Don’t Die of Ignorance

Or so the leaflet pushed through every household in Great Britain’s letter box said. The problem of this most iconic of public health responses was that at the same time it was incredibly naive but also too clever for its intended audience.

It depicted the HIV challenge in the early 1980s as an iceberg where we can only see the tip of the challenge. It suggested most impact, hidden lifestyles fuelling its growth. and knowledge of its prevention remained hidden under the surface. It was a great visual device, but it just did not work for its target audience.

It was not specific enough for those people actually at risk to understand the consequence of their sexual activities or drug injecting, and too vague for the general awareness of the public needed to create a supportive environment for policy change, increased sexual education and compassion for people affected. On both counts it just caused confusion and was simply too bland.

Recently it has become regarded as an iconic piece of public health, mainly because of its scale and recognisability but there is very little evidence of it actually changing behaviour. Curious then that in my current endeavours to explore how public health teaching is responding to openness in a web.20 world, that I keep returning to that picture of the iceberg, and to that same phrase “don’t die of ignorance”.

Catherine Cronin suggests educators should develop digital literacy (for me this reads as digital health literacy); help people navigate between openness and privacy; and, reflect on the role of education in a digitally connected world This has great resonance for the public health teaching task ahead and my current reflections upon how openness intersects with my own public health teaching and practice, struggle with just how ‘open’ we need to be in responding to the hidden and dishonest forces we face.

The open and hidden (below the waves) challenges for public health

In recently exploring the impact of the rise of Web 2.0 on health, public health’s inability to keep pace with it, and in questioning who ‘profits’ from ill health (by conduct their activities through cloaked; veiled; disguised, or purposely anonymised activities) I have constructed a mapping tool.

I am still working on it, but even within just a few examples it illustrates how web 2.0 offers both a rich environment within which to promote health but simultaneously enables pathogenic forces to flourish.

This spectrum of openness to anonymity (including the so called ‘dark web’) is a potentially rich field to explore in public health teaching and research, and some of it is in open view (above the waves) in very public debates about its impact on sexual and mental health/bullying and debates on the social media campaigns around sugar and obesity are well developed (the #AdEnough campaign includes a specific challenge to social media for targeting children’s sugar consumption). But is this enough? Does public health work with the same parameters that its opponents do? Is it effective? How much still lies unrecognised?

Does Public Teaching see the challenges beneath the waves, does it even see an iceberg?

Clearly there are a host of new challenges for public health, and, openness/anonymity is emerging as a key factor within that. What though of public health teaching? Has it seen the iceberg and responded to this challenge? Is it developing new social digitally aware curriculum material for promoting health, and is it harnessing open education tools and philosophies within its response?

There are curricula in public health that include attention to social media and health such as LSHTM’s Health Promotion Practice Module. Our own University of Manchester MRes Public Health Unit Working With Communities has developed in recent years to include virtual communities within its scope and is about to develop a parallel course unit on “Working with Virtual Communities”.

But these examples belie the fact that most public health course have just not caught up with the curve and on the whole public health teaching appears to only pay lip service to digital determinants of health! This is a bold claim but let me explain further…

Even within an unfamiliar Web 2.0 territory with challenges all along the open — anonymous continuum, public health teaching should have a wealth of things it can contribute. Theories, models, practice guidelines, evidence-based interventions etc. may need to be evolved for the virtual world but its vast history should provide a great foundation upon which to build this development. The teaching itself must become more open and more freely available so that ordinary people can access and use its tools and evidence base to understand and tackle virtual and digital health threats (e.g. the way illness causing industries manipulate the media and propagate poor science and skew health evidence).

Health information on the world wide web and in social media as it stands is able to be enhanced, degraded or twisted at will but where is the public health academic contribution to exposing/opposing his?

Openness by providing wider access to public health evidence, health promotion resources, skills development and tools is crucial but opening up in terms of research is also important. Promoting the importance of ethically sound research and ensuring good research gains a wider recognition and is not overlooked in the plethora of fake health stories and dumbing down of complex heath findings could help health educators in parts of the world not so rich in local public health or academic departments to tackle their local issues.

But isn’t this already happening? You might think so, but I am not sure whether the threat of this Web 2.0 iceberg is really taken so seriously after all.

The emergence of public health open education (OER) resources has been championed for the last decade drawing on public health’s supposed philanthropy and its implicit drive to redress global inequality and the Public Health Open Resources for the University Sector Collaborative (PHOR) have designed and tested OER but found that pre 2011 the UK had produced relatively little resources alongside a slowly growing global presence.

This may still be the case as my own recent search on Coursera for Public Health courses returned almost 500 hits, yet most were not actually recognisable public health curricula, and the valid ones I did find were very traditional in orientation (such as epidemiology) simply uploaded into a new medium but not bringing new skills and knowledge to the web 2.0 world.

A similar search on “public health MOOCs” returned a lot of hits but the traditional courses in global health; screening; health systems and human assistance, were again much in evidence whereas the sorts of courses I was searching for in tackling abuse of health online, or how to develop health promoting viral media or memes were largely absent.

More positively some OER developments are worth considering, such as exposing big tobacco’s tactics or teaching about impacts of social media (openness) and mental health for young people.

The John Hopkins School of Public health is particularly active in the field with 24 different courses which by 2014 had already enrolled over 2 million students; the University of Maryland School of Public Health have a valuable collection of OER for public health; and Public Health England have just launched their own digital public health strategy “Digital-first” which includes a maturity index for measuring digital progress that public health academics could take inspiration from.

These show public health teaching has begun to recognise the visible extent of the web 2.0 iceberg, there are some tailored resource for tackling digital public health and there are some OER public health programmes but in the main these remain traditional in their content and naive to the step change that is required.

I can only conclude that for some colleagues the implications of web 2.0 appear to remain like some far-off iceberg but if public health teaching itself is not to die of ignorance it really does need to alter its course and to borrow another iceberg analogy from the Titanic, steer in a radical new direction before it is too late.