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News Mixed uptake of social media among public health specialists Public health organizations are starting to use social media. Some specialists say they hold untapped potential for public health. Ben Jones reports. Sari Setiogi was worried. In the wake of WHO is among the public health organi- for the public health crowd”, while the the Japanese earthquake back in March zations using social media to disseminate Wall Street Journal’s health blog has a 2011, panic about the effects of a possible health information and counter rumours. business focus. radiation leak at the Fukushima nuclear But should public health be making more CDC has uploaded 243 videos to plant had caused a number of rumours use of such media? video-sharing site YouTube, and Shelly to spring up on social networking site Using social media may seem easy Diaz, a social media expert at the CDC, Twitter. but users say it is time-consuming and says social media are a key means of Chief among them was the miscon- can backfire when health messages be- getting the agency’s message across to ception that drinking iodized wound come distorted, such as when they are online visitors. For example, one CDC cleaner and consuming large quantities retweeted. That can jeopardize organi- Facebook page is targeted at parents of of iodized table salt would reduce the ef- zational reputations and undermine the teen drivers. “We spend a lot of time and fects of radiation (rather than potassium credibility of their information. we have a whole team of people working iodine tablets taken before exposure, on social media. It’s not investment free”, which is recommended). Setiogi learned she says. “We need a message that can be that people had started stockpiling salt in nimble. Social media allow us to upload China. One person had built up a five- year supply. It was time for her to act. Setiogi, a communications officer at the World Health Organization (WHO) in “ People retweeted our message and the number of messages messages quickly.” Not all public health organizations have embraced social media as enthusias- tically as the CDC. Rajiv Rimal, associate Geneva, knew she had to combat the wild- telling people to professor in the Department of Health, fire spread of such rumours with some well buy the salt went Behavior and Society at Johns Hopkins chosen advice. At the same time, WHO’s China Country Office and other public health agencies in China worked hard to raise awareness inside the country itself. down. Sari Setiogi ” University, contends that social media hold untapped potential for public health. He notes, though, that some public health organizations have found innovative The joint efforts paid off. “[For our ways to use these media. “Locating the part] we tweeted asking people not to eat “Due to the nature of social media presence of flu geographically based on excessive amounts of table salt because and the interaction on social media people’s search terms” during the H1N1 it leads to hypertension, and within a platforms, we can be sure of what we say influenza pandemic in 2009, he says, was couple of days we’d heard people had but we just can’t be sure how it will be “a really cutting edge use”. run back to the shops and asked for re- changed by others”, says Yousef Elbes, This year Google, the Internet search funds for the salt!” Setiogi says. “People a multilingual manager responsible for engine, launched a similar web-based retweeted our message and the number disseminating health information via tool called Google Dengue Trends to of messages telling people to buy the salt the Organization’s multilingual web monitor for dengue fever. The CDC also went down.” site. “When it comes to public health, provide “widgets”, which are small pieces Social media – networking web sites information must be accurate, timely of html code that users can upload to such as Facebook, Twitter, QQ in China, and reliable.” their own web sites. That way they can blogs, e-mail fora and video-sharing web Elbes says that it is possible to protect receive the latest CDC statistical updates, sites – have only been around a few years. sound public health information and which is particularly useful during an advice via social media. “You have to pro- outbreak. vide the correct information but then you The two-way nature that sets social must have mechanisms in place to follow media apart from traditional media also up and respond, reply and retweet if the presents opportunities. Public health messages are getting distorted.” organizations can monitor these media WHO has a Facebook page, a Twit- to find out people’s health concerns and ter feed and a section in YouTube, as interests, as well as to find out “what has do the Centers for Disease Control and been pushed out to them”, Rimal says. Prevention (CDC) in the United States of He believes that social networks can be America, several health ministries, uni- used to change people’s behaviour, for ex- versities that offer public health courses, ample, in selecting the right sunscreen for and many scientists and health writers. children based on both evidence-based There are popular blogs on health mat- recommendations and on “what other ters, such as Covering Health, run by the mums are using”.WHO Association of Health Care Journalists While getting evidence-based health for journalists. Another blog, the Pump information and messages out to the pub- Sari Setiogi Handle, describes itself as “a water cooler lic via social media may seem simple, the 784 Bull World Health Organ 2011;89:784–785 | doi:10.2471/BLT.11.031111
News challenge is in listening and responding what they just had for breakfast. But to- to questions and rumours in a timely way. day Twitter is an important tool to share “Using social media [at WHO] came information and frame policy debates”, about because of lessons learned from the Love says. “In a meeting or conference, H1N1  pandemic response”, Setiogi tweets can reach the people in the front of says. “There were a lot of rumours circu- the room, the back of the room and people lating but we didn’t listen. We didn’t know who are not even in the room. You can what people were talking about and what comment on events in real time, even if information they wanted from WHO. you are not physically attending. It changes After that, we started changing our ap- our sense of whose voices are being heard.” Courtesy of Knowledge Ecology proach to social media.” Two years on, in For Rimal social media are still October of this year, WHO had about 255 underused, especially in linking large International Online. 000 followers on its Twitter feed and 30 groups of people with common inter- 000 ‘fans’ on its Facebook page, numbers ests. “Social media help people who are that increase every month. concerned about similar issues to come together, to work together, to have a unified voice. That is an area that public “ Social media help people who are concerned about health has not really adapted to yet, in terms of mobilizing social networks to promote a particular cause.” In countries with low internet band- Thiru Balasubramaniam, who runs the Geneva office of Knowledge Ecology International, blogs at the General Assembly of the World Intellectual Property Organization (WIPO) in 2011 similar issues to come width, e-mail is easier to use for virtual together, to work networking than social-networking web together, to have a sites. One e-mail discussion forum, example, there are more than 900 videos unified voice. “ HIFA2015, aims to promote ‘health on YouTube expressing a wide range of information for all’ with a focus on the views on vaccination and many blogs and Rajiv Rimal developing world. “Social media can web sites suggesting the links between bring large numbers of people together smoking and lung cancer are myths. to discuss, explore, learn around a focus Social media and the web give people For activists, social media can be an of common purpose”, says HIFA2015 a forum to express their views, but these inexpensive and quick platform for their coordinator Neil Pakenham-Walsh. are debates that may never reach a con- campaigns. Jamie Love, director of NGO Rimal stresses the importance of clusion. For public health specialists this Knowledge Ecology International, reaches “source credibility”. “Where the infor- can be difficult ground. “Once you start wider audiences than ever before using his mation is originating from – whether interacting with social media, you have Twitter feed, where he has more than 2000 it comes from one’s friends, companies to be ready to carry the work forward”, ‘followers’, to publicize his web page. But trying to sell a product or public health says Elbes of WHO. “You can’t just start he understands why some health profes- agencies – becomes that much more and stop.” sionals are wary of using social media. critical”, he says. Not every user will check A recent editorial in the British “Some professionals may think that sources and many will be confused by the Medical Journal called widely-available Twitter is just for extroverts who share multitude of conflicting information. For health information “fundamental to global health improvement”. Measuring the success of public health campaigns is often hard enough. But measuring the impact of social media beyond counting the number of retweets or using web- based tool Klout, which measures online influence, would require more time and a new method. Diaz says the CDC recently surveyed its Twitter followers, asking if they were likely to make changes to their health behaviour based on the information they received via the CDC twitter accounts. “Most said that was likely”, Diaz says.WHO/Harold Ruiz “Theoretically, you can establish evaluation metrics for virtually any- thing”, says Elbes of WHO. “But when it comes to public health, it’s extremely difficult to measure the impact, be- cause it takes years to see the impact Scientists studying the H1N1 influenza virus on health.” ■ Bull World Health Organ 2011;89:784–785 | doi:10.2471/BLT.11.031111 785