and your work. and I'm just honored to get to have this conversation.

25:13Thank you. I had such a great time.

25:17We'll be right back after this quick break.

25:40Shoshana: you money. That's why today's episode is brought to you by Quo, spelled Q-U-O, the business phone system built so you never miss a call. Here's what I like about it. All your calls, texts, and voicemails live in one place, so anyone on your team can pick up a conversation, see the full history, and respond fast. No more, wait, who talked to this customer last? And if you're worried about after-hours leads slipping through, Quo's optional built-in AI agent can answer questions and even book appointments while your team's offline. It's the number one rated business phone system on G2 and over 90 ,000 businesses already trust it to stay reachable.

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27:37Shoshana: That's growtherapy.com slash ACAST. growtherapy.com slash ACAST. Availability and coverage vary by state and insurance plan. Is it just me or are things actually really scary right now in the world of public health? every day brings another confusing headline or yet again, a far-fetched claim. Vaccines are somehow up for debate and parents are scrolling TikTok for medical advice. I'm Chelsea Clinton, an advocate, author, investor, teacher, and mom navigating this insane time right alongside you. I hope you'll join me on my new podcast, That Can't Be True, a show that sorts fact from fiction, especially on issues impacting our health.

28:20Shoshana: From Lemonada Media and the Clinton Foundation, That Can't Be True is out now.

28:36Jessica's point about taking a moment to notice what information is doing to us gets at something bigger than any one headline or health claim. Our reactions are shaped, in part, by the systems deciding what reaches us in the first place. Hamish McKenzie, the co-founder of Substack, has been thinking about what a different media system could look like. One built more around direct relationships and trust, with a little more room for nuance. His talk moves beyond public health, but the connection feels clear. If trust matters so much to the choices we make, what happens when the systems carrying information are designed around something else?

29:18And now Hamish McKenzie's TED Talk.

29:22Shoshana: We're living through the most significant media disruption since the printing press. It's a transformation that explains everything from political polarization to why algorithms now do the jobs of editors. And it's creating a hell of a mess. But I secretly think that we're on our way to something greater than we've ever seen in human history. This is a massive deal, of course, because media systems don't just convey information. They shape how we think and how we behave. They shape our culture. I've spent my career navigating these shifts. As one of the founders of Substack, I help writers and creators make money directly from their audiences.

30:13Shoshana: Before Substack, I was the lead writer for Tesla. I wrote a book about the electric car revolution, and I covered media startups as a reporter. So I've witnessed firsthand how media systems evolve and how they collapse. The arrival of the Internet promised to democratize media. But so far, I think, it has broken more than it's fixed. Yes, social media has given everyone a voice, but it has still concentrated power in the hands of a few. But I see a new system starting to flourish, and I call it the garden. This garden includes a new generation of media platforms that give more power to creators and consumers.

31:02Shoshana: It's coming from places like Patreon, Twitch, Supercast, and then the company I started with, Chris Best and Jiraj Sethi, Substack. It's an ecosystem that gives economic autonomy to independent voices, and it fosters direct relationships that are built on trust instead of just putting everyone at the mercy of algorithms that maximize engagement and advertising revenue. For decades, we all lived in a media world that was kind of like a temple. It was top-down, centralized and controlled by gatekeepers. We had the city newspaper over breakfast, radio for the morning commutes, TV news just before dinner.

31:42Shoshana: and it was a relatively stable system, but it was also rigid. It could represent only a few perspectives, and new voices had to be let in by favor. Well, the internet companies came along, and they sat this temple. Craigslist took the classifieds, Google and Facebook captured the ad markets, streaming services are dismantling television. And now with the rise of social networks, we're in the age of chaos media. where anyone can have a voice, but the power still flows primarily to the platforms. We've gone from catechism to cacophony. And our political culture mirrors this chaos. Opponents are to be humiliated.

32:32Shoshana: Followers are expected to show fealty to specific doctrines and attention of any kind, whether it's positive or negative. wins the day. So we've gone from ask not what your country can do for you to what you can do for your country to dunk tweets and goading salutes. I'm not going to do one of those.

32:59But when you look closely, it is possible to see something new emerging.

33:05Shoshana: And when I look closely, I see the green shoots of a garden. This garden, to put it in somewhat inorganic terms, is a distributed system of independent voices who enjoy economic autonomy. Unlike Instagram or TikTok, where the power mostly goes to Mark Zuckerberg or the Chinese Communist Party, the garden model connects creators directly with their communities. We've seen in history how revolutions like this can take quite a long time to fully unfold. Thomas Edison demonstrated the first practical light bulb in 1879. But it wasn't until the 1920s when electricity started to become common in people's homes.

33:53The missing piece was the electric grid.

33:56Shoshana: And if we look today at our current media revolution, we can see that the missing piece has been a different kind of power. Economic power. This economic autonomy gives creators freedom. Instead of answering to bosses or an advertiser or an algorithm, they can focus on deeply serving their communities. Instead of chasing virality, they can spend all their energy on doing their best work. And in this way, the garden can bring a sense of order to social media's bedlam, distributing the power among the many instead of the few. Let's take a look at some examples of how the garden is already starting to flourish.

34:45Shoshana: Take Crystal Ball and Saga and Jetty. They're the hosts of a nonpartisan news show called Breaking Points. It used to be produced by The Hill and it had the name Rising, but then Crystal is from the left. Saga, who's from the right, decided to go independent. They moved it to Supercast and YouTube, and then to Rumble. Now they make more money from subscriptions and cover a broader range of political viewpoints for an audience of more than a million viewers. Take Caroline Chambers. When publishers spurned her proposal for a cookbook deal, she took matters into her own hands. She set up a substack, because she's a genius.

35:29Shoshana: She called it What to Cook When You Don't Feel Like Cooking, and she grew a community there to about half a million people. They were all based around practical, accessible recipes. So when she did eventually publish that cookbook, it became an instant New York Times bestseller, not because a publisher anointed her, but because of the genuine relationships she had cultivated with her readers. Consider Matt Iglesias. In 2020, Matt left Vox, the company he co-founded, to start a newsletter, which he called Slow Boring. Matt had been a blogger since the early 2000s. He went on and wrote for The Atlantic.

36:12Shoshana: Then he started Vox during the social media boom. But it's with Slow Boring that he's found true independence. Today he writes about what he wants to write for an audience of more than 200 ,000 subscribers and he makes more than a million dollars a year. What these creators share in common is independence from traditional gatekeepers and aggregators. They succeed by cultivating trust, not by gaming algorithms or knowing the right people. So when you subscribe to Breaking Points or you support Caroline's Substack, you're not just paying for content, You're entering into a relationship. The creator knows you're there, they value your support, and they can often engage with you directly in ways that just weren't possible in the old systems.

37:07This garden is about ownership and sustainability and resilience.

37:14Shoshana: When the creators own their relationships with their audiences directly, no platform or algorithm can suddenly cut them off from their community. That sense of ownership translates into a sustainable income that doesn't depend on algorithmic whims or viral trends. And the whole system is more resilient because it's not vulnerable to a single point of failure. If TikTok or Facebook change their policies overnight, the independent creator can continue to live off the value of their relationships with subscribers. This shift has profound implications. In the garden, the media can become less about capturing attention and more about nurturing relationships.

38:04Shoshana: There can be more space for nuance and complexity in a world that increasingly resists both. And in the garden, biodiversity can flourish. There can be many more winners. There can be much better coverage of a vast multitude of niches. And everyone can play a role in shaping the culture they live in. Of course, there are going to be some people who will say, well, this is all just going to lead to more echo chambers. But I think the opposite can be true, because when you network cultural connections, People can move freely between communities and be exposed to new ways of thinking in more moderate environments.

38:49Shoshana: The chaos of our current media moment cannot last. But then no one's quite sure what the new landscape's going to ultimately bring. And that's why our choices today matter so much. every subscription, every share, and every minute of our attention is a vote for the culture we want to flourish. And now we can invest in a system that values deep relationships. We can reclaim our attention from the doom scroll feeds and pour it like water onto the seedlings of a better future. And when we do this, It's not just about getting better content. It's about cultivating a richer and more thoughtful culture, a culture that can face up to the complex challenges of our time, a culture worth subscribing to.

39:49Shoshana: Thank you.

39:58That was Hamish McKenzie at the 2025 TED Conference. Thank you again to Jessica Malati Rivera for joining us. And that's our show for today. TED Health is a podcast from TED. And I'd love to hear your thoughts about this episode. Send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Ungerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lajas, Farah Degrange, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Heilash.

40:43Shoshana: When you think of Monica Lewinsky, you might immediately think about the White House scandal from the 90s. But I think of someone who is so surprisingly and genuinely hilarious. This 27-year-old guy hit on me that evening after my talk. And it was amazing because his pickup line was, I can make you feel 22 again. And, you know, he was cute. So maybe I thought about it for a second. But maturity prevailed. And I was telling a friend of mine this story on the phone that night. And I was like, you're not going to believe what happened to me. And I said, I'm probably the only person over 40 who doesn't want to be 22 again.

41:26Shoshana: That was a snippet from my live interview at TED 2026 with Monica Lewinsky about how she's reclaimed her life in the past 20 years, what we can all learn about shame and redemption, and how to laugh even when things are falling apart. You can listen to our full conversation on the How to Be a Better Human podcast. It might just surprise you.