5d. Focus on Social Media: A Panacea for Health Communication or a Threat to Population Health?  

Arguably the most significant development for population health practice over the past decade is the rapid growth of social media outlets. When Dr. Paul McDonald first developed this course in 2007, Facebook was less than three years old, YouTube was two years old, Twitter was one year old, and a number of social networking and sharing sites that are commonplace today (e.g., Instagram, Pinterest, Snapchat) had not yet been invented.

How has the public health sector utilized these new health communication vehicles to promote health and prevent disease? What challenges do public health organizations face in utilizing social media platforms? What do we know about the effectiveness of these initiatives? What are the health impacts associated with the excessive use of social media? I’m going to tackle this disparate set of questions now. Wish me luck!

Not surprisingly, the use of social media to disseminate health-related messages has increased in proportion with evidence indicating the effectiveness of social media in reaching desired audiences.¹ For example, one of your readings illustrates the creative use of Facebook pages to promote safe sex in select populations², though, as was the case for social marketing campaigns using more traditional media outlets (e.g., newspapers, television PSAs), I continue to be perplexed by evaluations that focus on number of people reached as THE key measure of impact (in an ever-changing world, some things remain the same).

Public health organizations have also turned to social media outlets as venues for advocacy. Some of you may recall when Toronto Public Health took to Twitter in an effort to keep Jenny McCarthy, who holds controversial views about the relationship between immunization and autism, from getting hired as a co-host of The View. If you’re not familiar with the backstory, you can find out more from the following video.

To make effective use of social media, public health agencies have had to adjust their organizational cultures. An environmental scan of Ontario health units identified a range of organizational barriers to the use of social media, including:

• the capacity to build and maintain social media channels;
• the risk of “losing control” (by opening up social media sites to staff, allowing staff to engage in conversation/post messages without approval, etc.);
• a need for guidelines and evidence, both internally and from external credible sources;
• staff confidence with social media (i.e., how/when to respond, especially to negative comments; how to use various platforms);
• the role of staff in relation to their current responsibilities;
• lack of comfort around new, less formal tools;
• ability to keep up with technology; and
• addressing privacy, confidentiality, and security requirements.³

All of these challenges can be resolved, with the caveat that the resolution of these issues may take some time, and time is a precious commodity for effective social media discourse. The effectiveness of social media outlets is largely dependent on timely, rapid responses. If it takes two weeks to gain the necessary approval for a 120-character tweet, then the moment of opportunity to make an impact in a health-related discussion may be lost.

What we know about the effectiveness of health communications utilizing social media tends to mirror what we already know about the effectiveness of “old school” print and broadcast health communication appeals. A meta-analysis of 85 studies found that social media interventions that were strongly based in theory had greater impact than those that were not, and interventions encompassing more behaviour change techniques tended to have greater effects.⁴ A Canadian systematic review noted that, while overall conclusions about the effectiveness of social media communications for health issues could not be made due to the paucity of rigorous studies, the evidence available suggested that online appeals were at least as effective as those using traditional media outlets and more cost-effective.⁵

The benefits of social media outlets as means of promoting health have to be balanced against potential health risks. In the decade since the creation of this course, the rapid growth of online social networking has caused profound changes in the nature of human interaction. There is some evidence indicating that not all of these changes may be positive in nature. Several studies have found associations between the prolonged use of social networking sites to symptoms of depression, internet addiction, and low self-esteem, especially in children and adolescents.⁶ And, as you already know, social media provides an all-too-convenient gateway for bullying, cyber-stalking, hate crimes, and the exploitation of vulnerable groups.

Stephenie Sutherland (2018, February 10). STEPHANIE SUTHERLAND: Social Media more dangerous to our mind and body than you think. Retrieved from http://www.alaskahighwaynews.ca/opinion/columnists/stephenie-sutherland-social-media-more-dangerous-to-our-mind-and-body-than-you-think-1.23167477 

In closing, I realize that the title of this section presents a false choice. I may be a bit of a Luddite in some respects, but I accept that social media is here to stay. If I were to dig into the historical archives, I’m sure I could find studies warning about the negative health impacts and challenges associated with automobiles, airplanes, television, microwave ovens, and a myriad of other innovations. The challenge, which we always face in public health, is to maximize the benefits of new technologies while reducing or minimizing potential negative health impacts.