Better Health For All

Social media is ever present in today’s society, and levels of interest in the use of social media to support action to promote and protect health, alongside understanding and protecting against potential harms is growing. To help harness social media to support health we need to better understand who, and how, people engage with the platforms available to them, and the impact of those actions.

In 2018 in Wales, Public Health Wales in collaboration with Bangor University, carried out a nationally representative survey amongst adults (aged 16 years and above). The household survey was delivered face to face and collected the views from over 1,200 people on their access and use of digital technologies, including social media, and demographics and levels of health and wellbeing.

Our findings were surprising. Overall, 77% of the adult population in Wales reported using social media, with 65% using it on a daily basis (weighted to the demographic distribution of the Welsh population). The most frequently used platforms were Facebook, followed by WhatsApp, and YouTube. Of those remaining, approximately 10% had access to the internet but did not engage with social media, and a further 10% did not have access to the internet at all.

Digital exclusion (not having access, skills or digital literacy needed to use internet enabled technology) has been highlighted before in Wales and across the UK, and is recognised to be higher amongst older populations those in more deprived areas, and in poorer health. Given the increasing reliance on internet and technology across society, digital exclusion could be considered as a new social determinant of health.  The continued efforts of many organisations such as Digital Communities Wales to support everyone to have the opportunity, skills and capability to engage with online platforms is essential – ensuring a progress on digital is not inadvertently widening inequalities.

Back to our survey – where our findings challenged the preconception that social media is only for the young. We found that, amongst those who do have access to the internet, use did decrease with increasing age but a high proportion of the older age groups were using social media – 76% of those aged 60-69 years and 60% aged 70+ years. We also found higher engagement with social media amongst women than men – but differences across platforms. For example, more women used social networking, photo content and messaging platforms, whereas a higher proportion of men used video content platforms.

When considering differences by health status, we found that people with lower self-reported health and those who engaged in health-harming behaviours (smoking, inactivity and/or high levels of alcohol consumption) were less likely to engage with social media. Many studies have explored how social media offers people the opportunity to communicate and interact with others and find and receive information about health conditions – but not all may be interested or able to engage.

Collectively, these findings highlight the importance of understanding the audience, where they are (or not) on digital platforms, to inform and target relevant information.

Lastly, we found that engagement in social media was similar across deprivation quintiles (see figure below), with the exception of Twitter and Whatsapp which had a lower level of engagement in those least affluent. The potential for social media to reach more deprived populations has also been reported elsewhere, and warrants further exploration to better understand how we can use social media to reach and engage all communities in health.

Back to my question – can social media offer a way to engage across social groups?

Possibly.

First there is the challenge of digital exclusion, recognised to be higher in more deprived areas, older populations and those in poorer health.  There remains the need to overcome structural, educational and behavioural barriers contributing to digital exclusion. Should this be achieved then our findings pose some interesting areas for further exploration, given that we found no difference in engagement in some social media platforms across deprivation groups.

However, in this short blog I have somewhat simplified a complex challenge, and one that includes questions of trust, quality and reliability of information online, better understanding the relationship with well-being, and the need to build in evaluation – all in a fast-paced environment.

There remains much to learn about the role of social media in health, both beneficial and harmful. But as public services move to digital channels, continued efforts are needed to understand and address inequalities in access, alongside recognising that social media may offer a platform to reach a wider audiences and engage differently with populations about health.

Written by Dr. Alisha Davies FFPH PhD  Head of Research & Evaluation, Public Health Wales

NOTE:

This report is the second in a series called Population health in a digital age, the first published in 2019 and explored the use of digital technology to support and monitor health in Wales.  Both reports and infographics are available here

• Population health in a digital age: The use of digital technology to support and monitor health in Wales
• Population health in a digital age: Patterns in the use of social media in Wales. Public Health Wales & Bangor University

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Health in All Policies (HiAP) is a way of working with policy makers in other sectors that aims to build the social, economic and physical conditions that support good health and prevent health inequalities. Healthy Lives, Fairer Futures, the call to action from the Committee of the Faculty of Public Health in Scotland, calls for a strong commitment to this approach to ensure that all public policies help everyone in Scotland to realise their Right to Health. As partnerships in several areas of Scotland are using HiAP, several colleagues attended a workshop in early December to share our experiences. The workshop was organised by the Scottish Health and Inequalities Impact Assessment Network, which is part of the Scottish Public Health Network.

WHO describes Health in All Policies as ‘an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity’. In public health we often work with partners to address defined public health priorities. HiAP differs from this because the starting point is a proposed policy and the aim is to identify all the likely effects on health, rather than focusing on one priority issue. This can help identify how to achieve the best overall health outcome from the policy. It often involves a formal approach like Health Impact Assessment, integrating health into other assessments or using other tools. The approach fits well with Scotland’s National Performance Framework, which places Wellbeing as a central purpose of government and recognises the contribution of the other national outcomes to that purpose.

Participants at the workshop shared their experiences of HiAP so far and discussed what is needed to develop and support this work. The group recognised that HiAP should be based on good working relationships and an openness to build understanding of constraints and opportunities in all policy areas. Every local authority area in Scotland has a Community Planning Partnership that brings together public, private and third sectors to agree how to meet the needs of their communities. These are an excellent platform for HiAP and other forms of partnership working and some Community Planning Partnerships have now developed formal governance structures to support HiAP in their areas. We also discussed the place of HiAP within the developing Whole System Approach being taken to the Scottish Public Health Priorities, and noted the need for alignment of national and local approaches and policies.

The workshop identified enthusiasm and commitment to this way of working across partnerships in Scotland. Participants agreed to continue to share experiences and develop our understanding of how use HiAP to achieve better outcomes. The Faculty can also support this, by continuing to advocate for Health in All Policies, at both local and national levels, and encourage Faculty members to adopt this approach. We are optimistic that by working collectively we can create public policies that allow people to thrive, improve health and reduce social and health inequalities.

Written by Dr Margaret Douglas, University of Edinburgh

Further information

Faculty of Public Health in Scotland (2017) Healthy Lives Fairer Futures: a call to action    https://www.fph.org.uk/about-fph/board-and-committees/a-call-to-action/

WHO (2013) Helsinki Statement on Health in All Policies https://www.who.int/healthpromotion/conferences/8gchp/8gchp_helsinki_statement.pdf

Scottish Government (undated) National Performance Framework                     https://nationalperformance.gov.scot/

Scottish Government and Confederation of Scottish Local Authorities (2019) Public Health Reform. Scotland’s Public Health Priorities – Local Partnerships and Whole System Approach                                        https://publichealthreform.scot/media/1570/whole-system-approach-for-the-public-health-priorities.pdf

Scottish Health and Inequalities Impact Assessment Network resources on HiAP and HIA: https://www.scotphn.net/networks/scottish-health-and-inequalities-impact-assessment-network-shiian/shiian-resources-information/reports/

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