Are Health and Social Awareness Campaigns Helpful or Harmful?

Today is the Chicago Pride Parade, an annual celebration of the LGBT community where a diverse crowd lines the streets of Boystown to speak up for gay rights.  This culminates a weekend of events and is part of the larger LGBT Pride Month, which celebrates achievements by gay activists and provides awareness and education for the community.

This is just one of what seems like an endless supply of social awareness campaigns aimed at educating the public about an issue, raising money for a cause, or both.  These events can be large in scope (e.g., Breast Cancer Awarenss month and all related events organized by the Susan B. Komen Foundation), have a smaller scope, but impact the social zeitgeist (e.g., yellow Livestrong bracelets, Save the Ta-Tas merchandise), or be extremely localized (e.g., any of the dozens of campaigns found on a college campus each day).  While it’s hard to argue many of these organizations are successfully getting out their message and raising money to support efforts, are these campaigns good for their causes or more harmful?

Increased awareness certainly has many benefits, especially when taking a controversial or taboo issue and removing the stigma – think AIDS and cancer.  Awareness events are snappy and create a sense of urgency, developing a community that feels more comfortable sharing their issue and changing the cultural landscape.  But at the same time, short sound bites about a cause can distort the message.  Two examples are Prostate Cancer Awareness month, which encourages men to get their PSA screening even though there is evidence that the test is flawed and leadsto overtreatment, and Kony 2012, which got the public’s attention despite Joseph Kony being a marginalized political figure. 

Then there are the challenges that fundraising present.  Susan B. Komen is a great example of when monetary decisions compromise the integrity of the organization and lead topublic outrage.  At the same time, just because a non-profit or awareness campaign is fighting a good cause does not mean they are spending their money efficiently or that every dollar raised is going back to advancing the cause.

Am I against awareness campaigns?  No - I think they can be beneficial as long as they are part of a larger education campaign and don’t just rely on emotional pitches to rally support.  I also worry about having so many messages coming from so many different sources that they all lose their meaning and do not engage enough people.  My hope is that people enjoy events like Chicago Pride Parade or other health-related events, but continue to educate themselves about the cause long after the rainbow flags are removed from Broadway.  And, if these messages are becoming watered down or distorted, I hope organizations have the self-awareness and lack of pride to reallocate their resources elsewhere to achieve better results in another way.

What Does An All-Inclusive Resort Teach Us About The Healthcare System?

Several weeks ago, I visited an all-inclusive resort In the Caribbean.  While I should have been relaxing and disconnecting from work, my mind kept drifting back to how this model reflected the challenges of our current healthcare system:

1) Overuse of benefits: Anyone who has been to an all-inclusive resort or cruise knows that there is an endless supply of food.  I found myself grazing on snacks throughout the day and having multiple meals even if I didn't need more food.  Although those meals provided no additional benefit (and probably hurt me – did I really need that last plate of nachos?), I ate and drank because it was there and it was free.  Similarly, people with more generous insurance benefits may use more than their fair share of services, which is costly to the system and does not always mean better outcomes for the patient.

2) Subsidizing high cost consumers: Given that a lot of people were eating a lot of food, how do these resorts stay in business?  Serving low cost products is one answer, but they also benefit from the people who don’t consume as much.  These guests are far less costly, but still pay a similar, flat price, helping to subsidize the other guests.  Insurance companies do the same thing, offsetting older, sicker, more expensive patients by balancing their risk pool with younger, healthier, and cheaper consumers.

3) Misaligned incentives for healthy behavior: The resort also offered excursions like scuba diving and zip lining that sounded like a lot of fun.  These trips could have been the best part of our trip, but we chose not to participate.  Why?  It took extra effort to book the trips (we wanted to make as few decisions as possible), they weren't pushed aggressively by the resort (they were provided by other companies), and they cost extra money. 

The public makes similar calculations when deciding between healthy or less healthy behavior.  For example, cooking healthy (or cooking at all vs. going out to eat) requires planning, time that many people may not have or want to invest.  Health foods are also marketed far less aggressively than fast food and processed meals (especially to kids), meaning consumer awareness of their options may be lower.  Finally, anything “healthy” has a stigma (whether true or not) of being more expensive, which dissuades people from making these better decisions even if it’s better for them in the long run.

Interestingly, all of these issues are addressed in the Affordable Care Act (i.e., eliminates Cadillac plans, requires individual mandate to pay for higher risk individuals, allows for free preventative services).  I’m not advocating for or against healthcare reform, but I do think addressing those problems moves our healthcare system away from being a hedonist escape for a select few towards a more balanced, sustainable model.

How Can Facebook Use Its Resources To Improve Public Health?

This past month, the big news out of Silicon Valley was the Facebook IPO, when they agreed to trade more access to capital for more public responsibility and scrutiny.  While most of this responsibility is financial, it’s hard to ignore the opportunities to improve social welfare.  Given how much data they collect and how many people they influence, it’s fair to ask if they should use that information to benefit health causes.

Facebook has already taken a first step with their organ donor initiative, which gives users the ability to sign up to become a donor and share their decision online.  In the first day, state registries saw nearly 15 times more people enroll than on a typical day and over 33k new members registered in the first week.

While some people may question the effectiveness and ethics of this, I think it’s a good illustration of how massive tech companies such as Facebook and Google can use the core foundation of their products (users and data) to benefit healthcare.  Broader opportunities for Facebook may fall into a few categories:

1) Resource Portal: With a dizzying array of healthcare non-profits, for-profits, government agencies, and homegrown support groups, Facebook could act as a curator for indexing user resources.  While this idea is very Web 1.0, having a personal improvement / health portal could spark greater awareness by promoting these links rather than relying on users to find them using Facebook’s clunky search tool

2) Personal Data Management and Analysis: Given the wealth of user data, Facebook could act as an aggregator of personal health information and predict future outcomes.  Privacy concerns aside, algorithms could analyze changes in behaviors based on posts or user-generated data and provide advice if that person was looking to change health behavior.  Google tried to collect digital health records with Google Health, but it required active management by the user.  By making it passive (i.e., collecting data already entered into the system), Facebook could build a large user base that might gain traction

3) Engagement Support for Healthcare Companies: Facebook is just beginning to realize its potential as an effective outreach tool, but there are some basics that healthcare companies need to understand to be effective.  As a public service, Facebook could offer free courses on the best way to utilize their tools to more effectively engage users

Obviously there are concerns and issues with each of these ideas and a strong business case against pursuing them.  But as their influence and scope grows, and as the healthcare landscape evolves, it will become more critical to harness their product to influence health changes