Which means that all of the myriad social networking support groups and blogs and websites and feeds that I follow each come out with their annual statistics on the size and scope of social media and what trends are coming and who’s swinging the most wood after raising Series C funds. And there’s usually a drop-shadow-less infographic that tells me some tip about how to make my pins more pin-tastic and that 65.4% of all B2B partnerships thrive due solely to LinkedIn conversations.
And I read them all. Because it’s my job.
And I’ve yet to glean ANYTHING useful out of them.
1,440,000,000 people on Facebook. 77,600,000 Instagram users in the US. 4,000,000,000+ views on YouTube every day.
Lovely. Wonderful. But what does that do for my organization? Nothing.
The problem comes down to the maturation of social media. When the field was young and needed to prove itself, it sold eyeballs. How many people can see your posts!? Follower counts were like gold. Every time the “Facebook nation” rose up the ranking list of most populous countries, we forwarded those stats to our executives and pleaded to stop being kept from the promised land.
But now, when I post to Facebook, when I want to talk to the 3,876 people who have taken a half a second to click that happy thumbs up icon on our Page, when I have something that could potentially save their lives, their health, their humor, and/or their sanity, I’m lucky if 387 people ever see that post.
Sad Clown Mark Holthusen Photography. Photography by Mark Holthusen
Maybe I’m not as funny as I think I am. Maybe not.
Today, though, I’m not concerned with how many people could see my posts. Telling me there are 15,000,000 pairs of eyeballs out there waiting for my posts doesn’t do anything for me. Because I know 15,000,000 pairs of eyeballs aren’t waiting for me.
What’s waiting for me are the twenty people in my city that are thinking about quitting smoking today. Or the 4,000 people that would be interested in free yoga on the Parkway. Or the 150 that need to be reminded not to leave their kids in the car because it’s 95 degrees out.
We need new metrics on engagement and interaction. We need new advice for today’s social media. So I call on you, Social Media Expert/Maven/Ace/Superhero Person/Group/Blog (honestly, I tried so many combinations there, but they’re all already taken by real people)! Instead of selling us on how to get 10 zillion views using your One Simple Trick! on social media, help us learn how to find the right people and get the right people to ENGAGE with our social media.
Until you guys start doing that, I’m swearing you off. I’ll make my own damn social media best practices that work for my audience.
Nina Simone is more than one of my favorite musicians; she was an absolute treasure, one of America’s finest exports. One of her most famous songs was famously performed at Carnegie Hall and it happened to be one of her more political songs: Mississippi Goddam.
Written in response to the Medgar Evers murder, Ms. Simone railed against the black establishment and their admonitions that equality takes time, to “do it slow.”
But that’s just the trouble “do it slow” Desegregation “do it slow” Mass participation “do it slow” Reunification “do it slow” Do things gradually “do it slow” But bring more tragedy “do it slow” Why don’t you see it Why don’t you feel it I don’t know I don’t know
Her frustrations are real, and I believe, completely justifiable. Medgar Evers was one of the rising stars of the equality movement, and a real American hero to boot. To accept his murder was to accept that black folks were little more than cannon fodder in the larger battle.
Now what the heck does this have to do with public health? Only everything. Because of a media article on one of the studies in the April edition of the International Journal of Obesity, the one on environmental affects on obesity. (I’m not writing the name of the study because it’s completely unreadable to real human beings.) The folks at The Salt, an NPR program on food and eating, covered that part of the study that focused on how food was stored in the house by talking to the lead author and soliciting comment from other public health researchers.
The upshot was that there is a real correlation between how food is stored in the home, and how fat the people who live there are. If you’re obese, it’s more likely that you’ve got food, like snacks, sitting out. It’s likely that that food is placed in the obese person’s favorite spot, like by the couch, or in the bedroom. The authors theorize that unhealthy snacks placed by a mindless place (like in front of a TV), makes them more likely to be consumed mindlessly, leading to or contributing to the person’s obesity. Skinnier folks tend to have food stowed away, and have less of it on hand.
Seems pretty simple, no? And not really a bad piece of advice, to boot:
If you’re looking to lose weight, don’t leave unhealthy food sitting out, where it’s easier to snack on.
But! Very August Public Health Thinkers tell us, “do it slow!”
James Hill, a physiological psychologist at the University of Colorado, says, “All [Emery’s study] does is point out a few things that seem to be different among people who are overweight and people who aren’t.” The NPR article attributes the idea that leaving a bag of chips by your favorite armchair doesn’t necessarily mean that habit will lead to obesity, just as being obese might not lead you to have chips by your side, to Dr. Hill.
Hill says that we shouldn’t be doling out advice based on these correlations, saying it “would be a mistake.”
Because heaven knows we wouldn’t want people to put the damn chips away!
Dr. Hill (whom I hold no enmity against; I’m sure he’s done tons of good work), and his Very August Public Health Thinker pals, ascribe to the idea that we shouldn’t be advocating for people to make changes to their lives until we know for sure that making a very specific change will provoke some specific, measurable change. Evidence-based, we call it.
Go slow! Until we have evidence!
Did Ms. Simone, when railing against the leaders in the fight for equality, counsel for us to wait until we have evidence that things would work out? Or did she simply point at the dead bodies and yell, “Shame! Despicable!”
Well I can do that, too. I can point at JAMA, AJPH, RWJF and the Trust for America’s Health, the US Surgeon General. I can point at the bodies. The millions of dead Americans and yell, “Shame! Despicable!” How dare we wait to tell people to put the chips away; wait while we search for funding for a study to prove that a bag of chips on your nightstand isn’t a particularly good idea.
This isn’t to say there isn’t a place for evidence-based recommendations. The cottage industry of academic research (and it is an industry) is safe. But this? Why isn’t this a full-throated recommendation? Why do we equivocate and delay and hem and haw and call for more study? Why do we wait while the cannon fodder of this war on obesity continue to be mowed down?
There is a place for common sense in public health. There is a place for good enough. There is a place to err on the side of the public. There is a place for public health on the mountaintop, shouting. To be unequivocal. To be an advocate. To be political. To be argumentative.
There’s a great post by Dr. Kumar over at Healthcare and Public Health directed at public health mavens. I’m not sure what a public health maven is specifically, but I’m willing to bet that anyone who reads a blog post proclaiming, “public health is boring,” probably fits that description. So you’re in the club, too.
Dr. Kumar says that public health’s message is important, but it gets lost. No, scratch that. It doesn’t get lost, it gets ignored. He asks:
So why don’t we, the general public, really hear your message?
I posit that the answer is simple: public health is boring. And I say that as someone who has worked in public health for more than eight years. As someone who holds a senior-level position in a health department in a major city in the US, and who is charged with communicating public health to the great masses. I have quite literally seen the enemy, and he is us.
I know that we’re boring because I’m complicit in it. I run our website. (BORING.) I manage our social media accounts. (SNORE.) I regularly review public education materials. (YAWN.) And doing those things makes me look like I’m in the top five percent of most UNboring public health workers. At least to other public health workers.
The thing is, though, that of everyone that I work with, I literally am THE MOST BORING PERSON THERE. I do nothing. I create nothing. I save no lives. I play around on Tumblr and hit the RT button with alarming alacrity.
Others here teach women how to breastfeed, saving their already poor families thousands of dollars and hours of time. Others track down insidious bugs that prey on the weakest among us, killing indiscriminately. Others are healthcare providers of last resort. Kill disease-spreading mosquitoes. Monitor the very air we breathe. Give vaccines. Help people quit smoking. Help people get health insurance. Shut down unsafe restaurants. And then train the people that work at those restaurants how to do it safely in the future. You want heroes? I can’t even count how many we’ve got.
So how, when you take all of those stories, all of those heroes, can public health still be seen as boring?
It’s easy, I’d argue. It’s because we’re an insular, disconnected field that talks to ourselves. Masturbatory, one might say (and yes, the public health double entendre is intended). Dr. Kumar lays it out so well:
The message of public health is not reserved for academic settings. It’s not just for conferences or journals. And it’s not for public health experts.
And yet.
Have you looked at public health outreach and education materials? Websites? Social media accounts?
Who are they written for? Even if you avoid the dichotomous groupings, general public versus gentrified academics and place these materials on a continuum, almost without fail more will fall on the academic, BORING side.
The reasons we’re boring are myriad and long-standing. First up is our field’s fetishization of John Snow. Additionally, we’re gun-shy thanks to a big miss in disease forecasting way back in 1976. AIDS played a role, and now age is slowing us down even further.
First things first. John Snow, father of epidemiology. Famous for removing the pump handle from the Broad Street pump to help hasten the end of a cholera outbreak in Soho, London in 1854; his map of confirmed cholera cases in relation to the public water pump is widely considered one of the first examples of using data to convey information about disease spread. He’s our rockstar. He’s our reason for being. Wind beneath our wings and all that.
I find no fault with Dr. Snow. He was a smart man (and a smart dresser) who did something innovative and world-changing. My problem, though, is that public health, as a field, has seen his success and tries to emulate it. Exactly. We collect data. And present it (sometimes even in map format). And then we wait for our decision-makers to emulate the St. James parish authorities and heed our advice, removing the pump handle. Dr. Snow’s data was powerful enough to stimulate action. As we feel our data should be. Instead of taking time and making effort to make our data digestible and understandable, we still want to put on our John Snow jammies and cape and save the world, just like he did, marketing be damned.
Then 222 years later, on the other side of an ocean, we freaked out about some pigs. Well, maybe freaked out isn’t exactly right. But that’s the way the public remembers it (those few who actually do remember it). For those of us who don’t remember it, in February 1976, four soldiers at Fort Dix, New Jersey were hospitalized with a novel type of influenza A (H1N1). One of the soldiers died. And public health authorities, knowing that it had been more than a decade since the last influenza pandemic, sounded the alarms. Between October and December of that year, more than 40 million Americans were vaccinated against this swine flu. Including President Gerald Ford:
But there were problems with the vaccine. The most notable were cases of Guillain–Barré syndrome as a side effect. The vaccine program was halted in December because of the GBS. All told, about 500 cases of GBS were blamed on the vaccine, with 25 deaths. The flu? One death, out of 20 sick.
One of the biggest lessons learned from that episode was for us not to get too excited about things. Slow down. Disease forecasting is an inexact science, at best, and when you mess up and people die, you naturally get gun-shy. This isn’t particularly a bad thing, but it’s another reason why we don’t get all excited and excitable about our work.
A few years later, as a new disease known as the 4H disease (homosexuals, heroin users, hemophiliacs, and Haitians) became GRID (gay-related immune deficiency), and finally became known as AIDS. The stigma associated with the disease, and the fact that this was primarily a public health concern lead us to further internalize our desire to stay out of the news and away from trumpeting our work. Far from there being no benefit to our crowing about our work, doing so could now very much harm people.
The combination of all of these things, most good, most natural and expected, is a toxic soup that shields public health from the public. Allows our messages to be ignored. So maybe it’s not that we’re boring. Maybe it’s that no one knows that we exist outside of our boring charts and graphs and walls of text written at a twelfth grade reading level in journals that charge to read those words and on websites that are nigh inscrutable (and don’t render on smartphones). We still have public health messages, and we still publish innovative thinking and ideas, we just don’t do it in public. Thinking back to Dr. Kumar, his quote comes into play again:
The message of public health is not reserved for academic settings. It’s not just for conferences or journals. And it’s not for public health experts.
Except that that’s where we talk. And that’s who we talk to. And that’s where we tell our stories.
And that’s a real shame, because today, more than ever in the history of the world, we have the ability to tell our stories in an unfiltered way thanks to things like social media. We don’t have to depend on the mass media to pick up our message and hope they get the word out. We don’t have to hope that the right someone is in the right place when our tri-folds are placed on a folding table. We don’t have to be boring anymore.
But, the fear. The risk aversion. The once bitten, twice shy. The particularly not-bad idea of, “let’s not over-hype everything.” Those things still exist. Those things still make public health boring.
But they need to stop. It’s okay to be nervous, we all know that the internet is forever. But until public health, as a field, gets over those fears, we will continue to be shouted down by those who understand that the permanency and virality of the internet and social media is useful to their cause.
We must compare how our field communicates with the Jenny McCarthy’s and the Dr. Mehmet Oz’s and the other modern-day snake oil salesmen who are exciting and easy to find and easy to understand and whose ideas are easy to share with our friends and family. When we do that, then we will see how we have been found wanting. And then, I believe, will we finally understand the answer to Dr. Kumar’s original question:
So why don’t we, the general public, really hear your message?
Public health, as a field, needs to undergo a radical realignment and re-envisioning of how we communicate. The status quo is not just, “not good enough,” anymore, it is now harmful.
So where do we go from here?
Students, administrators, public health mavens: enjoy your biostats classes, and your program eval classes. Understand and embrace the social determinants of health. And then take all of that knowledge and then don’t talk to another public health person for an entire year. Don’t mention an odds ratio or the transtheoretical model during that whole year.
Instead, take that year and learn how to use Instagram. Learn to code. Understand what lead generation and conversion rates are, and how to track them. Like Coca-Cola’s Facebook Page and steal all of their good ideas. Become a guerilla marketer. Blog, tweet, Vine. Learn how to tell a story. Learn how to sell.
Then, come back to public health. Take all that you’ve learned and teach public health how to not be boring. Pull us out of our doldrums and circle jerks and poster presentations. Give us our pride back. Make us cool.
Remaking Public Affairs 