Using Twitter big data to study global Public Health campaigns (Immunization Week: #VaccinesWork)

It is almost 50 years ago since “Our World”, the first live international satellite TV broadcast, most famous for the first performance of The Beatles’ “All You Need Is Love” (25 June 1967). The show reached an audience of 400-700 million. The most famous band on earth beamed out to living rooms across the world. This was an impressive achievement, but the information flowed just one way. The digital revolution was yet to happen.

Between 24 and 31 April this year Immunization Week tweets using the #VaccinesWork hashtag passed across devices almost 1.5 billion times(1). Information flowed in both directions – international and national health organisations promoting vaccination, and individuals responding and sharing information of their own. The overall impression of Immunization Week is an extremely well planned and organised multi-agency international campaign, with plenty of evidence-based tweets using images and links to informative webpages. There were tweets by national organisations that provided country specific information. There was also a considerable amount of high quality and informative tweeting at individual level, by clinicians, parents and many others, though these posts risked being overwhelmed by tweets from international organisations in the “big data” analysis.  While there was some negative tweeting by anti-vaccination campaigners, some of them with considerable reach on social media, the balance overall was firmly in favour of vaccination.

This blog summarises the main findings of the big data analysis, pulls out some detail (eg top tweets and resources, the type of influence exerted by top tweeters), and describes the methodology (basic and advanced) so that others can repeat this type of analysis on other global health campaigns. The big data techniques include NodeXL maps, similar in appearance to the spread of communicable diseases (figure 1), except in social media analysis spread is usually seen as a positive. I have used two Public Health evaluation frameworks to summarise main findings (Donabedian’s Structure, Process and Outcome; and RE-AIM).

Herd Immunity
Figure 1. Explaining herd immunity in 6 seconds via IFL Science

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Quality2017: watching in via Twitter

I can’t think of a better starting point for learning about quality improvement than the International Forum on Quality and Safety in Healthcare. Run by Institute for Healthcare Improvement (IHI) in Boston and the BMJ this huge quality improvement Forum attracts interest and expertise from across the world, with something for everybody, from beginner to quality improvement champion.

This year the Forum ran from Wednesday 26 to Friday 28 April in London. The Wednesday was an “experience day” – the Forum itself was on Thursday and Friday, with the theme ‘Ingniting Collective Excellence’. To quote from the Forum website: “We focus on how the power of collaboration can inspire all parties, including patients, families, new healthcare professionals and improvement leaders to deliver top quality, person-centred care in a sustainable framework.” This was an ambitious theme that anybody working in, or cared for by healthcare systems across the world, could get behind.

I have attended two Forums – Paris 2008 and Gothenburg 2016. A novice in Paris (presenting research rather than quality improvement), I was pleased to present quality improvement work on supporting low income families in Leith, Scotland at the Gothenburg Forum, which coincided with publication of that work in BMJ Quality Improvement Reports.

This year I wasn’t able to attend the Forum, but took some time to watch the tweets, retweet some of these tweets, post some ideas of my own, and run a “big data” analysis of the Forum tweets (identified using #Quality2017 hashtag) using NodeXL. See previous blog post and BJSM editorial for more on the methodology used here.

Colleagues interested in quality improvement have been early adopters of social media – almost evangelical in their promotion of Twitter for learning, networking and broadcasting. It is no surprise, therefore, that there are rich pickings from the tweet from the Forum. See Gill Phillip’s summary, capturing a flavour of the tweets. The snapshot presented in this blog is presented purely as an illustration of the potential (and limitations?) of big data.

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What is public health? Some reflections for teaching

From time to time I am asked to explain Public Health to students, colleagues from other disciplines or a more general audience. A traditional approach might be to structure such a session around the three domains of Public Health (health improvement, health protection, quality improvement), building on specific examples:

((+) For an excellent clear description of different types of epidemiology studies see Beaglehole et al’s Basic Epidemiology (free download in multiple languages)).

However, this approach perhaps doesn’t highlight the distinction between individual and population health clearly enough for a general audience. After all, one response to the final example above is to talk about uptake of smoking cessation services and other individual approaches to health. A GP may respond that Maslow’s hierarchy applies to an individual as well as a population – a patient is unlikely to be receptive to ideas about health screening or treatment if they are hungry or worried about their home or job.

As I prepare for a session teaching 4th year medical students this week I am keen to try something different, though informed by these and other key Public Health topics. The focus here is on highlighting the differences between approaches to improve individual and population health.

There is a lot of interest to Public Health in the scientific and general press at the moment. For example, over the last few weeks there have been major studies/ stories about the following topics in the world’s top medical journals:

We can learn from commentary around these stubbornly persistent threats to health: eg this individual reflection on diesel fumes and health in the Guardian. Individual response and action is important, and there is clearly a role for behaviour change and medical treatment, but measures to reduce the impact of these global threats to human health will take work at all levels, from individual to supranational and global approaches. In a period of political and economic uncertainty Public Health tools at regional, national and international level (tax, cost, regulation, legislation) are being discussed again, around topics that would have been as familiar Hogarth as to our Public Health predecessors in the Victorian era and first half of the 20th century.


(Image from BMJ 29 October 2016)

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Using Twitter to learn from conferences (even when you’re not there): #EPHVienna (European Public Health)

What can we learn from a conference even when we’re not there, using Twitter and some big data analysis? I beamed into the European Public Health conference in Vienna, 9-12 November, to find out…

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Sardines were never packed so tight!

On Wednesday 2 November 2016 I will be presenting a Patient Voices/ #DNAOfCare film at the Institute of Contemporary Arts in London (follow #DNAofCare #Exp4All on the day to see tweets about the event; more info here). I recorded the film with Patient Voices, sponsored by NHS England, in April 2016. Though I originally intended to speak about my current work, I was encouraged to develop a “leadership story” and the film that emerged explored my inspirations and route into Medicine, specialising in Public Health.

Watch film: 🎥

The film is about my connections with my Grandfather, K.G.F. Mackenzie and his encounters with Public Health (including typhus, TB, meningococcal disease and much more). The summary of his life, in his own words, is provided below (with thanks to my Father, Bruce Mackenzie, for providing this).

I will be approaching The BMJ to ask if, 16 years too late, they will accept this as an obituary for Kenneth Mackenzie and his wife Helen Gordon.


My Grandfather and me, Shotley Bridge, 1971

This experience has helped me capture my professional raison d’être. The reflections cover the three domains of Public Health – Health Protection, Health Improvement and Service Improvement – as well as key public health topics including poverty and inequalities.It also illustrates the point that Public Health involves a wide workforce, in the NHS and beyond. I plan to use the film to explain the purpose of Public Health work, and how while everything seems to change, some things remain the same.

Graham Mackenzie (@gmacscotland on Twitter)

Consultant in Public Health

31 October 2016

Cynergy_Graham MacKenzie_509 (1)

Watch film: 🎥

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Making a big bang with social media at Dunblane #ScotPublicHealth

Quick links for social media activity at Scottish FPH conference 27-28 October:

  • Conference website (which also shows conference tweets, presentations and will include webcasts) and programme
  • Ask a question for plenary and panel sessions using Slido
  • Check the Twitter statistics for the week of the conference (Mon – Fri inclusive)scotpublichealth-stats
  • Follow @ScotPublic on Twitter
  • Watch tweets from the conference using #ScotPublicHealth hashtag
  • Follow this blog by clicking “Follow” button in side or bottom bar (depends on your device)
  • Use the tweet summary (Storify) as a reminder when you come to write your CPD record (under development)
  • See the evolving map of tweets (20-28 Oct; full report with top influencers, URLs, hashtags and words/ wordpairs available here, with static map here)

ScotPublicHealth 27 and 28 Oct NodeXL map

On 27-28 October the Public Health community in Scotland and beyond gather at Dunblane for the annual Scottish Faculty of Public Health conference. The title, “Strong Voices: Pragmatic Public Health”, sounds upbeat and confident. The conference website summarises recommendations from the recent Public Health review: including “greater visibility” and closer and more effective links within and outwith the profession. Social media can play a part.

The three main aims of ScotPublicHealth social media activity: learning, networking and broadcasting
The three main aims of ScotPublicHealth social media activity: learning, networking and broadcasting

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Reflections on Realistic Medicine following #PublicHealthHour with Scotland’s Chief Medical Officer, Dr Catherine Calderwood, 7 September 2016

At the start of Dr Catherine Calderwood‘s first annual report as Scotland’s Chief Medical Officer, she notes how fitting it is, as a practising obstetrician and gynaecologist, that the report arrived 9 months after taking post. Another 9 months on from its publication “Realistic Medicine” is still in the limelight. It has received widespread praise, including big names from medicine and public health (Dr Ben Goldacre and Sir Muir Gray), and has become shorthand for a different approach to healthcare.

We had originally planned to discuss Realistic Medicine with the Chief Medical Officer for a Public Health Hour in May, but the purdah period before the 2016 Scottish Election put paid to that. In fact the delay worked to our advantage, allowing us to invite a much larger number of participants, to hear reflections on the CMO’s engagement with clinicians and patients around the report, and to include a discussion of Realistic Medicine and Public Health with an expert panel.

You can see the CMO’s slides on Slideshare.

During the panel discussion, as well as taking questions on Realistic Medicine from participants, we:

  • received a succinct masterclass in better value healthcare, screening and population healthcare from Sir Muir Gray, a leading light in UK Public Health, pioneer of screening programmes across the life course and currently director of Better Value Healthcare
  • heard pertinent insights on person centred care and quality improvement from Carol Read from her career as a nurse and more recently as fellow at the NHS England Horizons team. Carol has also demonstrated innovation in developing a skincare range for Salisbury NHS Foundation Trust
  • had a preliminary discussion about the positive “disruptive” potential of mobile phones as a nod to both innovation and engagement.

The NHS England Horizons team, headed by Helen Bevan, was also extremely generous in providing us access to their impressive Webex setup, for which I would like to note huge thanks to Paul Woodley.

The session is documented in more detail below and a full recording of the session is available here. The main message from the session is simple – Public Health has a major contribution to Realistic Medicine, across the 6 main headings of the report.

This blog will be updated to include answers to questions raised through social media and the Webex chat box that we didn’t have time to pose to the panel during the session. Running until 16 September there was also an opportunity to contribute to a Public Health focused platform on Realistic Medicine, kindly provided on a trial basis by Crowdicity, and written up here.

Resources and comments from the chatbox have been added to the end of this blog (on 28 September).

Continue reading “Reflections on Realistic Medicine following #PublicHealthHour with Scotland’s Chief Medical Officer, Dr Catherine Calderwood, 7 September 2016”

Sign up for #PublicHealthHour with Scotland’s Chief Medical Officer, Dr Catherine Calderwood, 7 September 2016

Join Scotland’s Chief Medical Officer (CMO), Dr Catherine Calderwood, on 7 September 2016, 12.30-1.30 (UK time) in a #PublicHealthHour webinar. Continue reading to find out more.

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Inequalities in uncertain times: reflections on the 1 June 2016 #PublicHealthHour, post EU referendum

This is a blog about the #ScotPublicHealth #PublicHealthHour 1 June 2016. The full session recording is available here. Tweets summarised using Storify. Quotes below are taken from tweets during PublicHealthHour.

We live in increasingly unequal and uncertain times. A nation’s politics and its government’s economic decisions have a profound impact on the health and wellbeing of its citizens. The result of the UK referendum on EU membership (23 June 2016) has been picked over during the past fortnight. Voting intentions leading up to the referendum show profound differences in outlook across the UK. Commentators have noted differences in voting patterns by area (urban vs rural vs former industrial), age, education level and income, charting the impact of decades of decline in our most deprived communities. The implications of the EU referendum decision for the future of the UK (including health and the NHS) are being debated at length, but the word “inequalities” is never far from the discussion. (/continues/)

Source: New Economics Forum (click image to see full document).

Continue reading “Inequalities in uncertain times: reflections on the 1 June 2016 #PublicHealthHour, post EU referendum”


The next #publichealthhour webinar sessions are:

Dr. Andrew Fraser from NHS Health Scotland and Dr. Angela Donkin from Institute of Health Equity talking about inequalities (1 June 2016, 12.30-1.30). Read blog from webinar here (posted 9 July)

Dr. Cath Calderwood, Scotland’s Chief Medical Officer (7 September 2016, 12.30-1.30)

Register for each session in the EventBrite box on this page (or click on the dates above) and I will email you the link to join the webinar in the days leading up to the session. I will also post the details on this page on the day of the webinar.

Post questions for inequalities webinar (1 Jun) up until 18 May on Slido (doesn’t need registration).

scotpublichealth logo

Graham Mackenzie 12.5.16 Cynergy_Graham MacKenzie_509 (1)

@gmacscotland on Twitter