Earlier this week, my friend Susannah Fox of the Pew Internet and American Life Project wrote a provocative post focusing on whether it was useless to focus on “Health 2.0” 
technologies like blogs, mobile and social networks when most people are resistant to change. She acknowledged that people may change their health behaviors for the better in the short-term, but when it comes to long-term behavior change, nothing seems to be working.
The post has generated a firestorm of commentary from across the Web and over the past couple of days I’ve taken the time to read a good amount of it. As I thought about how I would respond to this question, I began to wonder if we are asking the right one. I think the frustration Susannah highlighted has very little to do with technology and a lot to do with anger over human nature. Instead of asking: “What’s the point of focusing on all these fancy tech tools?,” the person who left a comment on Susannah’s post might as well have been asking, “What’s the point of doing anything period!” In fact, I think the sub-text of this question is: “People are stubborn and a little lazy. We keep on telling them not to slowly kill themselves, but they ignore our advice. It won’t matter if we use mobile, Facebook or Twitter to reach them, we’ll just get the same result. At some point, you have to wonder if we should just give up.”
Yes, this is the question, health marketers, public health communicators, social marketers, pharma marketers, data mavens (and others). Should we give up?
You see, I’m as tuned in as anyone to the steady march of technology. However, I never believed that the Internet, mobile phones, Twitter or Facebook would save the world – or make it more likely that people would change their behaviors. Instead, I recognized that technology, like anything else is an enabler. Media technologies make it easier to reach people, but it won’t make them change. No, a person has to want to change for change to happen. And, change often happens because the person thinks it will benefit them in some way.
A few years ago, I took a look at an initiative run by the Association of Black Cardiologists designed to decrease the risk of heart attack and stroke in African Americans. The initiative had a simple, but provocative name and message: “Children Should Know Their Grandparents.” ABC urged people to change their ways, not for themselves, but for those they loved. This project was launched before YouTube, Facebook, Twitter and MySpace were on the scene. However, if it were, I think it would have a major impact.
Yes, we don’t do a good job getting people to change their behaviors over the long-term. But, I don’t think we should despair. Instead, we should focus on recognizing what works and ensuring we spread the message of success far and wide. In the end, we should use whatever gets the job done — whether it be Facebook or a face-to-face meeting.
Susannah, it’s hard as heck to change behaviors, but I’m not ready to give up. I’m glad you aren’t either.
(P.S. anyone interested in how we can change behavior over the short and long term should study the CDC’s VERB Campaign. Click here for a case study on this initiative published on our knowledge community, Living the Path.)
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The issue is not about giving up, but rather about applying limited energies and resources more effectively. Here is my point…
Today we are looking at millions being pumped into health-app start-ups, none of them profitable (or nearly profitable). Billions being pumped into linking electronic health records that ePatientDave showed us can be quite inaccurate anyway (given his GHealth uploading experience, albeit with claims data). So, after a few billion dollars of public and private investment we will have some iPhone apps that “self-informers” will use, a few “vibrant” patient communities of 10,000 patients with only 1,000 patients active (does anyone hear the sound of “disruption” here?), and a vaguely interconnected network of health information space junk.
OR, we legislate that patients should be entitled to receive within 24 hours of demand a one page health summary from their doctor + a copy of test results that they ordered and scripts that they wrote in the past 12 months, and leave it up to the clinics to work out how they deliver on it. Period. Then, lets use the billions left over, and our passion to do more diabetes screens in schools, factories; more mammograms; more childcare for teenage moms so they can go to school/college; more after-school activities to promote fitness and wellbeing at an age where behavior modification can make a big difference.
Unfortunately most Health 2.0 debate revolves around defending new technologies as the solution. And in the process, we’re missing the main point that many preventable social and health problems are just festering away. When technologies are the answer, they take off by themselves (case in point, Google Maps vs Google Health). And I’m sorry, but the HIT horse has been whipped and crying, trying, dying for years.
Even Bill Gates, the informatician himself, isnt using his legacy to fund electronic health. He’s funding vaccines and development of treatments for real, preventable problems.
The bottom line -
I believe that most “Health 2.0″ evangelists today would be just as information hungry, and just as demanding of their doctors whether or not they had access to the internet – let alone migraine trackers and wireless glucometers. And while I believe that some patient forums and apps might be of some value to some patients, I find it hard to believe that those patients would really rather have the technology over more screening, medications and services available to help them with their disease.
Health 2.0 – prove yourself quickly or step aside.
@DarthMed
DarthMed: Thanks for your comments on my post. I’m not going to spend time defending technologies — whether they are called “Health 2.0″ or otherwise. At the end of the day, it’s not the technology you use, but whether the methods you are using are getting people to take action. One example I like is when AIDS.gov partnered with a company called Community Voice Mail to encourage homeless people to get tested for HIV/AIDS. (See a case study on this project here.) This population didn’t have fancy technology. In fact, they barely have phone access. Yet, AIDS.gov found a way for them to take action in a small way, which then can lead to long-term behavioral changes because they know their HIV status.
Again, it’s possible to get people to focus on doing things that help make their lives better, but it would be wrong to focus on technology rather creating, disseminating and duplicating best practices in behavioral change — for the short and long run.
Appreciate this post and comments. I believe a consumer movement can occur when health insurers, hospital networks, emr providers begin to message the importance for patients to be more accountable for their care. Gone are the days when we can assume everything will just work out. Seems to me there is a unique opportunity right now to educate consumers on the real cost of healthcare and benefit of technology within healthcare systems. Technology drives efficiency. Efficiencies save money. If we start with an EMR/like system, we can build from this base to message all the other incredible technologies and biomeds available to treat and track various things. There is no reason, why the industry can’t ask patients to keep track of their health and records. Further, with Healthcare and the economy currently in the spotlight, let’s have a real conversation about it at the customer level. We’ve got accounts that track hundreds of details about our life. Why wouldn’t we want an account to track our health and the health of our family members. Consumers have every right to demand efficiencies and cost savings in their care. Until we change the messaging, we’ll continue to have confusion and apathy. For providers/insurers who aren’t investing in technology due to the costs – I get that but never has there been a better time for supplier negotiations and deployments. The evolution of cloud technologies, advancements in products and implementations are all cost benefits you can realize right now. I think we’re close we just have to continue to build the path and have faith in consumers.
I’m a little baffled by darthmed’s point both on ePatients and over here.
Yeah, so it’s hard to change behavior. Yeah it’s a good thing to have more preventative and primary care.
But Health 2.0 communities and tools are clearly helping patients and saving lives here and abroad. And there’s oodles of research from Kate Lorig/David Sobel and lots of others that online (and offline) support groups help patients achieve better outcomes at lower costs.
So is the complaint that spending on building Health 2.0 technolgies is crowding out spending that should go to preventative care? I think that’s the point of Darthmed’s comment on Fard’s piece here. If so that’s totally laughable. Maybe, maybe (even counting Revolutions big dump) a total of $1 billion has been spent in recent years building Health 2.0 technologies. We spend $250 Billion a year on cardiac treatments that have very dubious efficacy. Americans spend $10 billion a year on supplements that don’t do anything (according to most rigorous scientists). We spend $14 billion a year on a single drug (Lipitor) that many people say is harmful, let alone has insufficient evidence of doing what it says it does (reduce death from cardiovascular disease)
Point 2 is more crucial. Are we building tools for just already engaged patients? My answer would be that the tools make patients who had the potential and latent desire to be engaged get involved very easily. Clearly we don’t have all levels of patients as engaged as some of us might like–but more Health 2.0 technologies will be developed to bridge that gap.
And if we don’t get to everyone, so what? We’ll get to more people and do more good than giving up.
Weightwatchers has had success showing that easy tools plus communities can lead to behavior change. That’s exactly what Health 2.0 does (combine tools and community support). And yes there are still obese people. That’s life–not everything will work 100%.
But I’m most puzzled by darthmed’s claim that instead of Health 2.0 we should just ” legislate that patients should be entitled to receive within 24 hours of demand a one page health summary from their doctor + a copy of test results that they ordered and scripts that they wrote in the past 12 months, and leave it up to the clinics to work out how they deliver on it.”
Err…who does he think is behind that demand? It’s the predominantly Health 2.0 crowd behind http://www.healthdatarights.org leading that charge. The Health 2.0 technology crowd would love that easy access to data.
How DarthMed sees that as contradictory to Health 2.0 is beyond me. And maybe it’s just intellectually sloppy on DarthMed’s part to talk about billions of public dollars going into linking records, and equating that with Health 2.0. The ARRA/HITECH stimulus dollars are primarily about getting physicians to use electronic clinical workflow tools, and part of that is a demand to make the data able to be presented to patients. That’s exactly what Darthmed wants (and what the Health 2.0 evangelists of which I’m barely one) want too.
We might agree that instead of the modest carrot the government is offering, they could use a much bigger stick (e.g. no data no pay) to get to the same place, but in the real world of Congressional politics, that isn’t going to happen.
So I’m bemused by Darthmed’s demand that “Health 2.0 – prove yourself quickly or step aside”
And if we’re really all for diabetic screening et al for the underserved (and I am) why isn’t Darthmed screaming about the collapse of the health care reform bill? In that as part of his “buyout” Bernie Sanders got $2 billion increased funding for community health centers which do exactly what Darthmed is looking for. Surely the loss of that funding as health care reform dies is far worse than any “waste” on Health 2.0 technologies.
I would have to agree with Suzanne Fox on this issue. There is no evidence yet to support a headlong rush into social medial by idividual physicians and providers. I address this very issue on my blog Mind the Gap in a post entitled “Patient-centered Care and Physician Use of Social Media.” http://healthecommunications.wordpress.com/ where I present data from recent published research on the subject.
From my persective, Social Media reminds me of that saying “if you have a hammer every problem look like a nail.” If social media eventuall adds value for healthcare consumers will eventually adopt it. How come we never hear anything these days about Friendster and Myspace – weren’t they the Twitter and Facebook only a few short years ago???
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