Scale of digital media use and its harmful effects justify action now: The Lancet

The way digital technologies are currently built and governed creates real risks to health worldwide, alongside genuine benefits, according to a new three paper series authored by 13 global experts, published in The Lancet.The authors call for coordinated governance of digital systems, with the health and online safety of children and young people be made an immediate global policy priority. (Shutterstock)The authors call for coordinated governance of digital systems, with the health and online safety of children and young people be made an immediate global policy priority.“Use of digital media is now woven into the fabric of childhood and life as a young adult. Governments have let technology companies write their own rules, leading to business models built to capture attention and collect data, with health treated as an afterthought,” said series chair Professor Ilona Kickbusch, Digital Transformations for Health Lab (DTH-Lab) (Switzerland). “The evidence linking problematic digital media use to poorer mental health, sleep and physical activity, although not conclusive, justifies coordinated, global action. With the right governance, a healthier digital world for young people is possible, one that allows them to benefit from online opportunities without substantial risk of harm to health.”Digital media includes the content people watch, make or share online. It spans the content itself, the platform it’s delivered through, and the device used to access it.A new umbrella review (a review of published reviews) for the series, covering nine million people under 25 across 121 reviews, finds consistent associations between problematic digital media use (defined by the series as addiction-like patterns of digital media use, rather than by time spent online) and a range of adverse health outcomes for children, adolescents and young adults. Problematic digital media use is linked to a higher risk of harm to health including common mental health problems, sleep problems, and reduced physical activity.Some beneficial health links are also identified via the review, including an association between moderate digital media use and higher well-being, and between active video game use and both higher well-being and healthier lifestyles.The authors caution that the certainty of the findings for both harms and benefits is low: “The associations between problematic digital media use and health harms identified in our review are modest in size and rest on low-certainty evidence that cannot establish cause and effect. Meanwhile, the most valuable data on how these platforms actually affect users are hidden within technology companies, limiting independent scrutiny and slowing scientific progress,” said series author Louise Holly, DTH-Lab (UK). “A key recommendation of our Series is that governments should require technology companies to share data on how their features affect users’ health with vetted public-interest researchers and provide the legal and technical infrastructure to make that possible.”To illustrate the potential harm at a population level of high rates of digital media use combined with even a small increased risk for individuals, the authors estimated that spending more than two hours a day on screens could be associated with around 2.8 million healthy years of life lost to depression and 240,000 to obesity worldwide each year. However, they caution that these estimates should be interpreted with caution.Author Dr Falk Müller-Riemenschneider, National University of Singapore, added, “Our global projections of how many healthy years could be lost to depression and obesity linked to excessive screen time are intended to be illustrative of the possible scale of harm. They should not be taken as an accurate measurement of harm as, although they are based on the best available research, the certainty of the evidence is low. More research is needed to provide accurate estimates of health impacts at the population level.”The series argues that digital media use today is predominantly shaped by large, international technology companies that governments have allowed to self-regulate for decades, producing a digital environment where commercial growth is favoured over health.“Most digital platforms are designed by companies to capture attention and collect data, not to protect health: features such as infinite scroll, autoplay and personalised recommendation feeds are deliberate design choices, not simply a matter of individual self-control,” said author Dr Jay Shaw, University of Toronto (Canada). “We need much more research into how these specific design choices in digital media influence the way people use the technology, instead of only investigating the impact of how long people spend online.”The series notes that single measures, such as age limits, are not enough on their own to tackle the risk of digital harms to health. Instead, the authors call for wide-ranging, coordinated policy action at the company, national and global levels.