Revolution meets reform: can social media help shrink health disparities in the United States?


By Jim Mittler, PhD, Medical Director (@jim_mittler)

We all know that the social media revolution is happening and it cannot be stopped¢‚Ǩ”this is according to the exponential growth of social media over the past several years. It has fundamentally changed the way in which information is disseminated and the way people communicate throughout the world today. While I believe change is a good thing, what we do with social media to improve public health communications remains to be seen. Sure, the Centers for Disease Control (CDC), whose mission is to protect the health of United States citizens, is participating quite well in social media. They have Facebook, Twitter, and YouTube pages, create widgets to add to Web sites, and actively blog; all of which serve to promote general health and release information on emerging health threats, like the swine flu. But how much of this information is really reaching patients and making an impact?

According to a recent report from Manhattan Research, patients and caregivers are harnessing the Web for health-related information like never before. Use of Web-based health resources has grown to nearly 160 million people in the United States in 2009. In fact, the number of people using the Web as their main source for health information has surpassed the number who get health information from their doctor. This is troubling in some ways because much of the information on the Web, and particularly the interactive discussions occurring in the social media realm, is unregulated. Clearly, the government puts out credible information, as do pharmaceutical companies because of FDA regulation. General health Web sites (eg, WebMD) or disease-specific advocacy groups (eg, the National Multiple Sclerosis Society) produce great patient-oriented information about medical conditions and they host blogs, messages boards, and chat rooms that build a network of support among affected patients and caregivers. While social media is great for finding information and providing support to users, the open exchange of information through unmoderated message boards, chat rooms, and Twitter can increase the potential for dissemination of noncredible and possibly erroneous health information, which could be harmful to patients. Even more troubling are the “snake oil salesmen who pose as experts and offer “medicinal products that are untested and unregulated and, therefore, are not safe. Despite these pros and cons of social media for health information, we must accept it and harness its power to improve public health and support patients in the best way possible.

The Web and social media offer convenient channels for obtaining health information, but who is using these resources?

According to recent survey data from the National Telecommunications and Information Administration (NTIA), users of the Web are more likely to be younger, more educated, have a higher economic status, and are White or Asian vs those who reported no Internet use. This is referred to as the “digital divide the gap between those who can access and have the skills to effectively use information technology and those who cannot. This concept is not new. Despite the efforts of many organizations who seek to close the digital divide, it still exists according to NTIA 2009 data.

Coincidentally, there is another divide in the United States that mirrors the digital divide. Healthcare disparities are the differences or gaps in the care experienced by one population compared to another population. The 2009 National Healthcare Disparities Report (NHDR) shows that some Americans received worse healthcare than others specifically, minorities (ie, African Americans and Hispanics) and the poor had worse access and use of healthcare, and when they did, it was of lower quality.

Can social media help close the healthcare disparity in the United States?

Several interesting observations of those who use the Web and social media suggest that it has the potential to narrow healthcare disparities. The good news is that the digital divide may be closing more quickly as people shift away from home computers and laptops to access the Web by using Web-enabled mobile devices (smart phones) more frequently. Interestingly, uptake of mobile devices to access the Web has been swift among African Americans. According to a 2009 Pew Internet report, African Americans are the most active users of the mobile Internet and their use is growing the fastest. Daily access to the Web via a mobile device by African Americans has increased 141% between 2007 and 2009. This suggests that minority populations who are most affected by health disparities are becoming increasingly connected to the Web and, therefore, have a wealth of health-related information at their fingertips.

If social media has the power to disseminate health information and support patients, it is important to know how those affected by health disparities are utilizing social media. An interesting report on the type of social media used for health-related information provides some insight on the implications for health communication. Using data from the Health Information Nation Trends Study, Chou et al found that all users most often turned to social networking sites more often than online support groups or blogs; however, significantly more nonwhite Americans used social networking sites than white Americans (45% vs 31%, respectively [P<.001]). These data suggest a unique opportunity to target minority populations with health information via social networking sites.

Where revolution meets reform.

The recently enacted Health Care Reform Act will expand access to health insurance coverage and reduce the costs associated with healthcare. Essentially, it will bring healthcare to more Americans and have an impact on health disparities in the United States. Parallel to this act, the American Recovery and Reinvestment Act of 2009 (ARRA) includes billions of dollars in Medicare and Medicaid incentive payments to providers and hospitals who adopt health information technology into their practices. The health information technology sections of ARRA (termed HITECH) are designed to improve healthcare quality, safety, efficiency, and reduce health disparities; engage patients and families; improve care coordination; ensure adequate privacy and security protections for personal health information; and improve public health.

The components of health information infrastructure are complex. However, one major component is the creation of electronic health records (EHRs). Ensuring meaningful and timely access to EHRs will be important to engage patients to take responsibility for their own healthcare. This can be achieved through a secure patient portal, which can be a standalone Web site or integrated into the Web site of the healthcare provider. A patient portal is more than a link to a patients medical record. It can also take on multiple functionalities that are akin to a social networking site. Patient portals allow interactive communication with a physician. Patients can ask questions about their disease or treatment and provide comments to their physician by self reporting disease symptoms or side effects of therapy. Patients can schedule “social events (ie, office appointments) through the portal. Healthcare providers can also post individualized educational materials to a patients splash page and suggest links where patients can find credible information on preventative health measures, diseases, and/or medications.

Patient portals represent a new form of health-related social media that can enhance the direct interaction between patients and healthcare providers and dissemination of valuable health information. Minorities who are affected by the health disparities in the United States are rapidly adopting Web-enabled mobile devices and tend to preferentially use social networking as a means to gather health-related information.

As patient portals become commonplace in the future, we may see healthcare disparities diminish thanks to power of social media.

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