Vasileios Nittas, doctoral candidate at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, looks at the impact of social media and digital self-tracking tools on public health.

Opinion: ePublic Health — Where tradition meets innovation

By Vasileios Nittas
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About the author: Vasileios Nittas is a doctoral candidate at the Epidemiology, Biostatistics and Prevention Institute, University of Zurich. The opinions in this piece are those of the author and do not necessarily reflect the opinions of MobiHealthNews or HIMSS.


Electronic Public Health, or shorter, ePublic Health is an emerging 'joint venture' between tradition and innovation. It is the convergence of wisdom, arising from well-known public health concepts and the rapidly evolving ideas of the digital health market. In fact, the main aims of traditional public health practice, such as increasing healthy life years, preventing disease and promoting physical, mental and social well-being provide a lot of space for digital health innovation to flourish.

Digital health has seen multiple paradigm shifts, from an initial focus on morbidity (disease) with the introduction of the personal computer and telemedicine in the 70s; to a focus on wellbeing with the invention of the world wide web in the 90s; to a focus on prevention with emergence smartphones and mHealth in the 2000s; to the currently unfolding focus on predictive medicine with the rise of wearables, social media and the Internet of Things. While the past has been highly influential, I would like to focus on two 'tools' that are shaping the present and are expected to shape the future of ePublic health, namely social media and digital self-tracking technology.

Social media as public health intervention channels

Despite the bitter aftertaste of recent privacy scandals, social media, if used appropriately, holds an enormous public health value. Undoubtedly, it offers a sense of connectedness and social support, while providing a platform for quick information exchange and wide reach. Social media has been proven to provide cost-efficient and practical tools for public health outreach, primarily in the form of health communication and broadly targeted prevention campaigns. An illustrative example is that of an alcohol harm reduction campaign in New Zealand, targeting the reduction of alcohol consumption at early pregnancy stages. The programme used Facebook’s advertisement functions to target women aged 18-30 with preventive video and banner adds. The exceptionally large and emotional user engagement did highlight the value of such channels for reaching and activating target populations.

Social media and precision public health

However, the future role of social media in public health is expected to shift beyond being simple communication channels, to constituting essential resources for developing precision public health. Precision public health moves beyond generic public health programmes, towards informed and targeted action that considers the socio-cultural, physical and emotional contexts of population subgroups. The abundance of data generated on social media platforms can indeed be harnessed to target, tailor and personalise public health interventions and messages. A nice example of that is the use of Twitter for addressing vaccine hesitancy in the Netherlands. Lutkenhaus and colleagues used extracted tweets to identify key online communities linked to vaccinations, as well as dominant perceptions and misconceptions. This was followed by identifying key social influencers as potential collaborators, through which targeted public health messages can be conveyed to key target groups.

A further future-oriented public health role of social media is linked to spatial epidemiology. In simpler words, social media data can be used to explore and understand how diseases, their causes, and their burden spread over space and time. Again, platforms like Twitter offer an invaluable resource, providing a large number of data points, ranging from explicit information (e.g. location tags) to extractable information (e.g. emotions), that can be analysed to identify trends. A study by Gruebner and colleagues used tweets to explore the mental health implications of Hurricane Sandy. The team extracted around 350,000 tweets across New York and applied several analytical techniques to identify basic emotions such as fear, anger or frustration. These were geographically mapped to identify excess risk areas, underlying Twitter’s power for guiding public health resources during and after emergencies.

Digital self-tracking for disease prevention

A further technology that is set to influence public health are self-trackers. Whether embedded in our mobile phones or worn around our wrists, sensors and wearables are gradually becoming part of our daily living. The future of self-tracking moves beyond wearables, to technology that is implantable or ingestible, fully embedded within bodies and constantly measuring what would have previously been considered unmeasurable. With the era of the Internet of Things having arrived, the large amount of self-tracking data can be exchanged and shared across devices with little to no human involvement, undoubtedly holding large public health potential. Back in 2013, Steele and Clarke suggested an innovative self-tracking-based public health information system, build upon multiple layers. The first layer of that system would be individual data-collecting sensors, flowing through the mobile devices of users into an anonymization layer and finally into a server, through which various public health actors can request anonymous data for informing public health programs, while also feeding their interventions into the system to reach targeted subgroups. While this sounds promising, the ethics and privacy concerns of self-tracking, especially if happening from within our bodies are immense and very complex.

The inevitable emergence of ePublic Health can be described as the blending of tradition and innovation, where population health practice keeps up with the technological developments of our century. ePublic Health is, in fact, pushing the boundaries of conventional concepts and well-established public health practice. While the possibilities seem endless, the associated risks and ethical concerns (which are not addressed in this article) are plentiful and deserve appropriate consideration.