Through the Wormhole – Public Health Journeys in Cyberspace
In China Mieville’s ‘The City and The City’, Inspector Borlu faces a novel challenge as he pursues his murder investigation. The two cities he needs to gather evidence from – Beszel and Ul Qoma – somehow co-occupy the same physical space. Inhabitants of each city are aware of the existence of the other, but have developed an elaborate social code based on “unseeing” the other place.
A lifetime’s interest in science fiction should have prepared me for my public health journeys through the wormhole.
But my explorations of the world of social media have proved every bit as startling and assumption-shattering as any imagined sci-fi universe. It began in earnest in 2009, when I first fired up my Twitter account in order to investigate the potential of social media as a serious means for progressing public health.
What I encountered changed the way I see almost every aspect of public health.
Like many public sector colleagues, the only realistic way to undertake this kind of journey was in a personal capacity. Because of this, I was free to explore whatever subjects were of interest, such as environmental issues, human rights and global development. Given that tackling health inequalities has been the central focus of my career, the way in which digital tech interacts with equity issues has been prominent too.
So what did I find through the wormhole? As my digital social network grew, a number of major themes started to emerge out of the initially chaotic asteroid belt of social media content. I’ve grouped these into three loose headings:
1. New ways of gaining and sharing knowledge;
2. New ways of addressing complex challenges;
3. The expression of different voices, including many groups who have traditionally been very marginalised.
Taking each of these three areas, I offer examples to illustrate the future potential for public health:
- New ways of gaining and sharing knowledge – developments range from sharing of academic and allied content through social media channels (e.g. Scottish Collaboration for Public Health Research and Policy @SCPHRP and the Sophie Project @sophieproject), use of hashtag searches as a great way to find new knowledge (e.g. #sdoh – social determinants of health) and adding value to events through live web and social media. Not only do these means broaden the range of material that can be accessed, they change the nature of it, by bringing multiple kinds of evidence and perspectives into the mix. One example that embodies the benefits of this interactive approach to health knowledge is the excellent Elf family, such as Mental Elf. Beyond social media, there are many other knowledge innovations that have the potential to transform key aspects of public health practice, such as the application of big data analytical methods – with contributions to the fight against Ebola being one current example.
- New ways of addressing complex challenges – among the innovations that caught my attention early on was crowd-sourcing. The web offers the ability to create new kinds of collaborative working, to better address ‘wicked challenges’ like poverty and inequalities. The global development and human rights spheres seem particularly active, with initiatives like OpenIDEO. The PanicButton tool for human rights activists was one of the tangible resources to emerge, with web-enabled collaborations having huge potential in the public health sphere.
Service design approaches also featured prominently, being applied to many kinds of social challenges – bringing a fresh approach understanding the needs of service users and to involving them in the process of crafting better solutions. See here for a summary report.
Perhaps most revelatory has been the degree to which digital innovation in public health is a global phenomena, not just confined to developed nations. The frugal innovation – or jugaad – approach prominent in India is a good example, with the principle of working with the resources and technology available, not always aiming at the highest tech, with its tendency to exclude those most at need.
Open source philosophy and crowd-mapping also has much to offer. A great example is Ushahidi – originally developed in Kenya as a tool to document election violence, but now used in for many different purposes, including supporting disaster responses and as the platform for the fascinating community asset mapping initiative in East Dunbartonshire.
Alternative finance mechanisms like crowdfunding are also contributing to a more participatory dynamic for how innovation can be taken forwards. One recent successful health example is the PEEK Retina smart phone system for preventing avoidable blindness, which raised over £110,000 via the IndieGoGo platform.
There is increasing evidence of the benefit of a wide range of digital assets as direct tools for health and wellbeing – spanning health promotion, self care through to clinical support, with a role too in advocacy and mobilising for change. Examples include online drugs surveys and web-supported drugs harm reduction services, SPARX online CBT system using a fantasy game virtual environment, the Mindings tablet app that helps older users maintain regular contact with their families and the Tyze system for supporting personal caring networks. Small bowel transplant recipient Michael Seres is a great example of embracing digital communication channels to pursue an expert patient approach.
Arguably, the public mental health sphere is seeing some of the most fascinating digital developments. From inspiring solo efforts like 1,000,000 million reasons blog set up by a 17 year old (which saved at least 10 lives), to a major research initiative like the Young and Well Cooperative Research Centre. From an NHS perspective, Victoria Betton’s blog, Coproducing Digital Mental Health brings together a wealth of insights relating to this territory, including discussions on the new kinds of interactions that are emerging via social media. See for example the Twitter based #dearmentalhealthprofessionals, with direct service user voices offering professionals much food for thought.
We got 99
Such learning has been a major influence on our health improvement work in Greater Glasgow and Clyde and helped to shape what became Project 99 (www.wegot99.com).
This initiative is exploring the potential of digital resources in promoting youth mental health – using coproduction with young people and our commissioned and local partners.
We’re delighted to have got confirmation of EU funding via CHEST to further develop this area during 2015.
- Enabling new voices – while digital exclusion is clearly a significant issue warranting concerted action, there are growing examples of use of digital media tools to raise awareness and support empowerment of traditionally marginalised groups – often as part of a wider mix of engagement methods. Examples span the globe, from the Catalytic Communites programme with Rio’s favela residents, the Invisible People vlog highlighting homelessness, PhotoVoice using photography to help people overcome addiction problems and numerous hyperlocal media initiatives in communities across the UK and beyond.
Such empowering uses of digital technology has major implications for public health. It offers the prospect of a more engaged, participatory approach with communities involved in all stages. These kinds of examples were the inspiration for our Mind Waves community media initiative, launched in 2011 – supporting volunteer Community Correspondents to create and share “news” content relating to mental health, wellbeing and recovery.
Scrutinising the status quo
None of the above amounts to a panacea of course, and no amount of innovative practice is a substitute for action on the underlying socio-economic determinants of health. Progress calls for use of appropriate research and evaluation methods to test for effectiveness – though as Paul Taylor notes, we should be equally rigorous about scrutinising the status quo and mediocrity!
Like Inspector Borlu who must navigate between the two Cities, it is not possible to “unsee” the opportunities that digital communication technology offers to public health. The question is can we harness such tools to promote inclusive approaches to public health and to tackle inequalities?
This requires public health workers not only to learn new technical skills, but also to be prepared to operate in a much more social, collaborative way, recognising that many actors have knowledge and skills that can contribute to effective approaches – not least, communities themselves.
And how does the good Inspector get on? You’ll have to read the book to find out, but I would be fascinated to hear of others’ journeys in public health cyberspace.
This week’s blog was by @syndrum (Dr Trevor Lakey). Dr Lakey has worked for 25 years in health promotion and public health, with his first role being in NHS Ayrshire and Arran. He is Health Improvement and Inequalities Manager at NHS Greater Glasgow and Clyde, where he leads on health improvement for mental health, alcohol and drugs and is involved in developing a number of collaborative programmes exploring the potential of digital approaches for health. He was recently elected as a Fellow of the Royal Society of the Arts.