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Navigating a Synthetic Visual Health Information Environment: Implications of Photorealistic Generative Artificial
Kathryn Heley1, Linnea I Laestadius1, Jeffrey K Hom1
1Kathryn Heley is with the Institute for Nicotine & Tobacco Studies at Rutgers University, New Brunswick, NJ, and the Zilber College of Public Health at the University of Wisconsin-Milwaukee. Linnea I. Laestadius is with the Zilber College of Public Health at the University of Wisconsin-Milwaukee. Jeffrey K. Hom is with the DrPH program at the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Andy J. King is with the Department of Communication and the Huntsman Cancer Institute, at the University of Utah, Salt Lake City.
Abstract:
The rapid emergence of photorealistic generative artificial intelligence (AI) has introduced synthetic visual content into health information ecosystems at an unprecedented scale, lowering barriers to creation while eroding the traditional reliability of visual evidence. Synthesizing perspectives from public health, communication, and psychology, we argue that photorealistic AI-generated images and videos (AIVs) have transformative and destabilizing potential with clear public health implications, creating a visual information environment where long-standing assumptions about visual evidence no longer hold. We reviewed relevant research and identified risks posed by AIVs, including mis- and disinformation, fraudulent medical representations, amplified stigma, and a possible collapse of visual trust. We applied the host‒agent‒vector‒environment (HAVE) model as a strategic framework to map determinants of AIV-related harms and identify multilevel intervention points. Strategic frameworks like HAVE are most effective when paired with a normative, deliberative layer that addresses the ethical dimensions of possible responses. We therefore propose a public health ethics deliberation guide designed to work alongside HAVE, encouraging responses to photorealistic AIVs that are strategically targeted, proportionate, equitable, and ethically grounded. (Am J Public Health. 2026;116(10):1539-1549. https://doi.org/10.2105/AJPH.2026.308675).