EDITORIALS
What social media offers to health professionals and citizens
Christine McNab*
Independent consultant, Coogee, NSW, Australia
Timely, accessible and credible health information is critical for improving public health outcomes, whether to help people take action during an outbreak or to prevent illness.1,2 Increased access to the Internet and mobile communication combined with strategic uses of social media can bring public health information to many more people, more quickly and directly than at any time in history.
Access to information and communication technology (ICT) is growing every year in all regions of the world. About one in four people globally are using the Internet.3,4 It's a United Nations Millennium Development Goal target and the World Summit of the Information Society has vowed "to connect villages ... health centres and hospitals with ICTs" by 2015.5 As access improves, people are increasingly using the Internet to find health information.6,7
Where Internet access is low or connection speeds are slow, the rapid growth in the use of mobile phones and other devices promises increased mobile broadband access. There are more than four billion mobile phone subscribers globally, two-thirds of them in developing countries, with the fastest growth on the African continent.4 Multiple mobile or "mHealth" projects are being piloted.8,9,10 The potential to use mobile phones for public health information is enormous.
Social media, a great information equalizer, is radically transforming the way people communicate around the world.11 Instant and borderless, it elevates electronic communication to near face-to-face. Until recently the predominant communication model was "one" authority to "many" - i.e. a health institution, the ministry of health or a journalist communicating to the public. Social media has changed the monologue to a dialogue, where anyone with ICT access can be a content creator and communicator. Health professionals should ensure that information is correct and accessible.
There are countless blogs on health topics written by specialists and non-specialists alike that are read, commented on and shared globally. Are they credible and accurate? If so, they should be encouraged and supported. Social networks such as Facebook or Hi5 are used by hundreds of millions of people to communicate about a huge range of topics, including health. Type "malaria" or "maternal mortality" into a search engine and Wikipedia, the online encyclopaedia that anyone can edit, is likely to be the first entry referenced. Visuals of unusual health events can be published minutes after they've occurred on YouTube or Flickr, video and photo sites with millions of users. Inexpensive video and still cameras, including those on mobile phones, dramatically increase the number of potential publishers globally.
Social messaging service Twitter provides an instant stream of information between people around the world. Users can follow health conferences, a developing health story, search for information or share web links instantly from their desks or mobile devices. Searching for any health topic on Twitter leads to new contacts, networks and information. The World Health Organization used Twitter during the influenza A (H1N1) pandemic and, at time of writing, had more than 11 700 "followers." One account from the Centers for Disease Control in the United States of America has more than 420 000.
Communication is also possible across languages as web-based machine translations improve. While far from perfect, they allow for near-instant basic communication across language groups where none previously existed. Global volunteer translation projects are also producing multilingual content. One blog, Global Voices, popularized the social translation model now used by conference group Technology, Entertainment, Design (TED).12,13
Social media, including citizen journalism, is rapidly changing the news business. Publishers, editors and journalists are finding ways to work and compete with social media content providers, who often arrive first on the scene and can be the only people with access to information.14 One resulting change is that health institutions can communicate instantly and directly with the public, bypassing the traditional media filter. This does however put more onus on the information provider to ensure timely, relevant content with clear language for laypeople.
What's the bottom line for growing social media and health communication? Be strategic and choose wisely. Identify what needs to be said and why, to whom and when. Focus efforts on the specific social media tools relevant to the audience and use them consistently. A string of abandoned or infrequently tended social media accounts hurts credibility. Critically, health professionals need to use social media to engage in a conversation, not only to "pass down" information. The global social media community expects to be able to add value to the conversation, to help correct rumours or misinformation, provide feedback or offer personal experience.
Social media is a new and constantly evolving area. While there is a growing body of research on health information and social media, most is focused on how it can be used by advertisers to attract new consumers.15 Much more needs to be known and shared about how best to use social media to achieve public health outcomes. Action research focused on "learning by doing" and sharing lessons among peers across the globe is vital. Public health professionals should also be aware of web-based analytical tools such as Google Insights16 and analytical tips from the social media community.17,18
Twitter and other social media tools might not bring health to all, but they can help to bring accurate health information to many more people than ever before. After all, one fact sheet or an emergency message about an outbreak can be spread through Twitter faster than any influenza virus. It's an opportunity for health professionals to explore, listen and engage. 
Competing interests: None declared.
References
Available at: http://www.who.int/bulletin/volumes/87/8/09-066712/en/index.html
References
1. Rimal RN, Lapinski MK. Why health communication is important in public health. Bull World Health Organ 2009;87:247. PMID:19551226 doi:10.2471/BLT.08.056713
2. Wall I, Robinson L. Left in the dark: the unmet need for information in humanitarian responses [policy briefing no.2]. London: BBC World Service Trust; 2008.
3. Internet world statistics: usage and population statistics [Internet site]. Available from: www.internetworldstats.com [accessed on 13 July 2009] .
4. Measuring the internet society: the ICT Development Index. Geneva: International Telecommunications Union; 2009.
5. Plan of Action. In: World Summit on the Information Society, Geneva, 12 December 2003 (WSIS-03/GENEVA/DOC/5-E).
6. Fox S, Jones S. The social life of health information. Pew Internet. 11 June 2009. Available from: www.pewinternet.org/Reports/2009/8-The-Social-Life-of-Health-Information.aspx [accessed on 13 July 2009] .
7. van Uden-Kraan CF, Drossaert CH, Taal E, Smit WM, Moens HJ, Siesling S, et al. Health-related Internet use by patients with somatic diseases: frequency of use and characteristics of users. Inform Health Soc Care. 2009;34:18-29. PMID:19306196
8. mHealth for Development: the opportunity of mobile technology for the developing world. Washington, DC: United Nations Foundation; 2009. Available from: http://www.unfoundation.org/press-center/publications/mhealth-for-development-mobile-technology-for-healthcare.html [accessed on 13 July 2009] .
9. Verclas K. Google launches health and trading SMS info services in Uganda (but at a high price). MobileActive.org, 30 June 2009. Available from: www.mobileactive.org [accessed on 13 July 2009] .
10. Google Mobile. Google SMS tips for your phone [Internet site]. Available from: www.google.co.ug/mobile/sms/#6001 [accessed on 13 July 2009] .
11. Social networking increases worldwide as sites increase their focus on cultural relevance [media release]. comScore, 12 August 2008. Available from: www.comscore.com/Press_Events/Press_Releases/2008/08/Social_Networking_World_Wide [accessed on 13 July 2009] .
12. Global Voices [Internet site]. Available at: www.globalvoicesonline.org [accessed on 13 July 2009] .
13. TED conference organizer [Internet site]. Available at: www.ted.com [accessed on 13 July 2009] .
14. Stelter B. Journalism rules are bent in news coverage from Iran. The New York Times, 28 June 2009. Available from: http://www.nytimes.com/2009/06/29/business/media/29coverage.html [accessed on 13 July 2009] .
15. Vance K, Howe W, Dellavalle RP. Social internet sites as a source of public health information. Dermatol Clin 2009;27:133-6. PMID:19254656 doi:10.1016/j.det.2008.11.010
16. Google Insights for Search [Internet site]. Available from: www.google.com/insights/search/ [accessed on13 July 2009] .
17. Uhrmacher, A. How to find statistics on social media. Mashable, the social media guide, 28 August 2008. Available from: www.mashable.com [accessed on 13 July 2009] .
18. Petrie KJ, Faasse K. Monitoring public anxiety about flu. BMJ Group Blogs, 11 June 2009. Available from: http://blogs.bmj.com/bmj/2009/06/11/keith-j-petrie-and-kate-faasse-monitoring-public-anxiety-about-flu/ [accessed on 13 July 2009] .
* Correspondence to Christine McNab (e-mail: christinemcnab@gmail.com).