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Public Health On Call
526 - YouTube's Dr. Garth Graham on Social Media and Misinformation
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- [00:06]
A
Welcome to Public Health on Call, a podcast from the Johns Hopkins Bloomberg School of Public Health. I'm Joshua Sharfstein, vice dean for public health practice and community engagement and a former health commissioner here in Baltimore. Our goal is to bring evidence and experience to illuminate critical public health issues. If you. If you have questions or ideas for us, please send an email to publichealthquestionhu.edu. that's publichealthquestionhu.edu for future podcast episodes.
- [00:38]
B
Hi, I'm Lindsay Smith Rogers, producer of Public Health on Call. Today, the challenge and opportunity of social media in an age of misinformation. Dr. Garth Graham, the director and global head of healthcare and public health at Google and YouTube, joins the podcast to talk with Dr. Josh Sharfstein. Let's listen.
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A
Dr. Garth Graham, it's so great to see you and to have you on the podcast. How are you doing today?
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C
I'm doing well, Josh, and it's great to be here. Good to see a longtime champion of public health helping get out information to the world. So I am honored to be on the podcast.
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A
Now, you have had some incredibly important jobs in public health and now you are at YouTube. So can you remind our listeners the arc of your career?
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C
Yeah, Yes, I have an interesting career. I'm a clinician. I'm a cardiologist by training. Actually. I trained at John Hopkins many years ago when stethoscopes were being invented. Then I got into public health. I was director of the Office of Minority Health. I was the deputy assistant secretary of Minority Health. I worked in the administration, working on the health disparities issues. Left there and then went and I was president of the Aetna foundation for a couple of years, and I was also chief of Health services research at the University of Florida. So I had a research background and then moved just in the most recent year and so over to Google to kind of run what we're doing With Health on YouTube.
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A
Now, you moved during the pandemic to Google and YouTube at a time when a lot of the social media companies were coming under some very heavy criticism for promoting, intentionally or not, a lot of misinformation.
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Yeah.
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C
So, you know, I, I'm always attracted to challenges like I think you are, and many people in this world, and we tend to run towards the issue, not away from it. So I, I was very much attracted this issue of health information and how people are getting information, and I was watching it unfold in my personal life and professional life and in my community. And so I just wanted to get Knee deep involved in this issue of information quality, how we're getting information. Because, Josh, the truth of the matter is many communities you and I care about, they're not opening up. The New England Journal of Medicine or the Journal of the American Public Health association are great places where science is being documented and produced. They're getting information as part of their daily walk and their daily journey. So I wanted to kind of be engaged in that. I think it's an evolving area, but I think it's also a part of public health that we're starting to recognize more and more.
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A
When you were the director of the Office of Minority Health, did health literacy play a big role in what you focused on?
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C
Yeah, I mean, health literacy. As you know, there was a health literacy action plan that came out during the administration. CDC had been working, working on it. And even that definition of health literacy at that point, Josh, has evolved over time. We used to talk about how people get written materials and making sure that it was grade appropriate and all of those things. Now, how much of our communities or our patients now open up a pamphlet or are waiting for that flyer to come in the mail to decide what to do. So this evolution of information and how people get information, I mean, that is. That is just what wakes me up in the morning. It's also where I think, where science and public health communication has evolved faster than I would think that we expected. Wanting to be a part of that and change that and work that at YouTube is what attracted me to this role.
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A
I think I'm getting the point here that you don't see this as a break from your career working on health equity. This is the next step in your career working on health equity.
- [04:47]
C
Exactly, exactly. This was just an evolution. You know, I'm Jamaican, and so I go back into my community in Florida that's a heavily Jamaican community, and I would go all the time, especially during COVID you know, I'd be like, where are my people getting information from? You know, the Caribbean American community here? And they just, again, like I said, they were not waiting for the next edition of JAMA to come out and then open it up, you know, on the corner in stores. You know, they were looking up on their phone. So I view this as a part of that. You mentioned health literacy. It was just interesting how people were evaluating science and understanding science. And so, like I said, gone are the days where I think of flyers and billboards as our primary mode of communicating health information to the public. And so this is part of that evolution for both Me as a person, but I think even public health overall got it.
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A
Now you walk into YouTube and like I was saying before, a lot of criticism coming the way of the social media companies. Yeah, I looked up some of the articles, you know, enormous numbers of views, like mind boggling numbers. Millions and millions and millions of people watching videos with misinformation about COVID misinformation about vaccines. You know, don't believe your doctor type videos. You know, how do you approach that? Some people would say that there may be a net negative effect on health equity because communities are getting information that is wrong.
- [06:16]
C
Yeah, well, the thing is communities are already getting their information this way. It's not us to tell people how they get information. They're just doing it as part of their daily lives. So, you know, when I got here, our goal was both how to continue to kind of elevate the right information for people to see, make sure it's engaging. Not lecture styles where people are watching to walk through your PowerPoint, but how do you present the information engaging, and also how do you tackle misinformation in terms of removing information? So we advance a lot around vaccine misinformation policies and information that we would remove that was harmful, but also focusing a lot on partnering with a lot of folks, you know, at the American Public Health Association, Kaiser Family Foundation, a lot of folks who have been producing health information and working on this and bringing them to platforms like us. And I mean, Josh, it's not just about YouTube. It's really about the patient journey and the public's journey and the community's journey and how are we a part of their daily lives. So I think for us it was a strategy around raising quality information, engaging partners to produce that information, and in removing and tackling misinformation as well.
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A
So I just have one more quick question on misinformation and then I really do want to understand what is happening to highlight really important health information for people. There has been a concern that the most provocative and often erroneous information gets rewarded on social media, that it gets the most clicks, that it gets suggested to new users the most. And it creates an environment where people can pretty quickly go down a rabbit hole of confusion and wind up deciding, for example, not to get vaccinated. When you started at Google, was that a concern? How do you think about that?
- [08:04]
C
The thing to do here is to think through again. How do you surface information early in people's questions and journeys? That is quality information. We've worked to have our systems do that. We Try to surface quality health information from credible health sources early on in the journey. Not driven by those facts that you mentioned primarily, but driven particularly by information that comes from credible quality health sources. And it's labeled as that. Especially if you go to YouTube now and look up a number of different disease entities, you'll say it says from an accredited hospital, from X. And you'll see it comes up and it says from health sources. And those health sources are identified by National Academy of Medicine from a paper. But primarily the idea is to drive visibility to quality health content primarily in
- [08:52]
A
a way for health. You're changing the way that information is presented to people, not maybe using just popularity as the. The metric.
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C
Yes, exactly. Emphasizing quality health information as a big part of what drives primarily what people see.
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A
So within those credible sources, there is great content that's really going to help people and there's content that maybe is a little bit boring. Maybe there's even content that could be wrong. But how do you look at the flip side of the question? How do you make good public health information, good health information for people, inspiring and useful?
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C
Yeah. So going back to your other question and dovetailing from that, it has to be kind of evidence based quality health information in terms of accuracy, but it has to be engaging and it has to kind of meet people in the journey where they are. Health literacy being a part of that, but also the cultural context of the way the information is presented is particularly important. So I think that's what we've been working on, particularly over the past year, is working with a number of hospital systems, a number of organizations, we're working with traditional health policy groups like the Kaiser Family foundation around how you create and elevate engaging quality health information overall. But I would say, Josh, this is part again of how we as public health, not just Google, not just YouTube, but the broader public health community evolve in terms of how we communicate and learn more and how we engage communities around health information.
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A
So for you, when you turn on a video, what do you look for to see whether you think it's going to be popular and good? How would you advise the world of public health content creators? What works in your mind?
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C
Think about what you would want to see. I don't always say that to people. I think sometimes we divorce our regular life or our professional life. And so a lot of times we think about engaging content that you would turn on, Josh, that any of us would look at and the kinds of things that makes it interesting, making sure you deliver the corrected information early, making sure. That you're thinking about audience first and the kind of questions and things the audience are concerned about. So for me, I look for engagement as that authenticity, that concept of cultural relevancy. But it is important that we not lose the context of evidence based science and the way we present science, just being able to take all of those ingredients into play. Josh, this is an evolving field is how I would put it. And I think many others will learn as much as we move forward in this effort. There's a lot going on at Johns Hopkins around that too.
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A
So on that question of an evolving field and learning, what's the role of research? To figure out what works and what doesn't work?
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C
Yeah, I mean, I think always there is the ongoing role for research and understanding, and research takes on a lot of different forms. There's certainly your traditional academic context, but there was also the idea of, again, how do we evolve as we get information? And so for us, we've been doing this around the world, and every time we kind of advance a strategy in a particular country, we learn more about what to do next. We just did a big launch in Indonesia around some of our efforts to get people quality health information in Indonesia, and we had the Indonesian health minister be a part of it. And even as we saw that unfold, we thought, oh man, we've learned a lot from just the different countries who've gone around the world in doing this. So it is an evolution. I would say that we're all on a journey.
- [12:42]
A
How do you measure success? You're trying to beat back the tide of misinformation and disinformation. You're trying to get not just accurate and scientifically based content out there, but content that people will actually enjoy watching and will share. How do you know if that's working?
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C
Yeah, so, I mean, you start with a basic context of just engagement and how much a lot of this is being watched. And we've seen growth year over year in terms of how much people have been engaged in health content overall. But more importantly, I think the longer tail of this for me is going to be how much have we changed public health communication? How much more people are communicating not just in our platform, but any platform? How much are people engaging in this and how much have we evolved as a field in terms of being where communities and people are? So for me, this is a marathon, not a sprint, meaning it is a longer arc to this and we'll have all kinds of public health information to communicate both now and in the future. And it's probably how we kind of grow and evolve. So me success is 15 years from now, five years from now, three years from now. We have partners from all across the world using this platform, these platforms like ours, other platforms, as part of their messaging when they were trying to get a critical health information.
- [14:07]
A
And so you see not just YouTube but all these different platforms as an important piece of the puzzle to actually improve health, to support public health agencies in health goals, in achieving health goals and inspiring communities and working with communities to make the world.
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C
Yeah, exactly, Josh. Well said. I would say that's exactly how we see it. We see it as really kind of a collective and having our role within that collective. And it's important to understand too, Josh, that this is a global context. You know, people share and get information global. So being able to kind of do this both domestically, globally, but also in a timely way. And so I think there's a lot to be learned. There's a lot of growth to be had. There is a lot of humility to be had as we're taking this process. But most importantly, I think we just have to be where people are in terms of how they get and receive information.
- [15:03]
A
Garth Graham, thank you so much for sharing this vision and I wish you the best in achieving it.
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C
Thank you, Josh. Thank you. A pleasure to have been on
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A
public health. On Call is produced by Joshua Sharfstein, Lindsay Smith Rogers and Stephanie Desmond. Audio production by J.B. arbogast, Holly Cardinal, Spencer Greer and Matthew Martin with support from Chip Hickey. Distribution by Nick Moran. Production support from Kathryn Ricardo. Social media run by Grace Holz Fernandez and Amber Bryan Singletary. Thank you for listening. Sam.