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Public health sector urged to address unhealthy power of digital giants

Introduction by Croakey: The power of multinational corporations has been identified as an important determinant of health, globally and for individual countries, in an article published in a special BMJ series on health equity and the pandemic.

Meanwhile, Google and Facebook are currently flexing their muscles in Australia to resist government regulation, in political manoeuvres being watched around the world for the precedent that could be set by regulation of digital platforms.

In this Croakey Longread below, journalist Marie McInerney highlights the similarities of the big tech campaigns with the tactics used by harmful industries and the challenges ahead for policymakers grappling with unhealthy products, platforms and politics.


Marie McInerney writes:

Public health experts are urging the sector to ramp up scrutiny of the health impacts of digital platforms like Facebook and Google, as the two tech giants employ the classic tactics of harmful industries like tobacco and alcohol in their bid to resist regulation in Australia.

Leading academics like Melbourne University Public Health Professor Rob Moodie say the risks of big tech are not yet on the research and policy agenda for public health, which will likely have to create new skillsets and alliances, and be properly funded, in order to keep pace with the unprecedented challenges to health and society of the big tech platforms.

But they say public health research and policymaking successes and challenges also offer important evidence and lessons for taking on harmful industries and the conflicts of interest embedded in industry sponsorship of academia and the media.

Moodie, who played a leading role in Australia’s world-leading tobacco control efforts over decades, chaired the Australian National Preventative Health Taskforce from 2008-2011 and is a member of the World Health Organization’s Expert Panel on Health Promotion.

He is increasingly concerned about the profound implications of “surveillance capitalism” — the term coined by Harvard Professor Shoshana Zuboff in her landmark 2019 book, The Art of Surveillance Capitalism, on how the digital giants track, store and onsell data to a vast range of corporations and agencies to predict our behaviour as well as influence, manipulate and modify it.

Moodie told Croakey the risks to the health of individuals, society and democracy are “enormous, both in terms of increasing the consumption of really unhealthy products as well as, in the long run, the consumption of unhealthy politics”.

That was seen most graphically, he said, in the scandal involving Cambridge Analytica, which bought Facebook data on tens of millions of Americans without their knowledge to build a “psychological warfare tool” to help elect Donald Trump as United States president.

“We need to know much more about surveillance capitalism,” he says, saying public health will need to partner much more with digital marketers and strategists, “particularly those that have worked out on the ‘dark side’ . . . who understand intimately how these corporations work and how we can constrain their damaging effects as much as we can”.

Turning point for regulation

Australia is currently on the frontline of international efforts to deal with the extraordinary power, reach and influence of the digital giants, with its proposed legislation for a mandatory news media bargaining code to require Google and Facebook, in the first instance, to pay Australian media outlets for news content on their platforms.

Importantly, writes RMIT research fellow James Meese, it also requires they abide by certain minimum standards, including informing media companies about the type of data collected through users’ interactions with news, and providing advance notice of any algorithmic changes that affect news content.

The tech giants have stepped up their campaign against the code in recent weeks, recognising that Australia’s planned reforms, which are being watched globally, represent a “turning point for platform regulation, which could embolden other governments to make their own costly demands,” Meese said.

On Sunday Federal Treasurer Josh Frydenberg reported that he and other senior ministers had been lobbied directly by Facebook CEO Mark Zuckerberg. Both Facebook and Google have threatened to withdraw services in Australia: Facebook to remove news from the feeds of all its Australian users, and Google to withdraw the Google search engine.

The stakes are high, as Mathias Doepfner, CEO of German publisher Axel Springer, outlined this week in an open letter to European Commission President Ursula von der Leyen, which described Google’s threat to Australian authorities as “blackmail”.

Doepfner, who as a global media chief of course has a vested interest in the issue, wrote that the market capitalisation of Google, Facebook, Amazon, Apple, Netflix, and Tesla had soared in just 12 months to $US7.1 trillion — a rise of 82 percent or $US3.2 trillion, with Google and Facebook alone capturing 46 percent of the global advertising market.

In Google’s submission to a Senate inquiry on media diversity, among other defences, the company rejected criticisms that the digital platforms have cannibalised media incomes, saying a large portion of the classified revenue that previously funded journalism “still flows to the same media business owners, but no longer cross-subsidises journalism in the way that it used to”.

Last week Google upped the ante in its campaign against the mandatory code, making its case via a prominent link on its own ‘front page’ to anyone using Google search for any inquiry — saying “You may have heard about a proposed new law. We are willing to pay to support journalism” — although that appears to be have been removed now.

It was a move that actually undermined the integrity of their argument and showed why regulation was needed, according to Croakey managing editor Dr Melissa Sweet. “They’re really demonstrating the problems with having a massive monopoly and how detrimental it is to the public interest,” she says.

Anti-regulation playbook

The threats and blandishments from Google and Facebook in the face of Australia’s legislation follow the well-trodden path of other harmful industries that have sought over decades to withstand regulation, says Sharon Friel, Professor of Health Equity at the Menzies Centre for Health Governance at the Australian National University.

And she warns that the resistance Australia is seeing at the moment to the code is likely the “tip of the iceberg”, with Google and Facebook, like other corporates faced with regulation, fearing the setting of a precedent which could “open the floodgates” globally.

“That’s what we see all the time with other corporates, like tobacco historically but also of course more recently with alcohol, and parts of the food industry,” Friel says.

“What they tried to do was introduce their own forms of regulation — standards and voluntary codes of practice — that help to suggest if we leave them to their own devices they will regulate themselves,” she said.

It’s a way of stalling any form of mandatory government regulation and, importantly, an effort to be perceived by the public “as trying to do the right thing”, she says.

Google has made much of the voluntary arrangements it has already come to with a number of Australian news publishers and is rolling out its News Showcase initiative to support public interest journalism, signed by 200 publishers globally, including here with Crikey, The Saturday Paper and The Conversation.

But such initiatives, and indeed the mandatory code itself, raise questions of conflict of interest if media outlets are beholden directly to the tech giants for income, and if these arrangements are used as an argument for resisting regulation.

Should, for example, The Walkley Foundation, which seeks to support excellence in journalism, partner in a Google News Initiative on debunking vaccine misinformation, given — as a powerful US inquiry found — that tech companies have used their dominant market power in ways that weaken democracy, erode diversity, entrepreneurship and innovation, degrade privacy online, and undermine the vibrancy of the free and diverse press?

RMIT journalism academic Dr Alex Wake has been interested to “see so much money being thrown around by the big platforms to try to show that they are supportive of news, and verifiable news”, adding “it’s a little too little too late”.

Given Google and Facebook make a lot of money out of Australians, and others, that alone should mean they “pay a fair share towards supporting our society and democracy”, but she admits the mandatory media code raises big conundrums for an industry already facing devastating long-term trends in loss of revenue.

“A lot of news organisations and journalists are in bed with Google, because they offer a lot of really useful products. And when your whole industry appears to be imploding, it is pretty easy to see why people would accept the cash,” she says.

Alarm bells ringing

Like other public interest journalism advocates, Croakey has welcomed the mandatory code as an important public policy issue, of global significance, but said it is not a panacea for the crisis facing journalism. We have urged the Federal Government to build in transparency and accountability to the code, with full disclosure of any funding arrangements.

But while transparency is critical, it won’t rule out conflict of interest, says Dr Ray Moynihan, a former investigative journalist who is now Assistant Professor at the Centre for Research in Evidence-Based Practice at Bond University with a big research focus on the impact of industry sponsorship on medical science and on over-diagnosis in medicine.

Moynihan has written that disclosure and transparency don’t fully “solve the problem of bias that flows from close financial relationships”. His co-author, Professor Lisa Bero, an international authority on research integrity, has reported that research funded by a corporate body is “much more likely to have a finding that supports the funder’s product”.

The mountain of evidence on how industry can distort medical science should raise big alarm bells for media and academics offered funding by the tech giants, he says, citing the old saying that ‘you don’t bite the hand that feeds you’.

“Knowing about those flows of money is vitally important but knowing about it does not stop the flow of influence, which often happens in very subtle ways, and the public discourse is distorted as a result,” he said, adding that his concern goes as well for the integrity of health research amid the growing interest of big tech companies like Apple and Amazon, and their big pockets, in healthcare.

Moynihan says he has no simple answers to the issues raised by the mandatory media code and is aware that many media outlets are reliant, for example, on Google ads for their lifeblood. But he says the media was already needing to move on “from a lot of ‘gee whiz’ kind of cheerleading to much more rigorous examination of subtle and not-so-subtle impacts of big tech on all aspects of our lives”.

“Of course, there is lots of good media coverage, but I also think that, similar to the story with medicine, our excitement about the latest shiny new thing can actually dull our interest in rigorous scrutiny,” he says, also recommending The Age of Surveillance Capitalism as a “real wake-up call” to the dangers to individuals and society of big tech.

“Big tech’s influence over public discourse is already at extreme levels and is a threat to democracy and the free flow of ideas, and if that influence is actually increased through their funding of mainstream media, we have great things to be concerned about.”

Moynihan has no criticism of public health for not having its full sights on big tech yet —“public health has its hands full, particularly at the moment”. But he says its medium term research agenda should be on the impacts of big tech on public health, “as broadly and as specifically as possible”, noting that will require government funding support.

“We as researchers, as journalists, as citizens, as policymakers, as governments, as taxpayers, are in uncharted waters,” he says. Working out how to respond is a massive task, but we can’t say it’s all too hard because we’re so reliant on the platforms, “we really do need to have a bit more backbone and a bit more scrutiny about these things”.

The standout concerns for Professor Fran Baum from the Southgate Institute for Health, Society and Equity at Flinders University are how Facebook is amplifying the voice of far right groups, including white supremacists, and where people cannot determine what is true or not.

“This is definitely a public health issue,” she says, though she notes that the influence of social media is very pervasive and hard to pin down – ” like the boiling frog metaphor where we are being influenced by social media to a significant  extent but don’t recognise how strong the influence is despite an increasing body of evidence”.

Public health needs to take account of this influence in terms of psychology and the impact across the population, especially on young people, and through a corporate determinants of health lens, she says.

But, unlike tobacco, she  says social media does also bring benefits, such as for the People’s Health Movement that “can only really operate as a global movement on a shoe-string because we can use social media.”

Because some of its members will not use some big tech platforms like Facebook and WhatsApp, she would like to see publicly funded services, like the ABC, that could be a real alternative.

Shifting the focus

Public Health Association of Australia CEO Terry Slevin says governments globally need to create new regulatory models for the new “behemoths” like Google and Facebook, though he warned there is no template “and we can certainly expect the new global media giants to prosecute their financial interests in the same way big gambling, big alcohol and big tobacco prosecute theirs”.

At the same time, he said, it’s important to understand that much of the regulatory response we are now seeing is driven by “old” media players looking to protect their own commercial interests and whose own regulatory regime is less than perfect.

“PHAA is in favour of strong clear community interest driven regulatory environment for these ‘new’ media, in the same way that we support stronger regulation on ‘old media’,” he said, adding that controls over the marketing of alcohol and junk food to children come to mind.

But Slevin said an open, fair and balanced media environment is essential to prosecute the case for evidence-based public health policy and that public health can suffer when commercial interests can use their financial power to dominate, control, influence or manipulate media coverage.

A fair and open “marketplace for ideas” can only thrive when competition and diversity exists and where public interest is a driving force, he said. “A vital component of that is strong, well-resourced high quality and independent publicly funded media.”

Friel acknowledges that public health is only just waking to the dangers of big tech, “really only starting to even ask questions about it, let alone understand it from a public health perspective”.

While there is a growing field of work on the commercial determinants of health, she says public health policy frameworks in Australia and globally have tended to focus on the food, alcohol, tobacco and gambling industries, looking “through the lens of industries that relate to particular behavioural risk factors”.

Now it needs to address that tech giant “blind spot”, to recognise the incredible power of the digital platforms “to decide and design what society sees and hears” in ways that shape the social determinants of health and make them “one of those big, underlying determinants”.

How public health can help to address that is a hard question, but she said there may be lessons from efforts to develop policy frameworks that embrace the social determinants.

Successes on that to date have come by collective demand, through demonstration — such as the better health outcomes delivered by Aboriginal community-controlled health organisations, from democratic processes of engagement, alliances with unusual bedfellows, and from constant advocacy and pushing to be at the governance table, she says.

Rob Moodie sees possibility in the positive commercial determinants of health, such as those we are seeing for climate change, where “the answers are commercial”, shifting investment from fossil fuel industries into renewables.

He says Australian radiation oncologist Dr Bronwyn King has shown one way ahead with her work to ensure tobacco free investment across the global superannuation industry, noting she has said “she no longer goes to medical conferences, she goes to finance conferences”.

Public health needs to develop new partnerships with digital strategists and analysts, Artificial Intelligence (AI) and big data engineers, investigative journalists, public health lawyers, and political economists and support whistleblowers and disillusioned former employees of the tech giants to work to minimise their harmful health and social effects, he says.

“It’s such a big issue (for public health),” he says. “It’s huge and yet unseen.”

“We been trying to get definition around commercial determinants of health, mostly around the classic unhealthy commodities but if you think about unhealthy platforms, we’ve done not much at all.”


Croakey acknowledges and thanks donors to our public interest journalism funding pool for supporting this article.

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