What will our epitaph read? We came, we saw – we did nothing

A widely accepted definition of a social determinant of health is ‘the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.’

According to the World Health Organization, research has revealed that social determinants of health may play a bigger role in influencing an individual’s health than healthcare or lifestyle choices, with numerous studies suggesting that
social determinants of health may account for between 30-55% of health outcomes.

We can all rattle off the traditional determinants: education, income and housing.
Recently, other elements of society such as access to childcare and public transportation have also become well-defined determinants of health.

And now we can add social media to the list.

In April 2023, the Commissioner of the Food and Drug Administration (FDA), Robert
Califf, cited the spread of misinformation as a contributing factor in the lowering of US life expectancy. Califf went on to suggest in multiple interviews that proven medical products and interventions were not being used as often as they were in other countries because of the choices being made in the US as a result of the proliferation of misinformation.

In May 2023, the US surgeon general, Vivek Murthy, issued a 19-page advisory report that stated that the effects of social media on adolescent mental health were not fully understood, and that while ‘social media can be beneficial to some users, there are ample indicators that social media can also have a profound risk of harm to the mental health and well-being of children and adolescents’.

But despite leading voices from government, public policy and healthcare itself, we don’t seem to be able to implement any meaningful change.

So here are three thoughts that may, in some way, be considered as a starting point to addressing this problem.

1. Content moderation is not working. There are simply too many users and too many posts to be able to monitor in real time. And there are not enough content moderators. Even though the reality is that 90% of all mis- and dis-information is posted by approximately 10% of users (or something close to that), that’s an enormous amount of people and content. We don’t need to moderate all the posts from all the users. We need to weed out the 10%. Easier said than done? You bet. First amendment concerns? Yes. I’m not sure what the balance is between protecting the mental and physical health of tens of millions of people versus the codified rights of people to free speech (which, ironically, is either incorrect, purposefully deceitful or both).
2. We need to eliminate the ‘share’ button as it relates to health information on all social media platforms. Immediately. Do not ask me how to make this happen. I have no idea how these sophisticated platforms work and there are much bigger brains than mine that can better explain the inner workings of these complicated algorithms. But the thinking behind this idea should be crystal clear to all readers: it is the amplification of mis- and dis-information, and the speed with which it spreads is the problem we must address. Eliminating the ‘share’ button is not perfect; in fact it may be a very blunt instrument. But it’s a start.
3. Any ‘recommendations’ that appear in your feed or on your ‘For You’ page that are related to healthcare must be disabled/ blocked. Unless the information comes from someone you have chosen to follow, it should not reach you. Easier said than done? First amendment concerns? Noted. The line forms to the left. Look, not all social media is bad. That’s not the point of this month’s column. In fact much of it is good. Neither is the point of this month’s column to suggest that we are all just sitting on our hands and doing nothing. In fact, Montana’s governor recently signed a bill banning TikTok from operating in the state. And earlier in 2023, Utah became the first state to require social media users under 18 to have the explicit consent of a parent or guardian in order to access their services. The point of this month’s column is to serve as a reminder that the world around us is changing. Traditional views of the determinants of health are still valid. But newer ones are emerging. We must recognise them. And we must act upon them.