Category: Guest Blog

Contagions, content, and confusion in the digital age of health information

by ihsection, posted in Guest Blog

SeymourHeadshotGuest blogger: Brittany Seymour, DDS, MPH

Sixteen years ago, a study alleged an association between the MMR vaccine and autism. The authors disclosed in their publication that they could not claim a causal link, and the paper was eventually found to be faulty and was retracted. Nonetheless, flaws and all, the information was made visible and still today, anti-vaccine sentiments continue to rekindle the paper’s alarming claims, plus additional concerns. Anxious parents persistently echo one another’s worries through blogs, video-sharing websites, and other social media platforms, which too often contradict scientific consensus and current knowledge. A small but mighty group of doubting individuals are dismantling decades of life-saving research and successful health policy.

Disturbingly, content errors and false information tend to linger, even following subsequent correction. Particularly in the face of highly charged and emotional topics, individuals can become even more unwilling to revise their beliefs. When virtually anyone anywhere can publish anything online, people have little difficulty finding support to back any belief, creating a digital “corrupted information environment” one blog, share, and tweet at a time. We are entering an age of digital pandemics: rapid spread of misguided and incomplete online health information that has resulted in unsubstantiated confusion around some of public health’s greatest achievements, such as vaccines, contraception, and fluoridated drinking water.

We are witnessing an accentuated Kruger and Dunning effect, namely that unskilled people are also unaware that they are unskilled. Individuals are crafting convincing and persuasive arguments riddled with empirical citations and links to scientific studies. However, they ultimately lack the sophisticated skillset required for deeper interpretation of their own sources within the context of the larger issue. Without formal expertise, they are unable to move from the basic stages of knowledge, comprehension, and even application to advanced strategies for accurate analysis, synthesis and evaluation of the subtle yet significant complexities embedded in the scientific method. Put simply, a clever compilation from Google does not qualify one as a health expert any more than possession of a fine camera makes one a photographer.

These shortcomings go unnoticed while their confidence motivates readers to action. Ultimately, they are unable to recognize the larger harm their social media “publications” are causing in the absence of information porters such as the peer-review process or expert consensus. Now that over half of adults turn to the internet for health information, including using social networking sites, the hosts of these digital pandemics are becoming easily accessible and their content is proving contagious. Conversely, the most competent experts often underestimate their own competence, the “burden of expertise;” in part because scientific competence requires open acknowledgment of limitations in order to discover accurate truths. But on a public forum, citing any limitation, even as a requisite for the scientific process, attracts the naysayers who predictably share it across the web without context, and thus without accurate meaning. When searching #fluoride on Twitter for example, we discover, at surface level, an evenly matched digital Clash of the Titans: the proficient yet restrained domain expert versus the unskilled but vociferous lay person touting content that is masquerading as science but is actually nothing more than shallow advocacy. It’s no wonder the public has become confused and distrustful.

Clearly, social media is an expanding worldwide phenomenon. Yet, little is known about the precise mechanisms at play at the interface of social media and high-level global health strategies. Why does some content “go viral” when others don’t? Key findings include factors like an innate desire to share, emotion, storytelling, and public access- aspects that are perfectly ripe for success across social media. Yet, these aspects are also in direct conflict with the gold standard for acquiring, conveying, and applying scientific knowledge: objectivity, avoidance of conclusions based on anecdotal accounts, and publication in private peer-reviewed journals.

Despite its shortcomings, social media can provide public health experts with answers that once were private yet now are public: individuals, along with sharing misinformation, are also sharing their most intimate sentiments about that information.  In the past, interviews and conversations would have been necessary to uncover the numerous and highly nuanced reasons why individuals oppose particular public health interventions. Today, on the very websites publishing information that infuriate the experts also exist literally thousands of personal concerns made public for all to see, and minus researcher bias. The public nature of social media is perhaps our utmost barrier to information accuracy and yet a tremendous untapped resource for public health research, innovation, and intervention.

Brittany Seymour is an Instructor on Global Health at the Harvard School of Dental Medicine’s Department of Oral Health Policy and Epidemiology and the Inaugural Harvard Global Health Institute Fellow. Her research includes interdisciplinary global health curriculum development and pedagogy, capacity strengthening for oral health delivery systems in resource-challenged regions, and digital information transfer and impacts on health.

An emerging threat of “digital pandemics”- lessons learned from the anti-vaccine movement

by ihsection, posted in Guest Blog, Information and Social Media

SeymourHeadshotGuest blogger: Brittany Seymour, DDS, MPH

During the 20th century alone, the world experienced a larger gain in life expectancy than in all the previously accumulated history of humankind. This triumph has been dubbed one of the greatest achievements in global health and is largely attributed to the 20th century success of vaccines. However, a digital assault (one that began with autism but has ballooned to numerous other concerns) regarding the safety and importance of vaccines has permeated the Internet. Anti-vaccine sentiments, derived from this study – now retracted – perpetuated by celebrities such as Jenny McCarthy and Kristin Cavallari, and other concerned citizens, have gone viral. A “digital pandemic” is underway, and like a game of telephone, the truth has morphed, facts were lost in translation, and the story of vaccines today boggles the mind. Public acceptance and trust in their safety and utility has waned. Regions of the world, including the United States, are experiencing their worst disease outbreaks in nearly two generations (IOW since the invention of the associated vaccines), and many of these are attributed to exemptions from the recommended vaccine schedule. As rotavirus vaccine inventor (and recipient of death threats due to his pro-vaccine work) Paul Offit describes it, every story has a hero, victim, and villain; in this story gone viral, Jenny McCarthy is the hero, the children the victims, which leaves one role for public health experts: the villain.

More recently, is public health at the forefront of yet another digital assault, susceptible once again to the label of villain? Last month, a study with known limitations was released naming fluoride as one of six newly identified developmental toxins in children. Ironically, this followed the American Dental Association’s announcement only two weeks prior that it has changed its longstanding guidelines for the use of fluoride in young children, recommending an increase in fluoride exposure before the age of two years old, as compared to the former recommendations. Yet, within a matter of hours from the release of the study, the story of fluoride as a new threat to normal child development created a flood of posts on Twitter (just search #fluoride) and was covered in popular media news stories for CNN,USA Today, Forbes, and Time. These news sources alone generated over 54,000 views and shares over social media by the end of the weekend. Does fluoride share the same vulnerabilities as vaccines?

To many public health experts, these stories trigger bewildering thoughts. How is it possible that such misguided health information can spread so far so fast, painting public health experts as villains? Is there a way we can reverse our role in this story and emerge the heroes? Lessons learned from the vaccine story provide insights into an emerging threat of digital pandemics and the power of social media as the medium. Public health is encountering an unfamiliar menace, a rising global pandemic of rapid and unrestricted information transfer.

In today’s global society undergoing tremendous technological advances, new and emerging media modalities are greatly affecting health by influencing policy decisions, direction of philanthropic aid, and individual health behaviors. No doubt, due to the power of handheld technology and online social networking,social media and “citizen journalist”have played a role in propagating potential detriment to what is revered as one of public health’s greatest triumphs (vaccines). Thomas Patterson explains that information accuracy is becoming obscured, “The internet is at once a gold mine of solid content and a hellhole of misinformation.” As Nicco Mele illustrates, the internet makes David the new Goliath, where citizens are capitalizing on the power of social media’s velocity and reach, disarming the traditional gatekeepers of information quality.

Even when presented with corrective information, it’s no wonder the public continues to be confused, and concerned, about potential dangers of our intentional public health interventions. But what triggers a digital pandemic, and where is the threshold between an outbreak of bad health information versus a true online pandemic wrought with content persuasion? In a world of expanding voices sharing health information online through social media, how can we ensure that the cream still rises to the top and the public is making health decisions based on the most accurate information possible?These are the big “opportunity” questions we as public health experts need to be addressing under our responsibility to keep today’s citizens, their children, and our societies healthy.

Brittany Seymour is an Instructor on Global Health at the Harvard School of Dental Medicine’s Department of Oral Health Policy and Epidemiology and the Inaugural Harvard Global Health Institute Fellow. Her research includes interdisciplinary global health curriculum development and pedagogy, capacity strengthening for oral health delivery systems in resource-challenged regions, and digital information transfer and impacts on health.

How will a trade agreement – the TPP — impact global health?

by ihsection, posted in Guest Blog, Policy and Advocacy

Guest post by Mary Anne Mercer, Senior MCH Advisor for Health Alliance International and the IH Section’s liaison with the Trade and Health Forum. Mary Anne spoke at a recent activist rally in Seattle on January 31st about public health concerns related to the TPP.

Only six months ago, when the TPP, or the Trans-Pacific Partnership, was brought up in discussions, even well-informed activists generally gave blank stares.  TP what?  But in recent weeks it’s been the subject of increasing news coverage, along with exposure to the so-called fast track authority bill that would grant President Obama authority to sign the agreement without prior Congressional review.  Although extensive negotiations on the TPP have been going on in secret over the past several years, as information about the TPP becomes better known, activist groups around the world have organized to oppose it. Just what is the TPP, and why do we care about it?

The Trans-Pacific Partnership is a “trade” deal (but encompassing many other areas of corporate rights) among 12 countries of the Pacific Rim, including the United States. Official discussions are held behind closed doors without public information or input, and without input from our elected representatives in Congress, so little is known about the specific terms of the agreement.  However, WikiLeaks has published two chapters over the past few months detailing regulations concerning intellectual property and the environment. We have good reason to expect that the TPP will ratchet up terms that are prominent in existing trade agreements that have been signed between individual countries. So although only the negotiating committees, which include about 600 diplomats and corporate representatives, know the exact terms of the deal, we have substantial cause for concern.

National and international groups concerned about global health have voiced opposition to many terms of the agreement, believing that they would affect the health and quality of life of people around the world if enacted.  Some of the main health-related concerns about the TPP include:

  • Restrictions on individual countries’ abilities to pass and enforce laws protecting public health. Through a mechanism known as Investor-State Dispute resolution, corporations would be entitled to sue sovereign governments for passing laws that ‘restrict trade’ – even public health measures such as restricting tobacco advertising on cigarette packaging, which the Australian and other governments are now facing.
  • Intellectual property laws that would set up barriers to accessing generic medicines and other health commodities (including AIDS drugs), thus dramatically increasing their costs. By extending the already lengthy duration of patents and other corporate protections, Big Pharma will have an even stronger hold on the economic gains to be made from health problems around the world.
  • Detrimental effects on equity, including the distribution of income and other resources.  There is good evidence 20 years after NAFTA that poverty and inequality have increased in Mexico and wages in the US have stagnated.  The promises of NAFTA have not been kept.

But the TPP is far from a done deal.  Many progressive groups, including a number of labor, environmental and community organizations, as well as APHA’s Trade and Health Forum, are working to oppose the TPP and the Fast Track bill.

Sen. Harry Reid, Majority Leader in the U.S. Senate, recently indicated that he is not interested in having the Senate vote on legislation granting Fast Track Authority this year. There is no question that Reid’s decision is a result of mobilization of voters across the country. We need to continue to educate and inform as many people as possible about the content of the TPP and the negative impact it would have on jobs, the environment, and on public health in the US and globally.

Violence against Women: An Important Global Health Priority

by ihsection, posted in Guest Blog, Human Rights

This is a guest post by Sarah M. Simpson.

Violence against women is a major health problem around the world and continues to be an important cause of morbidity and mortality among women.  Women suffer violent deaths either directly or indirectly, and this violence is also can important cause of morbidities such as mental, physical, sexual and reproductive health outcomes and is also linked to important risk factors for poor health, such as alcohol and drug use, smoking and unsafe sex.  The problem is so widespread that it has its own Millennium Development Goal 3 which seeks to “promote gender equality and empower women” along with Millennium Development Goal 5 which seeks to “improve maternal health”. However, in the light of several publicized acts of violence against women, this important issue is once again at the forefront of everyday discussion. Some key facts about violence against women from a United Nations factsheet:

  • A WHO multi-country study found that between 15–71% of women aged 15- 49 years reported physical and/or sexual violence by an intimate partner at some point in their lives.
  • These forms of violence can result in physical, mental, sexual, reproductive health and other health problems, and may increase vulnerability to HIV.
  • Risk factors for being a perpetrator also include low education, past exposure to child maltreatment or witnessing violence in the family, harmful use of alcohol, attitudes accepting of violence and gender inequality.
  • Risk factors for being a victim of intimate partner and sexual violence include low education, witnessing violence between parents, exposure to abuse during childhood and attitudes accepting violence and gender inequality.

In the wake of the world-wide Valentine’s Day  One Billion Rising events calling people everywhere to unite and bring an end to violence against women, The Guardian’s “Global Development podcast” has recently released a podcast proceeding  the United Nations Fifty-seventh session of the Commission on the Status of Women.

podcast

In this podcast, deputy editor of Guardian global development Liz Ford speaks with Irene Khan, head of the International Development Law Organization; Korto Williams, country director of ActionAid Liberia; Andrew Long from the U.K. Foreign Office’s prevention of sexual violence in conflict initiative; and Lakshmi Puri, deputy executive director of U.N. Women, about current global efforts to stop violence against women.

Against the backdrop of these movements to unite people world-wide, all eyes will be on policymakers at this upcoming session of the UN Commission on the Status of Women to produce and deliver results abroad and even in the United States.  Recently, two UN experts addressed the US State House of Representatives to approve the Violence Against Women Act (VAWA) which lapsed in 2011. Overall, the impact of violence against women needs to continue to be researched and explored from a public health perspective.

US Political Party Platforms on Global Health Development – A Summary by Jeff Meer/PHI

by ihsection, posted in Guest Blog, Policy and Advocacy

2012 is an election year, so political rhetoric is at an all-time high. While every possible issue under the sun is being debated and bandied back and forth, sometimes global health and development can get lost in the fray. Jeff Meer/PHI put the following document together. It contains some of the elements of the draft Democratic Party 2012 Platform, now under discussion in Charlotte. It is interesting to contrast these sections with similar ones from the Republican Party Platform, included below.

DEMOCRATIC PARTY PLATFORM:

Climate Change. The national security threat from climate change is real, urgent, and severe. The change wrought by a warming planet will lead to new conflicts over refugees and resources; new suffering from drought and famine; catastrophic natural disasters; and the degradation of vital ecosystems across the globe. That is why…the President and the Democratic Party have steadily worked to build an international framework to combat climate change. We will seek to implement agreements and build on the progress made during climate talks in Copenhagen, Cancun, and Durban, working to ensure a response to climate change policy that draws upon decisive action by all nations. Our goal is an effective, international effort in which all major economies commit to reduce their emissions, nations meet their commitments in a transparent manner, and the necessary financing is mobilized so that developing countries can mitigate the effects of climate change and invest in clean energy technologies…It is also why we have worked regionally to build clean energy partnerships in Asia, the Americas, and Africa…”

Global Development. As the United States works with allies and partners to establish an international order that advances peace and prosperity, President Obama and the Democratic Party will continue to build three key pillars of American global leadership: a prosperous and inclusive economy, our unsurpassed military strength, and an enduring commitment to advancing universal values.

President Obama recognizes that promoting global development is a strategic, economic, and moral imperative for the United States. Development expands markets for American products and creates American jobs. Strong and prosperous regional partners are critical to addressing global challenges, ending regional conflicts, and countering the spread of global criminal networks. And good governance and stability cannot take root, and basic human dignity cannot be protected, where poverty reigns and people lack access to the food, basic education, clean water, and medicine they need to survive.

For these reasons, the President this year announced a new strategy toward sub-Saharan Africa that commits to…we believe that the private sector will be the engine of prosperity in the developing world. The administration continues to work to promote opportunity and development in sub-Saharan Africa by improving the region’s trade competitiveness, encouraging economic diversification, and ensuring that the benefits from growth are broad-based…

HIV/AIDS and Infectious Disease. Recognizing that health is a prerequisite for development, the President has made unprecedented progress in the global fight against HIV/AIDS and other infectious diseases. Building on the strong foundation created during the previous administration, the President’s Emergency Plan for AIDS Relief (PEPFAR) has expanded its prevention, care, and treatment programming. As a result, PEPFAR now has made significant investments in more than 30 countries, and we set a goal to roughly double the number of lifesaving anti-retroviral treatments we provide by the end of 2013. With his latest budget, the President is fulfilling his historic commitment to request $4 billion over three years for the Global Fund, and the President remains committed to robust funding for PEPFAR and the Global Fund in the future. And President Obama lifted the 25-year ban that prevented non-citizens living with HIV from entering the United States, allowing the world’s largest group of HIV/AIDS researchers, policymakers, medical professionals, and advocates to convene in Washington to continue their efforts to improve prevention and treatment.

Our efforts to combat HIV/AIDS are part of a broader commitment to address the challenges posed by infectious disease. Over the past four years, the administration has leveraged billions of dollars in commitments from donors to meet the demand for new vaccines, making it possible to immunize millions of children and prevent premature deaths…

Women’s Rights. As we work to advance universal values and human dignity, the President and the Democratic Party understand the critical importance of expanding protections and opportunities for women and girls around the world. Ensuring full equality and providing women and girls the opportunity to learn, earn a livable wage, and participate in public decision-making are essential to reduce violence, improve economies, and strengthen democracy. To continue to make progress at home and advance women’s rights and opportunities abroad, we will urge ratification of the Convention for the Elimination of All Forms of Discrimination Against Women (CEDAW).

President Obama, Secretary of State Hillary Rodham Clinton, and the State Department are committed to advancing the rights of women and girls as a central focus of U.S. diplomatic, development, and defense interests. We will continue to promote the full engagement of women in the political and economic spheres. We will work to address underlying socio-economic problems, including women’s access to health, education, and food security. And we will ensure that women are equal participants in reconciliation and development in areas affected by conflict.

International Family Planning. President Obama and the Democratic Party are committed to supporting family planning around the globe to help women care for their families, support their communities, and lead their countries to be healthier and more productive. That’s why, in his first month in office, President Obama overturned the ‘global gag rule,’ a ban on federal funds to foreign family planning organizations that provided information about, counseling on, or offered abortions. And that is why the administration has supported lifesaving family planning health information and services…

REPUBLICAN PARTY PLATFORM:

Under “A Failed National Security Strategy,” the draft platform states that the Administration’s current National Security Strategy “subordinates our national security interests to environmental, energy, and international health issues, and elevates “climate change” to the level of a “severe threat” equivalent to foreign aggression.”

Under “Sovereign American Leadership in International Organizations,” the draft platform states that “the United Nations Population Fund has a shameful record of collaboration with China’s program of compulsory abortion. We affirm the Republican Party’s long-held position known as the Mexico City policy, first announced by President Reagan in 1984, which prohibits the granting of federal monies to non-governmental organizations that provide or promote abortion.” It also states that “Under our constitution, treaties become the law of the land. So it is all the more important that the Congress – the Senate through its ratifying power and the House through its appropriating power – shall reject agreements whose long-range impact on the American family is ominous or unclear. These include the U.N. Convention on Women’s Rights, the Convention on the Rights of the Child, the Convention on the Rights of Persons with Disabilities, and the U.N. Arms Trade Treaty as well as the various declarations from the U.N. Conference on Environment and Development.”

Under “America’s Generosity: International Assistance that Makes a Difference,” the draft platform states, “Americans are the most generous people in the world. Apart from the taxpayer dollars our government donates abroad, our foundations, educational institutions, faith-based groups, and committed men and women of charity devote billions of dollars and volunteer hours every year to help the poor and needy around the world. This effort, along with commercial investment from the private sector, dwarfs the results from official development assistance, most of which is based on an outdated, statist, government-to-government model, the proven breeding ground for corruption and mismanagement by foreign kleptocrats. Limiting foreign aid spending helps keep taxes lower, which frees more resources in the private and charitable sectors, whose giving tends to be more efficient and effective.

Foreign aid should serve our national interest, an essential part of which is the peaceful development of less advanced and vulnerable societies in critical parts of the world. Assistance should be seen as an alternative means of keeping the peace, far less costly in both dollars and human lives than military engagement. The economic success and political progress of former aid recipients, From Latin America to East Asia, has justified our investment in their future. U.S. aid should be based on the model of the Millennium Challenge Corporation, for which foreign governments must, in effect, compete for the dollars by showing respect for the rule of law, free enterprise, and measurable results. In short, aid money should follow positive outcomes, not pleas for more cash in the same corrupt official pockets.

The effectiveness of our foreign aid has been limited by the cultural agenda of the current Administration, attempting to impose on foreign countries, especially the peoples of Africa, legalized abortion and the homosexual rights agenda. At the same time faith-based groups – the sector that has had the best track record in promoting lasting development – have been excluded from grants because they will not conform to the administration’s social agenda. We will reverse this tragic course – encourage more involvement by the most effective aid organizations, and trust developing peoples to build their futures from the ground up.

Under “Advancing Hope and Prosperity in Africa,” the draft platform states “PEPFAR, President George W. Bush’s Plan for AIDS Relief, is one of the most successful global health programs in history. It has saved literally millions of lives. Along with the Global Fund to Fight AIDS, TB, and Malaria, another initiative of President Bush, it represents America’s humanitarian commitment to the peoples of Africa, though these are only one aspect of our assistance to the nations of the continent. From Peace Corps volunteers teaching in one-room schools to U.S. Seabees building village projects, we will continue to strengthen the personal and commercial ties between our country and African nations.”