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How can social media support knowledge exchange on the social determinants of health?

This blog was written by Cameron Norman and Pemma Muzumdar for the National Collaborating Centre for Determinants of Health and was first published on November 3, 2013, at

My humanity is bound up in yours, for we can only be human together
-- Desmond Tutu

Social media represents more than a set of tools and technologies that connect people to information and each other. Rather, social media represents a simultaneous return to the roots of health promotion and a paradigm shift in health communications. Social media tools may enhance public health efforts to engage the public, collaborate across sectors, and exert influence. This blog, along with a webinar and online conversation, looks at social media and its emerging role in supporting public health to exchange knowledge on the social determinants of health and take action to advance health equity.

Social media communication is mobile, fast, scalable, non-hierarchical, non-linear, narrative-based, and collaborative. Unlike traditional communications media, social media channels are designed for conversation rather than broadcast, and users – individually and collectively – are placed at the centre of the message and the medium (, and are responsible for generating content. Messages no longer flow from one to one or one to many, but rather from many to many. Every participant has equal voice, and has an equal opportunity to use it. What’s more, a range of communication channels are always at play: a photo and message from Instagram ( may be included in a Wordpress blog (; compressed to a tweet and published on Twitter (; fed into a LinkedIn ( profile, shared in a YouTube video (; posted on Facebook (; captured in a storify story (; and the list goes on.

By placing organizations, networks and individuals on equal ground, social media can create opportunities to engage multiple sectors on issues related to the social determinants of health ( and health equity (, and can offer a complementary online environment within which public health professionals can share thoughts, resources, and follow opportunities for further exchange.

In their review of social media and public health, Schein, Wilson and Keelan (2010) ( describe the social media landscape as being characterized by interactivity, user-generated content and multi-directional communication flows (p.4); all of these characteristics challenge the model used in many public health communications. That being said, engaging others in dialogue fits with the central tenets of health promotion practice (

Starting and participating in conversations related to the social determinants of health, health equity, and public health

Social media creates a hybrid space where interactions can be highly personal. Information can also be personalized; modified for and directed to specific individuals, organizations, and networks. Participating in social media is akin to having intimate conversations in public. Thus, many of the same conventions we would use in our conversations apply. This means creating a space for give-and-take, sharing, and a willingness to hear other perspectives.

General rules for participating in conversations

Have something to say, be authentic, and share what you know.

A strategy is critical for using social media effectively. This does not mean prescribing each message or limiting flexibility to respond in conversation. Rather, it means knowing why you are having certain conversations. Are you starting a conversation to encourage the use of evidence? Share a resource? Invite discussion around a possible area of tension? Inform a specific group? To learn from, or with, others? Or, is it a combination of the above, as they may happen simultaneously? Being strategic will help you to “speak” with an authentic voice across social media channels.

Give and take, conversations are not one-sided.

You may want to start the conversation by sharing what you know, and also including a question, or an invitation to comment “What do you think?”, “How might we do X?” or “How has this affected you?” are all questions that elicit different kinds of reactions to which social media is well-suited.

Whenever possible, make connections: hyperlink, mention, and tag.

To better connect related posts, as well as to help other users follow relevant information, make an effort to learn conventions such as hyperlinking words within text (, mentioning organizations and individuals when appropriate (, and embedding tags into your social media posts (

Sensitize yourself to the needs of your organization, if relevant, as well as your audience.

Make sure your organization has a policy for how to handle the sharing of material and what constitutes an endorsement or what is considered to be a personal perspective vs. an organizational perspective. Ask some questions about what can be shared across your accounts and your networks like those asked in a post on public health and social media. (

Start and end when appropriate. Throughout the process assess how things are working relative to expectations. Social media strategy requires ongoing developmental evaluation and iterative steps to creating, re-creating and sharing messages and conversations on a timeline appropriate to the conversations being had.

Tracking conversations related to the social determinants of health, health equity, and public health.

The introduction of the hashtag (#) ( as a tracking mechanism on Twitteris one of the most widely used tools within social media. When you click on a hashtag, you are directed to a page that contains all other tweets that have been similarly “tagged.”

Colleen Young promotes the #hcsmca hashtag to denote healthcare social media canada in all of her (and her peers') related posts to allow people across networks to track conversations. Although the hashtag originated as a means to denote Twitter topics, it is often used with other tools such as Instagram, Facebook, and Youtube more often because it is easily searchable and distinguishes it from other text.

Certain hashtags are specific to the social determinants of health (#sdoh), health equity (#healthequity), and public health practice (#publichealth). Social media postings, particularly on Twitter, often have character limits, and must remain concise. To save space, hashtags are often used to replace the words they represent. For example, one would say “check out this #sdoh resource” instead of “check out this resource related to the social determinants of health.”

Capturing (documenting) conversations

Tools such as Storify( and Tweetchat (the website) ( can be used to aggregate comments and posts organized through a hashtag. Specific media objects (e.g., pictures, websites, other  social media posts) can be included and curated – selected, edited, and/or placed in a specific sequence – to create ‘storylines’ that show the flow of conversation. These are really collections of artifacts gathered from the conversation stream that can be used to preserve learning, generate further conversation, and assist in the identifying next steps and follow up actions.

The blog post was intended to spark a larger conversation. Two online events that took place included a Health Equity Clicks online conversation November 7–14, 2013, and a webinar on November 12, 2013, that explored the following questions:

  • How is your organization using social media to exchange knowledge related to the social determinants of health and health equity?
  • What are the challenges and opportunities associated with using social media to support social determinant of health interventions and programs?
  • What do public health practitioners need to capture and evaluate the use of social media in their social determinants of health-related efforts?

Below are some of the comments that appeared in the Health Equity Clicks online conversation in response to the question: How is your organization using social media to exchange knowledge related to the social determinants of health and health equity?

At Upstream (, social media is currently our primary way of engaging our audience. We’ve found Facebook, Twitter, and Google+ great platforms for disseminating information about the social determinants of health, and regularly encourage our followers to share posts/tweets broadly so that we can reach people who aren’t already following us. Because our work is more focused on reframing discourse than direct policy advocacy, social media is an invaluable tool. Our think-tank is still in the making, but it will feature clusters of experts, advocates, and community members on the different social determinants of health, each group in charge of developing accessible, shareable content for our website and social media. This might include pointing us to a great community initiative or paraphrasing a seminal research paper in layman’s terms.

At the end of the day, however, engagement on social media is the first rung on our ladder of engagement. Using NationBuilder (an online community building platform) and custom software that we’re developing, we’ll be able to track the engagement of individual followers, including what types of information appears to be most meaningful to them and what issues compel them to ‘like’ or ‘share’. This way, we will be able to follow up with specific action items and campaigns to get involved with. So if someone retweets every post we make about poverty, we would follow up with them and point them to a local organization working toward income equality that needs volunteers. If someone shares a couple of posts about better cycling infrastructure, we would check in to see if they could help us with an upcoming bike lanes campaign.

Social media can be highly passive, but if you can follow up strategically, it can be a low-barrier entry point for people who care deeply about the social determinants of health without ever identifying themselves as such."

–Rachel Malena

At the Wellesley Institute, we use our corporate accounts (website, including blog; Facebook, Twitter) as well as personal accounts of key staffers to highlight important and interesting developments in social determinants of health. We have several goals: to raise visibility of SDOH issues and practice; to ask important questions; to provide links to on-line resources; to drive people in the social media world to our website – or the sites of others – for a more thorough analysis of issues and solutions; and to engage people in events and activities. We track a variety of metrics – both in social media and on our website – to determine activity. We’ve also found that social media is a good way to connect with mainstream journalists, many of whom are now using social media as a basic source for story ideas and contacts.

–Michael Shapcott

The Health Promotion Clearinghouse joined Twitter @HealthPromoNS in February/13 and find it extremely useful for exchanging information and knowledge about events and resources related to sdoh and health equity. Though we do a lot of tweeting, we have only participated in a handful of live tweet chats and conversations.  We hope to do more in the near future.  We are also on Facebook, YouTube, LinkedIn, and have used a blog to get the word out about health equity and the sdoh. We tend to focus a lot on the sdoh, but our mandate is broader than that so we also include info on other health determinants. We have a very small staff (3) and we all contribute to Twitter when we can, trying to strike a balance between stimulating interest and not over-tweeting. Twitter has been the most rewarding social media channel for us to date, but that may be related to its ease of use and that it has truly been a team effort.  I suspect if we spent a bit more time with other social media, we could broaden our reach.  We are always learning.

–Caroline Ploem

My experience has been that “social media” is all “sound and fury, signifying nothing.” Tweets and Facebook deny any role for contemplation and reflection and lead to action being merely clicking on “like” or “favour.”  In contrast the 1500 members of my social determinants of health listserv has evolved into a community that shares materials, reflects upon it, and then moves towards real action. 

In terms of education and action, Juha Mikkonen’s Social Determinants of Health: The Canadian Facts” has been downloaded 200,000 times and virtually all of this traffic has come from course outlines, health unit and other agency websites, and articles and journals.  In other words, from places that require more than a click on a mouse. Even then, all attempts to get traffic to the Facts from twitter and other “social media” has amounted to nothing. See SMALL CHANGE: Why the revolution will not be tweeted.

 –Dennis Raphael

And you can read the entire conversation at, as well as find a list of resources on the topic and connect with others interested in the social determinants of health and social media.

To connect with over 1300 Canadian public health colleagues interested in reducing inequities, join the Health Equity Clicks: Community. You can browse through existing discussion threads, start your own conversation, share a resource, or ask a question. To sign up, visit For questions or support, please don't hesitate to contact Pemma Muzumdar, Knowledge Broker at