Tag: tobacco control

knowledge translationpublic healthscience & technologysocial media

The Fourth Estate of Health and Medicine

Who Will Hold Evidence To Account?

Journalists occupy an important, yet often unacknowledged, role in the health system by providing a dispassionate account of the system’s strengths, weaknesses, and opportunities to the public. It is through journalists that much of the research we scientists and practitioners produce gets communicated to the audiences likely to use them. This fourth estate is also a  place where hard questions can be asked and answered, holding governments, business and the health system itself to account because journalists operate apart from this space, unlike scientists and clinicians. We are at risk of losing this and it’s time to consider what that means for our collective health and wellbeing.

Disrupted Media

The news business is going through a massive upheaval, part of a larger overall disruption in media. Many newspapers are reducing the size of their print offerings, publishing less frequently or ceasing operations altogether.

This reduction in the capacity and size of the fourth estate begs two simple questions: Who will hold health scientists, clinicians, pharmaceutical companies, health product manufacturers, and policy makers to account? and who will tell the stories of science, health and medicine in public?

While we have some activist academics doing great work on influencing broader audiences like policy makers, they are exceptions not the norm. Stanton Glantz, a major tobacco control champion from UCSF who taken to blogging as a means of communicating to professionals and the public directly, is one of these such people. But Stan is atypical and holds a tenured position at a major university, something he’s acknowledged protected him when pursuing issues of evidence withholding from the tobacco companies in the 1990’s and beyond. Many faculty (particularly younger ones) are not this secure and even fewer independently funded scientists are. Academia is changing and not in ways that favour security and stability, which has implications for the kind of stories that get told.

Journalists have traditionally relied on protection from their publisher or producer under the name of journalistic freedom (the fourth estate) as a key pillar of their profession. It’s hard to imagine the Watergate scandal coming to light had Bob Woodward, Carl Bernstein and the other reporters working for the Washington Post, Time Magazine and New York Times not had the resources, stability and support provided by their newspapers . But what happens when these resources are no longer available or there are no institutions to support journalists in serving as watchdogs to hold people or institutions to account for what they do and don’t do?

Are ‘Monkeys in Coats’ A Healthy Story?

It’s been suggested that the Internet will take care of this. Citizen journalists, armed with camera-laden handsets connected to social media will fill the news gap. For example, it was citizens, not journalists, who first captured the story of Darwin the monkey, dressed in a shearling coat, walking around an Ikea parking lot in Toronto that went viral on a global scale on December 10, 2012. This is great for those interested in simian fashions and retail adventures, but the reason it was captured was because the story was obvious and in the face (or at the ankles) of those who told it. (For those of you not familiar with Toronto, coat-wearing monkeys are not typically seen at shopping centres or anywhere around town for that matter.)

Health and medicine is not the same as monkeys wearing coats (no matter what kind of joke you want to make). There is nuance, debate and reason that requires sustained attention and focus that someone with an iPhone and Twitter account is less likely to convey. Reasoned arguments for citizen journalism’s potential suggest it can complement the work of traditional journalism, not replace it. Yet, is this belief in one form (citizen journalism) undermining support for the other (traditional journalism) and serving as a fix that ultimately fails? If free-and-easy content is available, how likely are publishers willing to pay for professional work? Particularly if the choice of stories of one group (e.g., monkeys in coats) are more likely to garner the kind of attention that drives advertising than that of another (e.g., health care financing). Only one of these stories will impact our collective health.

Why does this matter? Trained journalists are required to be good communicators to a broad audience, scientists are not. Clinicians are slightly better, but decades of research has shown it is still highly problematic across areas of practice. This will not be solved overnight, if at all. Scientists and clinicians have told me they are already burdened with enough job expectations and adding knowledge translation skills to that list is asking too much.

As I have argued previously, there is a valued place for synthetics in research: those are who are good at taking ideas and weaving them together into an accessible narrative. Journalists are ideally suited to play or support this role. They do the job that many scientists can’t or won’t do and have better to tools, skills and strategies to do it. They write in a style that is suited to broad audiences in a way that suit those audiences’ needs, not what funders, disciplinary traditions, universities, or scientific peers demand (without evidence that those methods of communication are effective). There are reasons why journalists assess the reach of their work in the thousands and social scientists in the dozens (by citations in their field of practice).

Going Deeper to See Clearer

Although we have more information about health available to us than ever before, this may not be healthy for patients. The potential for those uninformed about medical diagnostics, evidence, and the nature of health itself to make poor choices based on incomplete, incorrect or overwhelming information is high. Further, without the kind of dispassionate examination of evidence in a synthetic manner that is tied to the way in which that evidence is expressed in the world through public opinion, policy making and healthcare practices, we lose a major accountability mechanism and means of informing public discourse.

In October I co-delivered a workshop on health evidence for students at the University of Toronto with the 2012 Hancock Lecturer and journalist Julia Belluz. Julia writes the Science-ish blog for Macleans Magazine and is an Associate Editor with the Medical Post. Julia`s lecture was on the role that social media plays in our health system and how its power to leverage the attention of the masses — for good and ill — is shaping the public understanding of health and medicine often in the absence of evidence for effects of conditions, processes, and practice. The lecture is summarized online on Science-ish beginning here.

Reading through the lecture notes one sees a depth of study that would be unlikely to be found anywhere within the formal health system. The reasons are that it blends evidence with commentary, observation with carefully selected sources, and takes a perspective that seeks to inform a wide, not narrow audience in both practical and intellectually stimulating ways. Taken together, this is a collection of activities that are not within the scope of practice for scientists and practitioners. There are reasons why the greatest contributors to public discourse on many scientific issues has come from journalists, not the scientists who generate the research. They tell the story better.

Malcolm Gladwell, Steven Johnson, Mitch Waldrop, Julia Belluz, Andre Picard and others are a big part of the reasons most of the those who vote to support funding of science, who donate to research-related causes, and fight for policies to keep us healthy know of the research that backs those ideas up.

Imperfect as journalism is, it serves the public when done with integrity. It’s worth spending some time considering what can be done to support the fourth estate so it supports us.

Photo credit: DBduo Photography on Flickr used under Creative Commons Licence.

behaviour changecomplexitymarketingsystems thinking

Marketing Metaphors of Meaning in Complexity

Karl Heyden Eine interessante Geschichte

Metaphors and storytelling are ways to navigate through complex, inter-related ideas in a way that brings coherence and delight to them in narrative form. Stories are not just for children, but a serious tool for bringing complexity to life, making it accessible and usable to a world that can benefit from learning more about it.

Have you ever found yourself curled up in bed with a book that you can’t put down or found yourself up much later than you’d planned because of a TV program or movie you got caught up in? Ever have the same experience with a piece of academic writing? How about a technical report? I’ll bet the answer is yes to the former examples more than the latter (if there is a yes at all to the second two). Books — mostly, but not always, fiction books — magazine and newspaper, articles, poems and even blog posts thrive on a narrative that takes you a journey even if you don’t know the destination. That narrative, if its engaging, has consistency, a tone, a flow and a ‘texture’ that makes it enriching. It is perhaps the reason why so much scholarly writing is so dull: the texture is rather dry and lacks appeal.

Not all scientific articles require such appeal. Indeed, the standardized methods of reporting experiments can be very useful in interpreting results and deriving meaning from complicated interactions. Yet, this application of the standard model of writing from science to other areas is perhaps taking scholarly work to places it didn’t need to go. Or perhaps it is preventing us from going places we need to go.

In terms of complexity, one of those places it needs to go is into widespread discourse on public policy, health promotion, and social program planning. Storytelling and metaphors are one vehicle.

Making metaphors and embodied cognition

A recent Scientific American blog post by explored the role of metaphors in some depth, bringing attention to some of the early work of psycholinguist pioneers George Lakoff and Noam Chomsky in looking at the role of embodied cognition, a concept where a metaphor actually gets integrated into the body (literally or figuratively). In the column Samuel McNerny looks at the history of the idea and the use of metaphor, drawing on interviews, literature and recent research.

As Lakoff points out, metaphors are more than mere language and literary devices, they are conceptual in nature and represented physically in the brain. As a result, such metaphorical brain circuitry can affect behavior. For example, in a study done by Yale psychologist John Bargh, participants holding warm as opposed to cold cups of coffee were more likely to judge a confederate as trustworthy after only a brief interaction. Similarly, at the University of Toronto, “subjects were asked to remember a time when they were either socially accepted or socially snubbed. Those with warm memories of acceptance judged the room to be 5 degrees warmer on the average than those who remembered being coldly snubbed. Another effect of Affection Is Warmth.” This means that we both physically and literary “warm up” to people.

Metaphors like “warming up” are therefore representations of real phenomena that become figurative in certain scenarios. McNerny adds:

The last few years have seen many complementary studies, all of which are grounded in primary experiences:

• Thinking about the future caused participants to lean slightly forward whilethinking about the past caused participants to lean slightly backwards. Future is Ahead

• Squeezing a soft ball influenced subjects to perceive gender neutral faces as female while squeezing a hard ball influenced subjects to perceive gender neutral faces as male. Female is Soft

• Those who held heavier clipboards judged currencies to be more valuable and their opinions and leaders to be more important. Important is Heavy.

• Subjects asked to think about a moral transgression like adultery or cheating on a test were more likely to request an antiseptic cloth after the experiment than those who had thought about good deeds. Morality is Purity

The challenge for complexity in social life is coming up with the right metaphor and finding one that is embodied within the systems we seek to influence.

Telling systems stories

One of the best examples of the use of storytelling and metaphors to explain complexity comes from Dave Snowden of Cognitive Edge with his humourous, insightful look at order and the art of organizing a children’s party.

What Snowden does is anchor something new (complexity) in a familiar frame of reference (a children’s party). While this is not something that directly translates to how we operate social organizations such as “warming up” does to explain relations between people, it offers something close.

Anchoring the novel in the familiar. Childhood is the one universal we adults all share. Travel the globe and watch children interact and you’ll see patterns repeated everywhere. Emotion is another universal: joy, fear, anger, contentment, curiosity, and such are all platforms that can be used to create and share stories about our world. For those of us working in communities, we need to understand what universals exist in those realms. This means paying deep attention to the systems we are a part of.

In short: systems thinkers may need to be participant observers to the systems they wish to influence and learn about the big and small things that drive them.

As systems are large, complicated and complex, it is unreasonable and perhaps impossible to know everything necessary to successfully navigate through it and maneuver the leverage points necessary to create responsible, sustained systems change. To do so, we need to enlist others and that means getting complexity into the minds of many operating in the system and not just a few ‘systems thinkers’.

We need to get better at telling stories and marketing metaphors of meaning.

Learning storytelling from marketers

Marketing is largely about identity and stories about identity. Marketers want to influence what you do (choose, use, purchase, etc..) and how you experience what you do when you do it. To do this, they know the importance of design and the stories to accompany that design. Design, when done well, is partly about creating empathy with those who are to benefit from the products of design and the best products out there are ones that apply empathy and guide behaviour at the same time. Steve Jobs and his design team led by Jonathan Ive were (are) famous for doing this at Apple.

In an earlier post I mentioned the work of Rory Sutherland and his discussion of tobacco use as an illustration of the ways in which failing to empathize with a product user’s life can change the impact of policies and programs aimed to improve it. The case (made in the video below) is that there are some real, tangible benefits to smoking that get ignored when we aim to snuff it out (bad pun intended). For public health to enhance its effectiveness, we need to pay attention to these benefits and find ways for people to derive them in healthier contexts.

But listen to what Sutherland says not only here, but in another of his TED talks he points to ways in which small changes can have enormous consequences if done in a systems-forward manner (my term, not his).

What Sutherland does is not just provide good ideas, but tells good stories. Like Dave Snowden, he captures our interest and makes us want to think about concepts like behavioural economics and marketing just as Snowden inspires thinking about the differences between order and chaos.

Not all of us can be great storytellers or funnymen (and women), but we need to take this seriously if we wish to use complexity and systems thinking to advance change in our world purposefully, because massive change is happening whether we want it or not. The key is whether we will be telling stories in the future of how we helped shepherd change that helped us be more resilient and thrive or let these forces shape us in ways that caused unnecessary problems. It is, as Bruce Mau said, not about the world of design, but the design of the world.

behaviour changedesign thinkinghealth promotionmarketingpublic health

Contemplating Better Public Health: Perspective is Everything

Design No Smoking

Cigarette smoking remains among the most significant and pernicious global public health challenges. On World No Tobacco Day it’s time to consider re-designing our approach to public health and tobacco control in the hopes of meeting this challenge and others like it more effectively.

Today is World No Tobacco Day and offers us an opportunity to take a pause and think about the ways in which we approach tobacco control as an example for public health.

Marketing funnyman Rory Sutherland,  and smoker, makes a terrific observation about smoking and its power to promote quiet contemplation in one of his recent TED talks (which is well worth watching for many reasons, only some related to tobacco use):

“Ever since they banned smoking in the UK in public places I’ve never enjoyed a drinks party ever again. The reason… is when you go to a drinks party and you hold up a glass of red wine and you stand up and talk endlessly to people sometimes you don’t actually want to spend the whole time talking. It’s really, really tiring. Sometimes you just want to stand their silently, alone with your thoughts. Sometimes you just want to stand in the corner and stare out of the window.

Now the problem is now that you can’t smoke, if you stand there and stare out of the window on your own you’re an antisocial, friendless idiot.

If you stand there and stare out of the window on your own with a cigarette, you’re a fucking philosopher.”

In this  tongue-in-cheek presentation, Sutherland inadvertently hits on a powerful reason to smoke, but not for the reason you might first imagine. It is less about social perspective, but internal perspectives of the self and the opportunity to better acquaint oneself with them.

Sutherland speaks to the perception of others in this talk, but I am more interested in what this act of contemplation — the ‘fucking philosopher’ aspect of smoking for some and why public health sometimes gets it wrong when it comes to tobacco control, but could get it right with mental health with the right design.

Over the past year I’ve made a concerted effort to better understand the motivations and habits of cigarette smokers from the perspective of a designer, not a public health researcher. In doing so I have sought to pay greater attention — as Rory Sutherland does — to the actual experience of smoking. And what I have noticed is the powerful contemplative effect it has on many smokers.

By no means is this a by product of cigarettes, and I certainly cannot endorse their use on health grounds, but one positive by-product of the act of smoking is greater attention to the self in the moment. Sutherland speaks to how a cigarette gives him the license to take time out of a busy party and contemplate, reflect, and gain some perspective that might seem odd or “antisocial” without the prop created by a cigarette.

Strange that we seem unable to develop the same habits and social acceptance of everyday contemplative acts in public, yet fully recognize this as legitmate with smokers even if we question the device used to precipitate the “time out”.

Smokers take breaks throughout the day to engage their cigarettes. Even in cold weather, they will go outside and sit or stand for 10 minutes just to indulge their habit, compulsion or pleasure, sometimes in small groups. This act of smoking provides a sense of community (with other smokers), contemplative space, and a pause from the everyday rush of life. Indeed, as they engage in activities that threaten their physical health they also engage in an activity that is very healthy for their mental well-being.

This is potentially another area that requires further investigation both from a positive standpoint (designing healthy space for contemplative inquiry or reflection) and looking at negative impacts of our well-intentioned efforts to curb tobacco use. While the loss of potential smoking peers has been examined, I could not find any research that examines the loss of contemplative time and its impact on smokers who quit. Doing so firstly acknowledges that cigarette use has benefits, which is problematic for many in public health. It also means getting into a zone of complexity whereby we need to consider how something that is so demonstrably toxic to the human body and others around the smoker can have potentially positive effects in other ways.

From a design perspective, how might we apply the lessons from cigarette use to mental health promotion? How might we design programs, spaces, places, and social conventions that promote the quiet contemplative acts that smokers gain from taking that cigarette break and offer potentially great value to tobacco users without creating harmful effects for others? How can we promote the quitting of smoking without the loss of the contemplative benefits that come with the act of lighting up?

Engaging design, complexity and imagining the systems that influence them both might yield considerable insight into how we manage other public health problems and how we might better promote mental health in the protection of physical well-being.

Photo No Smoking Poster 1 by Sempliok used under Creative Commons License from Deviant Art.

social mediasystems science

Social Networks: Beyond the Numbers

There's More to Connections Than Lines

Social networking research is becoming a hot topic as people discover the potential that mapping has for guiding policy and practice, however like many other “hot” research methods, there is a need to go beyond the numbers to make sense of what they really mean lest we create beautiful maps and have no place to go with them. 

The rise of social media applications and the ability for anyone to use simple tools to create, extend and shape their social graph with a mouse click or tap of the app has helped stoke interest in network research. Social networking methods are those that tend to favour quantitative development of maps and numerical representations of what a social network looks like. We are most often terribly ignorant of the role and position we play within a network so to see ourselves and peers positioned literally on a map can be revealing in more ways than one.

Between 2005 and 2006 my colleague Tim Huerta and I did a study that looked at the formation of a community of practice (CoP) in tobacco control through the lens of the social network and published a paper on this based on that work. Part of the study involved giving a group of people who were meeting face-to-face a survey and ask them about who they knew that influenced their work in the web-assisted tobacco interventions (the CoP’s focus), how well they knew the people they identified, and what kind of things they did together. This data was entered over the first night and analyzed for the next day’s meeting with the network map revealed (see summary here, full article here) .

While the map itself was generated through quantitative analysis, revealing patterns akin to the image above, it was the meaning that people gave to those connections that allowed this group to begin envisioning how they could leverage their untapped potential in the network to advance their interests as a community. This sense-making process is too often neglected in social network research and risks turning something meaningful (like a relationship) into a statistic that can more easily be dismissed — or misunderstood.

This week another social network study was published looking at tobacco control and the use of Twitter as a medium to support that. This study didn’t map the network per se, but rather looked at the type of people in the network and what the content of the messages that were shared within it. This represents another type of social networking study where the researchers aim to peer into the activities of a group of people who are interconnected and describe from afar what they see and who they think they see. This has some utility for those wanting to delve into areas where there is little known (such as Twitter and smoking cessation), but can also mislead people if used improperly. Networks are dynamic, with influence shifting and participants activity modulating greatly within its lifespan and because of this, cross-sectional data poses the risk of capturing a slice of activity that might not reflect the whole.

Which slice do you want?

Consider the analogy of slicing a watermelon sideways and doing so at the end, rather than in the middle: if you love watermelon, you want the middle slice because it’s bigger and richer than the end. The same might be true for social networking activity.

The tendency to want to produce network maps using numbers alone to explain them is highly problematic. Even Facebook has decided it will give greater priority to what people do in the network, rather than how big the network is as evidenced by the push to add Skype-powered video to its service this week. Facebook knows that their value is determined less by how many friends you have, but more about how you truly connect: photosharing, comments, game-playing.

True, this can all be quantified, but they are going a little further beyond the numbers. The Facebook example provides an interesting example of potential social network studies that could look at the type and content of the photos shared, how people have reacted to them, and what kind of social movement has been formed by the content created for and shared through that network. If you want to leverage a network for social change and good, this is the kind of stuff you need to focus on, not just the total numbers of people involved.

Powerful social network research is as much about having a good statistician as it is an anthropologist and together, they need to have the story that comes from it, woven together by the users and a good storytelling host.

*** Watermelon photo by Rameez Sadlkot used under Creative Commons Licence from Flickr. Network image used under licence.

complexityemergencepublic healthscience & technologysocial media

Seeing Simplicity / Seeing Complexity

 

We are on the cusp of what is known in public health circles as ‘flu season’. Unless you don’t get out much, you probably know that this year’s season has special significance because of the presence of a new relatively new, and powerful strain of influenza known as H1N1 (or ‘the swine flu’ to some). This week we saw the first large-scale roll-outs of vaccinations for H1N1 along with the annual drive to provide the public with flu shots. As is to be expected, there has been a lot of coverage of the flu and the efforts to provide a form of preventive medicine (a vaccine) in anticipation of what is expected to be a heavier-than-usual year of the flu. Judging by the waves of people I know reporting they and their loved ones are (or have been) sick in person, on Facebook or Twitter , I’d say we’re already off to a big year.

Vaccines provoke a lot of concern from people. After all, the basic tenets of a vaccine are to inject someone with either a dead or live version of the virus in tiny forms to boost the host’s immune system and it is natural to those without immunology or biology in their educational history to find this odd. Yet, we’ve nearly wiped out diseases like polio and smallpox because of these vaccines. Those successes have not translated into desire for more vaccines (despite their declared importance to public health), rather the opposite is happening. The current issue of Wired magazine focuses on this problem surrounding the link that some have drawn between Autism and vaccines. This link is possible because the diagnosis of autism often is made about the same time that the most common childhood vaccinations are administered. Despite there being considerable evidence to the contrary, a connection between two unrelated activities gets put together. Something simple is made complex.

This same example also illustrates the opposite. Vaccines and drugs are often developed by profit-making companies who hope to make money as well as profit health benefits. This profit motive can easily get translated into callous disregard for the public’s health and the inability to see the harm products cause: greed rules. Something complex is made simple.

The ability to shift between these two levels of abstraction is a critical challenge for public health. Unlike some areas of health practice, public health deals in the public realm, looking at issues that have importance to everyone, not just individual citizens. We are guided by public ethics, not private morals. But public health is messy for this very reason, because at its root are problems that are mostly complex ones — those with multiple causes and overlapping sets of consequences that cannot be fully predicted using simple methods or models. Complicated problems are ones that have a lot of components to them, but their organization and relationship to each other allows us to diagnose and prescribe a solution. Simple ones have few parts and very straightforward relationships. (A great illustration of these problems is here) .

Yet the impact of making problems at one level look like those at another cannot be understated. This is how myths develop and conspiracy theories take hold. In Canada, public health officials are trying to counteract the myths that the H1N1 vaccine (and flu shots in general) are being perpetuated. But in a social media ecology, that is hard to do, particularly when the myth-makers get so much attention and are motivated — by many conflicting reasons — to get their message out. Research has looked at the messaging behind anti-vaccination messages on YouTube and found it to be a source of a lot of contradictory messaging.

For public health, this is complexity in action and perhaps it is complexity — and social media — that might be the lens and tools to address these myths, otherwise they will continue to flourish. This isn’t such a problem when the consequences of doing something or not doing something has little impact on others. Vaccinations on the other hand impact us all – whether we take them or not — because compromised immunity for one, can lead to disease transmission to another. But things aren’t always what they seem. Once we believed that smoking was a simple choice, then we realized that it caused problems to the individual smokers’ health in myriad ways making it much more complicated, and now research has shown that cigarette smoking is having wide-scale complications to the health of others through second-hand smoke.

So is it simple or is it complex?

behaviour changeeducation & learningeHealthhealth promotionpublic health

eHealth Deja Vu All Over Again

"This social media stuff is like eHealth deja vu all over again"

"This social media stuff is like eHealth deja vu all over again"

Yesterday I had the privilege of speaking to Cancer Care Ontario‘s LEARN community of practice meeting in Toronto about social media and how it could be used to support their health promotion (specifically tobacco control) work with youth and young adults. This group does a lot of work with young adults so information technologies are not alien to them (indeed, many had blogs, Facebook pages and other social media tools), yet they were still uncertain about how best to use these tools and why they might want to in the first place. In preparing for the presentation and in the subsequent discussion afterwards I had this overwhelming sense of having been here (and there) before. It was, as Yogi Berra famously said: deja vu all over again.

My first study on the Internet was conducted in 1995, a time when the World Wide Web was just becoming known outside of academia and the best option for social support was UseNet groups. With a friend of mine, we did the first (to my knowledge) global survey on the use of the Internet for social support (note: this is why its important to publish your results as soon as you get them, otherwise it will never happen 😦 . I did, however, present findings at the Prairie Undergraduate Research Conference at the University of Winnipeg, perhaps the most remarkable event in support of student scholarship in psychology (or any other discipline) I’ve witnessed. But I digress…)

As I moved along in my career, I continued to work with the Internet as a tool — from discussion boards to interactive smoking cessation support tools and using qualitative methods and design principles to large randomized trials. All along I would hear (and still do) comments like “isn’t that (technology) stuff just for fun?” or “why would anyone want to use that?” .

The same pattern keeps repeating. 20 years ago if you were to describe using email as a serious means of communicating – something that one should devote work time to – most employers would scoff. Now, email is integrated deeply into the very fabric of nearly every knowledge-based enterprise to the point that the corporate market for mobile services to deliver email to its workforce is in likely in the billions. 10 years ago if you were found in your office searching the World Wide Web for content of a serious (i.e., work-related) nature, a similar scoff might come. Now? Open access journals are becoming top publishing venues in their field (see the Journal of Medical Internet Research in the Health Services Research area as one example) and tools like Google Scholar are invaluable resources for scientists and practitioners alike.  The LEARN group gets this. They are the ones who are trying things out and trying to push the boundaries of their organizations, changing mindsets and considering whether or not social media is for them or not and in what measure.

A few months ago I spoke to another, similar group of health practitioners about eHealth and asked the audience about their experience using social media. Many of these settings — particularly public health units — didn’t allow Facebook or YouTube to be accessed.  Presumably, it was to avoid people doing things that weren’t serious work. This all reflects a mindset pattern that repeats in many organizations — public health or otherwise: people don’t see how the new technology can help because it is not obvious (or they haven’t even tried it), therefore it is dismissed as irrelevant or even banned outright.

The challenge here — and one that I take up — is about lowering these barriers through education. I think it is imperative that those of us (perhaps you, dear reader) who work in social media and eHealth help others to support their efforts to change the culture of their organizations. The LEARN folk are doing this, just as I did so with them. No matter how much we as ‘experts’ like to showcase new tools, we are the early adopters and massive social change will not happen until we inspire the next wave of people to take it up.  One forum for this is at the eHealth Promotion social network, a Ning group formed out of the experiences at this year’s Health Promotion Summer School in Toronto, that was on the very topic of teaching people about eHealth in public health. Best of all, when we get these new adopters joining into the discussion and familiar with the tools, they can also help us determine what doesn’t work with these tools, what their limits are, and even what risks they bring in a manner that is informed, constructive and not dismissive.

If public health is going to be innovative, that is doing things that haven’t been done or in new ways to address emerging problems, then it needs to understand social media. What and how much it adopts it is really a matter of need and circumstance, but as I pointed out in my talk yesterday, we cannot wait for the evidence to come in to make that leap. Last year, the research on Web-Assisted Tobacco Interventions (perhaps the leading domain of public eHealth research) finally reached a point where we could say with some confidence that the principal of using the Web to support smoking cessation and prevention is evidence-based. That was more than 15 years after the birth of WWW.

Are we going to have to wait another 15 years before public health widely adopts tools like microblogging (e.g. Twitter) or considers the use of mobile messaging and video or social networks in its work? By then the evidence might be in and if that is what it takes to get this adopted or accepted it will be deja vu all over again, and that’s not a good thing.