What Role Does Google Play in Public Health?

Welcome, everyone. I'm Dr. John Whyte, the Chief Medical Officer at WebMD. There's a lot of lessons we've learned from the COVID pandemic. And certainly, in the digital space, there's been a lot of transformation. And we're going to see even more.

Joining me to discuss what we've learned, as well as what the future holds, is Dr. Karen DeSalvo. She's the Chief Health Officer at Google. Karen, it's nice to see you.

John, it's great to be here. Thanks for having me.

Now, Karen, I your interest in public health, acting Assistant Secretary for Health, National Coordinator for Health IT, Commissioner of Health in New Orleans. So I your interest over the past few decades. But what is Google's interest in public health?

I think as much as we were working in public health, especially with respect to areas like looking at climate and health, even when I arrived at the company, there were researchers working in those areas. It was certainly the pandemic that caught our attention about how we are actually a public health company, and we have responsibility and accountability to the hundreds of millions of people that come to platforms like search every day, asking questions about health.

And COVID was a very big request that we were getting. And so we knew quite early in the pandemic, we were going to need to amplify the messages of public health entities, starting with the World Health Organization and over time, getting granular to your city health department, and then also help them get those messages out to make them more engaging, more interesting, through a variety of channels and tools that we have that maybe we can talk about. But certainly for us, it's about information as a determinant of health and seeing that we're helping public health get the information out about how people can help themselves and help the community.

I want to push on that issue of information as a determinant of health. But I got I got to backtrack for a second, when you say, Google is a public health company. Do you think people are going to be surprised to hear you say-- be like, really, a public health company?

We are a life company, honestly. And public health is a critical part of life. It is also true, John, that the definition of public health is what we do together as a society to create the conditions in which everyone can be healthy. That's a slight paraphrase of the National Academy of Medicine's definition.

And it is true that every institution, company, and person has a responsibility to lean in on public health. So I believe pretty firmly that as a company, but especially as a life company, we have a role to play. And there's been many ways that we've been supportive throughout the pandemic and are continuing to work with public health as we move into the next chapter when the pandemic finally ends.

What everyone wants to know-- I'm asked this a gazillion times at WebMD. I'm sure you're asked even more-- how do you tackle misinformation? It's critical people get reliable, credible, useful, practical information. But there's so much misinformation out there.

And it's been really especially difficult during the pandemic for a variety of reasons. I think some of it is that science has been unfolding in front of everyone's eyes, not just the clinical world. Clinically, many of us have been so busy learning every day about what's evolving with respect to testing and vaccinations and countermeasures, like therapeutics to treat COVID, much less the virus itself.

But it's not just the clinical world. Because the way that the scientific enterprise has made data available, even in preprint, has made this much more a part of the general population's access to information. And as science evolves, it can be confusing to people.

There's debates. There's failed trials. There's safety polls. We saw that in some of the vaccine trials. It's actually a great opportunity to teach people about how the scientific enterprise works. And this is something that we have worked on at Google is to use our platforms, like YouTube or search to help people learn about, what is the normal life cycle of developing a vaccine, just as one example.

And the approach we generally use is to do what we can to raise high-quality information. This is very similar to public health risk messaging approach, where you want to get quality information out to the public. Same thing for us. We want to see that when you go to the landing page, and you're searching on information about vaccines or testing that we're going to surface the highest quality information, typically from authoritative groups, like the CDC or the FDA.

And then where needed, we'll help build out what we call knowledge panels. So we'll work with the CDC or others to help push their information forward. We do something very similar on YouTube. But on YouTube, we have the opportunity to work with messengers. So it's not just the message to raise, but the person delivering that.

And so influencers who already have large followings have worked throughout the pandemic to partner either interviewing Fauci or bringing forward high-quality content. It's not to say we don't address misinformation, John, which we do. We do that sometimes, through AI, identifying misinformation words, "COVID is a hoax." Or we do that manually by looking at the video, have clinicians that do that, or thinking through carefully, what is the gray space?

I do want to call one particular thing out though, which is that disinformation is a particularly challenging issue, because that is the intentional spread of misinformation. And it can be very difficult to keep up with. So we're thinking in all those buckets, literally every day, and not just about COVID, but about all health information and working with external parties and partners, like American College of Physicians, the National Academy of Medicine, or the "New England Journal of Medicine" to raise up the highest quality information and highest quality content that we can. That's when people have the best access.

You've been talking about social determinants of health before it was popular to talk about social determinants of health. And now, Google is talking about how it's involved the social determinants of health because of your efforts. And one of those areas is in the space of food insecurity and this concept of, people want to search content, but then they want to connect it to something. We often talk about that at WebMD, connecting content to care.

But you're in many ways, connecting content on things like food insecurity and food pantries and then help direct people to those locations. Can you talk about your work in that?

Food is often one of the most common social determinants that causes people to either seek care because they have medical conditions related to their food insecurity, or they're just hungry. And so they arrive in the emergency room because they haven't been able to feed themselves. This is a common refrain that people have taken care of low-income seniors would know, unfortunately, very well.

One of the things that we have done is, you search on "food stamps" or "SNAP" in your area. We put buttons right at the top of the screen, so that it's easy for people to click on those buttons and enroll, see if they're eligible for food stamps in their state. That's an example of how we want to help people not just get information, but take those next steps on their health journey.

We do this for social determinants. And we're going to add more supports as we can. You may have also seen that we're trying to help people get access to care in a very similar way, finding a doctor that takes their insurance, and being able to schedule right on line. Again, really just trying to curate that ecosystem to make it as easy as possible for people to take those next steps to support their health or to be along their health journey.

Now, everything didn't go as well as one would have planned during the last two years. And one of those areas is an area of contact tracing. Here, we have the technology. Here we had the tools to do that. We the role of contact tracing in terms of reducing infectious disease.

We saw around the world, typically, it was less than 10% adoption of these contact tracing. Why do you think that was the case? Do you think it was an issue or concern about courtesy? But what was going on there? What would you have done differently too?

Contact tracing is an important capability for public health. But given the success of public health and medicine in knocking out communicable disease, there's not a lot of capacity, especially in high-income countries like the US. So we were asked a lot, how could we potentially help with contact tracing.

So we developed, in partnership with Apple, and interoperable, basically API. So a way for an app to be built that people could put on their smartphone. It was a way for Bluetooth Low Energy to be used about proximity of phones for a certain amount of time.

I remember when the engineers asked me about it. I thought, oh, I was so shocked that you could do that. And I needed them to explain the technical piece. Now, I'm not completely naive about technical issues. I'm certainly not a software engineer.

But if you take the surprise and learning that I had to do being inside of Google, and then we had to talk to public health institutions around the world for adoption, and it was difficult, because public health didn't have all the language to understand what we were offering, and especially in the US, where we had to go state by state by state. Now, in places like the UK or Germany where there's a single national public health entity that could adopt it and pick it up, we had much better lessons learned. It was higher adoption. They were able to do research to show that it save thousands of lives and averted infections.

In the US, because of the structure of public health, it was much more difficult to build the trust and the relationships. What's great about it is that now we have. We've listened to public health also. We've iterated the technology. And we have built strong partnerships with groups like the American Public Health Laboratory Association. And going forward, those are opportunities for companies, like Google, to continue to be a part of the public health ecosystem and be helpful where we can.

Search serves such an important role in our lives, many positive aspects. But some people say we're spending too much time in front of our screens. So I want to ask you about this digital well-being study that you have going on that I was reading about, where you say you're going to look at how patterns of smartphone use are associated with measures of mental and physical health.

So, Karen, I know you're a scientist. You have to have a working hypothesis. What do you expect to find from this study?

John, this is also an example of how-- we built a platform, like Google Health Studies, which is available for scientists, like the researchers at Oregon Health Sciences University to use to be able to do this work. And so this is being generated by an academic partner to understand, what are the impacts of digital on health, as you described?

We care about two things very much here, and it's the reason that we wanted to partner on this. One is we care about mental health. It's a really important priority for us. Right now, in '22 and going forward, not only mental health, but substance use disorder. And we have a number of partnerships to try to understand how we can amplify information, provide data to inform action.

Digital brings a lot of good things to our lives. So do screens. They can be really helpful for things like telehealth visits. On the other hand, too much can be emotionally or physically difficult for individuals. So we just want to understand that.

And I think it also ties in, John, to our broader thinking about how important it is for us to recognize that digital is not the only solution. It's just a part of the set of tools. And so understanding how people respond and interact and how that varies based upon the color of their skin, their socioeconomics-- these are things that we want to know more about as we build inclusive products and as we're thinking about driving equity with our digital tools and not just putting them out there because we can. We want to do it because it's going to make a difference.

I want to end with a quote from you that I really like. And I wish I had said it myself, but maybe now, I will. And you say, I saw it online, you say, "my job is to get up every day and make billions of people health."

It's pretty great job. So I'm really grateful. And all of my journey has helped inform and guide the way that I think about this responsibility that I have here at Google. But it is going back to the beginning of our conversation that we are a life company, and health is a critical part of life. People are coming to us, wanting good information.

And what I want is for Doctor Google to be trusted. I want people, including clinicians to know that we're going to be a partner, and we're going to be a place to turn to, not only for information, but also for tools and supports. And we're really thinking globally about that, which is a tall order.

But at the end of the day, it's really about health for everyone everywhere. So yeah, it's a pretty wonderful opportunity. And I'm very grateful for it.

Dr. Karen DeSalvo, thank you for taking the time, for sharing your insights, and really helping us understand how digital is changing.

Thank you, John.

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