The Revolution Will Be Tweeted

Chaos and opportunity. The digital revolution has spawned both.

A 1,000-foot wave moving at 1,000 miles an hour, the Web/mobile technology/social media surge has upended industries, academia, government, cultures and the entire global economy in its head-long rush to the future. It has ceded broadcast rights to everyone and shattered (and often shuttered) the traditional media. Numbers tell the story: 1.1 billion Facebook users, 400 million tweets per day, 6 billion hours of YouTube videos viewed each month (almost an hour every month for every human being). 

Like everything else, global health communications—how we gather data and stories about public health, convey discoveries and persuade others to act—has not been exempted. Traditional journalists have lost the financial model that supported global health reporting, while researchers, practitioners and advocates have embraced the possibilities of connecting directly with their communities through social media. And for their part, experts in behavior change communications now work in a wholly new world with a bewildering array of media and platforms through which to channel their messages. 

For better (mostly) or worse, we live in an era rife with change. Based on interviews with journalists, communications experts, and others, here are five key lessons for the new world of global health communications.

It’s Time to Adopt New Models 

In the last decade or so, newspapers like the Boston Globe, Miami Herald and Baltimore Sun closed their international bureaus. More than a third of U.S. foreign correspondent positions were shed between 2003 and 2011, according to the American Journalism Review. With them went many of the opportunities for the general public to encounter stories about malaria, AIDS, tuberculosis, and other health issues outside the U.S. 

To ensure that global health issues still make it to the mainstream media, journalists have found support from the Bill & Melinda Gates Foundation and other organizations such as the Pulitzer Center on Crisis Reporting. (The Bloomberg School recently partnered with the Pulitzer Center on a student reporting fellowship. See the resulting article on page 38.) Beginning in 2010, the Gates Foundation has supported a global development news section in the U.K. newspaper The Guardian. Recent stories supported by the Pulitzer Center have appeared in The Economist, The New York Times, The New Yorker and in other venues. 

Financial support from foundations and other organizations is a new model for journalists. “The bottom line in the global health reporting community is there’s no other money to do this with, so we have to make sure we are very careful to report what we see and not let where the money comes from influence us,” says Joanne Silberner, who used a Pulitzer Center grant to report on cancer in Uganda, India and Haiti for Public Radio International’s The World. “This is new so it’s concerning. I think the firewalls are being constructed.”

Information Needs to Lead to Motivation

Like nature, the Web abhors a vacuum.

The digital revolution has empowered NGOs, universities, government agencies and foundations to fill the void in global health information left by old-school media.  

The Gates Foundation, Population Services International, and many others daily post articles, videos, photo galleries, and podcasts about global health issues related to their efforts. One powerful example of the possibilities of new media happened in August 2012. The UN Foundation filled the traditionally slow news month with “Blogust”—a relay of blog posts about vaccines by top “mom bloggers.” Each day, a different blogger took up the topic and touted vaccines’ importance to her legion of followers. The effort raised $200,000 and attracted more than 29 million page views, according to the Foundation. “[The UN Foundation has] worked with [the moms] since to great effect,” notes Kate James, the Gates Foundation’s chief communications officer. “They are building this group that wouldn’t automatically be engaged to be real champions around vaccines.” 

The Gates Foundation itself recently partnered with social media companies like Tencent and Sina Weibo in China and with China’s Ministry of Health on a successful tuberculosis prevention campaign, she says. They followed that with a campaign on tobacco control in 2012 and raised awareness of the dangers of passive smoking from 5 percent to 19 percent, James says. 

The greater challenge for global health organizations, says James, is to push beyond awareness. “The big shift now is how to move from output—the sheer number of articles about an issue—to outcomes, in terms of commitment to investment and [other] worthwhile things,” she says.

Use Social Media’s Brilliant Feedback Loop 

Traditional media relies on the “blunt instrument” approach, says Christy Feig, MPH ’08, director of Communications for WHO. 

The story is researched, written and published—and then readers and viewers may or may not understand it.

Social media is more of a conversation, says Feig. “With social media, you put something out, and the thought process people go through is live. You can add more information and modify and refute misinformation—all while the thought process is going on,” Feig says.

As an example, she points to her teams’ efforts after Japan’s Fukushima nuclear disaster in March 2011. In the days after the damaged plant’s release of radiation, her team discovered rumors circulating in social media. Some messages circulating in China advised people to consume large amounts of iodized salt to protect themselves. (The rumors had a kernel of truth: Potassium iodide, taken in proper amounts at the right time, can prevent radioactive iodine from being absorbed by the thyroid, according to the CDC.) “We instantly jumped in there and said… ‘Don’t eat excessive amounts of iodized salt. There’s not enough iodine to protect you, and too much salt can be toxic,’” Feig recalls. 

WHO’s messages were picked up and circulated through social networks and mainstream media. Iodized salt stopped flying off store shelves. Three days after the initial rumor, Agence France-Presse ran a story with the headline “Chinese seek refunds as salt panic subsides.”

“I think the days of just putting information out there are long gone,” Feig says. “With social media we can get a real quick look at whether or not people are hearing our message the way we need them to. It’s a brilliant feedback loop.”

There’s Still a Place for Skepticism

In the eternal quest for attention and support, many NGOs emphasize the positive and trumpet success rather than acknowledge nuance and the messy complexity of real life.

Missing from this mission-driven media is journalism’s skeptical filter. Reporters seek out more than one side of a story and report on failures in the belief that it’s as worthwhile to learn what doesn’t work as much as what does.

“I am very happy to write about success [but] I’m just concerned that within global health we should not assume that all is always for the best, just because our intentions are good,” says Sarah Boseley, a Guardian editor who runs its global health blog. “I think journalists should approach everything with a critical eye and seek more than one point of view, if there is such.”

She adds: “I think if we only ever write the upbeat and positive stories, we will cease to be believed, because life is not like that.”

Indeed, as traditional media and its skeptical oversight has pulled back, communicators within NGOs, agencies and other organizations need to ensure their leaders stay honest in their messages, says Dick Thompson, a former Time magazine correspondent and communications advisor to the WHO director-general.

Leaders need to realize that credibility is their most important resource, says Thompson, now a senior advisor to the Pulitzer Center. And internal communications teams should be responsible for reining in claims that could endanger the organization’s reputation. He adds: “People responsible for communications [within organizations] have to be very aggressive and sometimes have difficult relations with people in their programs.”

For Best Results, Mix Media

The profusion of communication channels has made it much harder for any organization to hold readers’ and viewers’ attention—this is especially true for programs advocating behavior change. Susan Krenn, director of the Johns Hopkins Center for Communication Programs, says things were simpler when she started at CCP in 1985. Then, CCP teams could put their behavior change messages on a country’s single television station or one of its few radio stations and be assured of a significant audience. (Often, they could barter for airtime with a box of sorely needed new video or audio tapes.) Now, they must deal with dozens of channels and stations, as well as investing in social media and other efforts.

Still, she believes that today’s tools are pretty amazing. By tying mobile health efforts with traditional media, CCP can achieve powerful synergies in disseminating their message. For example, in Tanzania, they used an ongoing family planning mass media campaign to promote a text message service that dispensed information on family planning methods, services, etc. They increased the number of hits on the service’s website from 5,000 to 100,000 per month.

By harnessing old and new media, her team was able to tame the chaos and maximize the opportunity.