JMIR Publications

ABSTRACT

The digital information environment produces health externalities that public health systems are currently not equipped to address. Driven by commercial incentives, there are four main mechanisms of health harms. Namely the current environment 1) prioritizes extracting engagement from users over their wellbeing; 2) amplifies misinformation that spread false health content faster than corrections can travel; 3) enables generative AI to serve as a mediation interface between people and health information; and 4) financially supports a data extraction economy that underlies and enables all three. A healthy information environment is not one free of error or disagreement. It makes it easier for people to make sense of health information over time, locate services, sustain (justified) trust in institutions, and reduce the cognitive, emotional, and practical barriers to care. Creating a healthier information environment requires action on the underlying structures producing harm, not just the content those structures carry. Public health has largely responded to information environment failures by trying to correct bad information. That strategy has not worked and has, in places, accelerated the erosion of institutional trust. Sub-national public health agencies hold relevant surveillance, regulatory, fiscal, and community engagement authorities that need not be constrained by federal inaction. Drawing on the precedent of public health responses to urbanization, we argue that sub-national public health departments can take bold action through assessment, regulation, fiscal instruments, and community engagement directed at the structures producing harm.