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Social Media and Health

Volume 797: debated on Tuesday 30 April 2019


My Lords, with the leave of the House I shall now repeat a Statement made today by my right honourable friend the Secretary of State for the Department of Health and Social Care, Matt Hancock. The Statement is as follows:

“Mr Speaker, I would like to update the House on yesterday’s social media summit and the progress we have made to tackle online harms to health. We called this summit to bring together principal social media companies, including Facebook, Instagram, Twitter, Pinterest and Google, as well as Samaritans and the eating disorder charity, BEAT. Along with the Education Secretary and the Minister for Suicide Prevention, this was the second such meeting I have held on how we can protect people, particularly children, from online content that promotes eating disorders, self-harm and suicide, as well as on how we address the growing problem of anti-vaccination misinformation.

Social media companies have a duty of care for people on their sites. Just because they are global does not mean that they can be irresponsible. We have been resolute that we will act to keep the internet safe, especially for children. I am grateful to the companies for their engagement. We have all seen and heard about tragic cases of vulnerable children turning to self-harm, even taking their own lives, after accessing graphic images online promoting, even encouraging, suicide and self-harm. In the same way, we know that online content on eating disorders can be extremely harmful to vulnerable children and young adults. I have met the parents of children brought up in loving homes who had no idea of the dangers their child was being exposed to on their smartphone or tablet while they were supposed to be safe at home. We all know parents whose children have been affected. For all of us, this is very close to home. We must do everything we can to keep our children safe online.

I am pleased to inform the House that, as a result of yesterday’s summit, leading global social media companies have agreed to work with experts from Samaritans to speed up the identification and removal of suicide and self-harm content, and create greater protections online. Not only will they financially support Samaritans in its work but, crucially, Samaritans suicide prevention experts will determine harmful and dangerous content. The social media platforms committed to either remove it or prevent others seeing it, and help vulnerable people to get the positive support they need. The mainstream media already have well-established codes of practice and training to remove material that promotes suicide and self-harm. In my experience of the British media, they act with great responsibility. It is time that social media companies do the same.

This partnership marks, for the first time globally, a collective commitment to act, build knowledge through research and insights, and implement real changes that will ultimately save lives. Social media companies also gave us an update on the actions they have already taken. Following the first summit in February, Instagram now has a global policy of removing all graphic self-harm imagery. Other sites have also taken action but there is much more to do and much more content to remove.

Importantly, the commitments that companies made at yesterday’s summit are what Samaritans asked for and are a positive step forward. The progress we have made so far shows that we can effect positive change, but I know that this House feels strongly that just because these companies are global does not mean that we cannot determine society’s rules and expectations. We are prepared to act on this. My right honourable friends the Home Secretary and the Culture Secretary recently published the online harms White Paper, which sets out the proposed regulatory framework for addressing online harms. It sets out a new statutory duty of care to require companies to take more responsibility for the safety of their users and tackle harm caused by content or activity on their services.

Compliance with this duty of care will be overseen and enforced by an independent regulator, which will be responsible for producing codes of practice that will explain what companies need to do to fulfil their duty and the robust action they need to take to remove illegal or harmful content. The White Paper also proposes sharing of information, research and best practice to improve the understanding of harmful content across the industry.

The summit also allowed us to discuss how we can work together to tackle another online danger: the spread of anti-vaccination misinformation. Since Edward Jenner’s discovery, vaccination has saved hundreds of millions of lives around the world. There are few innovations that have reduced human misery so much. After clean water, vaccination has prevented more deaths and disease than anything else in human history. The science is settled: vaccination saves lives. It not only protects your children, it protects other vulnerable people who cannot do anything about it themselves. Failure to vaccinate puts their lives at risk. The rise of social media now makes it easier to spread lies about vaccination, so there is a special responsibility on the social media companies to act.

Coverage for the measles, mumps and rubella vaccine in England decreased for the fourth year in a row last year to 91%, and there was a steep rise in confirmed measles cases from 259 to 966. We forget that measles is a horrible disease. We have one of the most comprehensive vaccination programmes in Europe. The well-documented problems in America and on the continent are worse than here, but we are determined to get ahead of this problem because there are real and devastating consequences for people from the failure to vaccinate. Our action to promote vaccines is not limited to removing anti-vaccination misinformation. We are promoting the objective facts about the importance of vaccination. We are increasing funding to primary care to improve access, and our prevention Green Paper will set out further actions.

Social media can be a great force for good and can help us to promote positive messages, but it is the responsibility of us all that this new technology, with all its great potential and power, be moulded to the benefit of society. We will not duck this challenge. I commend the Statement to the House”.

My Lords, that concludes the Statement.

My Lords, I thank the Minister for repeating this important Statement. This discussion provides a good backdrop to the debate to follow, on the online harms White Paper. There are essentially two matters of concern here: online harm and false news, which includes the health impact of anti-vax material.

After the scandal that followed the death of Molly Russell, and the bravery of her father in speaking out against the online harm perpetrated by platforms such as Instagram, we were promised decisive action, and the tragedy gave serious momentum to the content of the online harms White Paper. Mr Russell tweeted a link to a Telegraph article yesterday, saying that he had challenged Instagram and the company has said that it will now act. Coming out of yesterday’s hour-long meeting with the industry, the Secretary of State announced a few hundred thousand pounds in donations to the Samaritans for research into online harm, which is of course welcome. However, these social media platforms must be made to take responsibility for the harmful content and dangerous fake news they host.

Instagram said that it would ban all graphic and non-graphic images of self-harm in February. As far as I can see, it has not done so. Like my honourable friend Jon Ashworth MP in the Commons earlier, I did a test a couple of hours ago. To be more accurate, since I am not an Instagram subscriber, I got my researcher to demonstrate for me what happens if you type into Instagram’s search engine the term “self-harm”. You get several columns of results; the first is called “Top Results” and does not produce any links. It says that no content can be found, which is good, but I am afraid the content is still there. If you click on the next column, headed “Accounts”, there are hundreds of accounts concerning self-harm that you can access. If you click on the third column, headed “Tags”, there are 725,000 posts that mention self-harm. Some may direct you to get help but most will not, and some show graphic self-harm pictures and videos. Some of them romanticise, if you can imagine such a thing, this activity. As any health expert will tell you, for those youngsters—some are very young indeed—these are the triggers to self-harm.

The noble Baroness says that Instagram now has a policy of globally removing graphic self-harm imagery. As far as I can see, it has not done so yet. The same applies to websites concerning suicide. If you search for “#killmyself”, you will find huge numbers of results; ditto if you search for “eating disorders”. Research shows that 22 % of young adults report self-harm and suicide-related internet use. This is a crisis. There may be many reasons for this figure, and many solutions, but the internet must take responsibility for the content it contributes to this. Did the Secretary of State challenge Instagram on the assertion that it had taken down content? Has he done what my honourable friend and I did and tested it himself?

Did Instagram give a timescale, or is it waiting for the Samaritans’ research? That seems to me to be not an acceptable solution right now. I welcome the involvement of the Samaritans, but not if it means a further delay to action. It does not need research to know that the content of some of these sites is totally unacceptable and needs to be got rid of. Perhaps the noble Baroness can explain what the Samaritans’ research will be used for and its timescale? These are very, very rich organisations, and a few hundred thousand pounds to the Samaritans does not mean they can offload their responsibility to deal with this content; they have billions of pounds that can be used for this purpose.

The reason I am concerned is that these companies have form. Over many years of warm words and no change, they have consistently resisted taking responsibility for the content they carry. They have had to be pulled, kicking and screaming at every turn, into behaving with responsibility. I repeat: will the Secretary of State test this by looking at it himself?

The content of these platforms is why the White Paper is so urgently needed. I want to ask only one question about it; the debate will take place in a few moments and my noble friend will certainly pose many questions. However, if a young person even accidently accesses, for example, a self-harm image, there is a likelihood that the algorithms—which look at what every one of us is accessing online—will pick this up. While noble Lords may receive unwanted information about house extensions or the cost of flights, such a youngster may find that they are being led to more sites depicting self-harm. In other words, the algorithms can reinforce harmful content. How will the Government seek to mitigate this unintended consequence?

I turn now to the use of false information in anti-vax campaigns, which has led to a massive increase in outbreaks of measles, as the noble Baroness said in her Statement. The issue here is not just the dangerous anti-vax propaganda on platforms such as Facebook, or indeed Amazon. A story in today’s Guardian says that a young person was delivered a book, and inserted in it was an anti-vax leaflet. One has to ask how on earth it got there. The wider issue is that of public health policy and resourcing.

Are the Government considering banning unvaccinated children from schools in England, as the Secretary of State suggested on the radio last week? I hope not. Do the Government have a clear vaccination action plan? Public health services have been cut by £800 million and, in recent years, health visitors have been cut by 8% and school nurses by 24%. This will not help with the vaccination drive. Will the Government commit to reversing public health cuts and cuts to health visitors, and invest in general practice to meet the recommended 95% national vaccination coverage rate, as recommended by the World Health Organization?

My Lords, I too thank the Minister for repeating the Statement. I am sure nobody in your Lordships’ House doubts the benefits, as well as the dangers, of social media. As the noble Baroness, Lady Thornton, has just stated, the tech giants really need to recognise their responsibilities by taking action now to remove material that could damage the vulnerable.

I would like to link the Statement with the NHS Long Term Plan. In it, there is a commitment to increase spending on children’s and adult mental health services. What figure will this amount to? How much of it does the department anticipate will be earmarked for technology? Where will it be directed? Who will receive the money? What does the department expect the NHS to do to support this move? What criteria will govern its use?

Vaccination uptake is clearly a current issue. How does the department anticipate that social media can help and not hinder the uptake of these life-saving shots?

I thank the noble Baronesses, Lady Thornton and Lady Jolly, for their questions. They are right: the Health Secretary has taken a personal interest in this issue and is determined to drive this policy forward, not only through the work of my honourable friend the Minister for Suicide Prevention but through the prevention Green Paper mentioned in the Statement. He will ensure that he keeps a personal eye on this issue.

I turn first to the question raised about the social media company Instagram saying that it has a global policy of removing graphic self-harm images—other sites also say that they have taken action—so that if you search today you cannot find such images, although on top searches you can find them through accounts in other places. It is recognised that there is much more to do and more content to remove. That was one reason why the Secretary of State convened these summits. A more coherent approach to this work is needed. While I recognise that the noble Baroness feels it is obvious what self-harm content is, the approach that has been taken as an outcome of the summit is encouraging. It has led to the strategic partnership, which will ensure that the policy that has come forward from the social media companies will now lead to effective implementation. Such companies will be held to account, not only through the strategic partnership but through the outcomes of the online harms White Paper. There will be not only a duty of care but a regulator associated with it. Those combined strategies are encouraging.

The noble Baroness asked about the unintended impact. This is where the second set of proposals to have come out of the summit is extremely important. As well as developing industry-wide standards on identifying harmful suicide and self-harm content and agreeing robust responses to it, it will lead to a clearer understanding of what is harmful content. It will also lead to better training for mediators to respond to it and to support vulnerable users, which I think is exactly the point she was after.

On the important questions about public health spending in response to anti-vax campaigners and ensuring that we have a robust vaccination programme, the noble Baroness is right that vaccination programmes rest on the basis of strong public health support. We have a £3 billion ring-fenced public health spend every year and we must ensure that that goes forward. It will be a key part of the public health bid in the spending review and part of the Green Paper that is to be published. I know she will look forward to holding me to account on the effectiveness of that Green Paper.

The noble Baroness, Lady Jolly, raised an important question about the effectiveness and benefits of social media. We do not think that compulsory vaccination at the moment is an evidence-based policy. The Health Secretary has said that nothing is off the table and this is the right response given the serious concerns of other countries. At the moment, in the UK, we operate a system of informed consent. This is the right thing to do, given our high uptake. There is no immediate plan to change it and we strongly encourage families to take up vaccinations when offered.

One of the ways in which we spread information about the effectiveness of vaccines, and shall continue to do so, is through our online accounts at, which are highly trusted. In the UK the public attitude to and confidence in vaccination is monitored through a series of annual surveys, including Public Health England’s annual attitudinal survey, which show high levels of trust in health professionals and the NHS. The public trust the NHS as a source of advice and that is why our digital media output, through the NHS, our social media outlets and, is a crucial way of encouraging and maintaining trust in vaccinations. We shall continue to drive it forward.

My Lords, my noble friend referred to the discussion with the social media companies about vaccination, but the Statement did not refer to any specific commitments on their part or even acceptance of a responsibility in relation to disinformation about vaccination. Does my noble friend agree that it is important to understand why immunisation rates and vaccination coverage have dipped? I was Secretary of State when we reached the highest level of, I think, 94% for MMR following a period from 2007, bringing it up from 80%. It has not dipped back to those levels, but we need to understand why this has happened. If it is about disinformation on social media, what have the companies said about this up to this point?

The social media companies accept that they have a responsibility to deal with anti-vaccination misinformation, harmful information relating to eating disorders and general health-related misinformation that can be found online. The Health Secretary has been clear with social media companies that they are expected to address these harms. The Department of Health looks forward to working with them on it. My noble friend is right when he says that our levels of vaccination are extremely high compared to other countries’, but we must not be complacent and must ensure that we not only maintain the current vaccination rates but drive them further and do not tolerate any further permeation of the pernicious anti-vaccination messaging which is starting to leak out online.

My Lords, the approach being taken is welcome, but in itself probably will not be enough. We cannot ban and regulate everything that goes on on the internet. For example, a blogger who may have nothing to do with health may have 80,000 to 100,000 followers and may blog about a health issue, and that becomes fact. What is needed in the modern world is alternative narratives; that is what is seen on social media. Rather than just using statutory websites and web pages, what is the NHS doing to adopt a much smarter, blogging/lifestyling approach—involving those who influence young people and who use these media outlets—and to use effective alternative narratives that work, rather than just putting all its eggs in the banning approach basket?

I do not have access to the statistics now, but I know that a lot of research has gone into assessing the amount of peer-to-peer support young people access online from medical charities and other charities via social media routes, or other online routes such as blogs or influencers who engage very effectively with various different medical charities. There is some very encouraging evidence that social media can be used in this way to direct people to the help and support they need, if it is used effectively. As the noble Lord says, we must be very careful not to throw the baby out with the bathwater and must produce alternative narratives to direct young people and vulnerable people to access the support they need in the most effective way. This is done very effectively by many organisations. It is a matter of making sure that, wherever possible, young people and vulnerable people are protected as much as possible from harms that they really should not be exposed to.

I am grateful for the Statement. I want to address the social media aspect rather than vaccination. We have a paper from DCMS on social media—the online harms White Paper. The Minister mentioned coherence; I am finding the situation increasingly incoherent, and I will be raising this topic later. Who is giving a lead in this area? The Statement said:

“This partnership marks, for the first time globally, a collective commitment to act, build knowledge through research and insights, and implement real changes that will ultimately save lives”.

It also said that there was a second summit, but DCMS and the Home Office were not involved. The Education Secretary has been attending those meetings. Are more meetings planned? What agenda will be pursued at those meetings? Which departments will be involved? Who is going to take the lead?

The noble Lord asks a number of questions, but I think the nub of the issue is to ensure coherence across government in approaching an important and complex policy issue. He is right, in that the correct approach is to ensure effective implementation of our significant policy commitments in the online harms White Paper and in the outcomes from this summit. Of course, DCMS and the Home Office have been engaged in different policy proposals, development and engagement, and they will continue to be so. The Department of Health and the Department for Education have been leading on this in relation to the mental health Green Paper because of the policy specialisms around vaccinations, suicide and harm and the effect on young people. That work started some time ago so it makes sense for the department to continue, but it will be working hand in glove with the online harms White Paper. I am sure that that discussion will continue in the next debate this afternoon.