Digital Detox Is a Public Health Intervention

All around the world, countries are imposing bans on smartphones in schools. This fall, B.C. is just one of six provinces restricting their use in classrooms. Some provinces are allowing phone use between classes, but B.C. is banning them “bell to bell.”

Meanwhile other parents aren’t waiting for their provincial governments to step in before they take their children’s technology use into their own hands. In Vancouver, an advocacy organization called Unplugged Canada invites parents to support their children to “rekindle real-life connections” and “guide our children towards a life filled with the warmth of human relationships and the beauty of the natural world” by signing a pledge that they will delay giving their kids smartphones until they’re 14.

Similarly, California Gov. Gavin Newsom has signed a bill that stops internet service and web applications from providing “addictive feeds” to minors without parental consent. “Addictive feeds” are defined as social media feeds that offer content catering to the social media user’s preferences, whether user-provided or gathered through social media algorithms.

“With this bill,” Newsom said, “California is helping protect children and teenagers from purposely designed features that feed destructive habits.”

Back in B.C., the immediate concern is to draw students’ attention away from their phones and back to the focus of their classrooms. But smartphones, and screen devices in general, are coming to be seen as both aids to public health and serious threats to it: they and the platforms they access are digital determinants of health.

Could AI improve health?

At least one scientific journal, PLOS Digital Health, explores the potential of digital devices to improve health through use of artificial intelligence as well as through improved diagnosis and treatment of specific diseases.

The World Health Organization recently stated that digital media could save over two million lives through telemedicine, mobile messaging and chatbots — while also preventing seven million acute events and hospitalizations. A recent article in the journal The Lancet Public Health acknowledges the positive aspects of digitalization, including the role of digital media in promoting public health, particularly during the early years of the COVID-19 pandemic.

But it also argues that smartphone use can itself be a health hazard — especially for children.

“Childhood, especially early childhood and adolescence, are crucial windows for brain development and there is growing evidence that use of digital technologies can change brain function and structure,” write the Lancet authors.

“Public health interventions in childhood can prevent health issues and promote well-being throughout the entire life course and help break cycles of intergenerational health inequalities.”

Interventions are a tough sell

“Interventions,” of course, are what got public health in trouble in the early pandemic years. Countless Canadians resented being inconvenienced by health measures, even if it meant saving other Canadians’ lives.

So it’s hard to see how similar interventions could work in the face of the ongoing corporate promotion of phones and platforms, not to mention how ingrained smartphones have become in the social lives of many children.

Sixty years ago, taking up smoking and drinking was a rite of passage, a kind of self-declaration of adulthood if not maturity. Tobacco and alcohol producers indirectly encouraged that attitude, and both substances featured prominently in pop culture portrayals of cool people and the good life.

In the movies, the tough private eye chain-smoked his way through every case, pausing only to review his evidence over a bottle of scotch. Beer commercials promised that beer was the key ingredient for meeting cute girls.

If doctors and public health experts warned about the hazards of smoking and drinking, they only made young people feel tough and brave to ignore the warnings.

But warnings work, sometimes.

After decades of campaigning, daily tobacco smoking among Canadian high school students in 2018-19 was down to one per cent. But 40 per cent were vaping daily or almost daily.

As for alcohol, 44 per cent of high school students were drinkers, with almost a quarter admitting to engaging in “high-risk” drinking (five or more drinks on a single occasion) at least once in the previous year.

Dangerous rites of passage

This is why some products are known as commercial determinants of health: they are heavily marketed, they offer an agreeable shock to the system, they are addictive, and users often consume them in social settings. In addition, their known harms make them off limits to children; their use is therefore a sign of adulthood.

The same is true of the digital determinants of health, which also provide access to other determinants like online gambling, pornography and social media. As the Lancet article notes, “Comparisons have been made between social media platforms and tobacco because both are marketed by profit-driven companies and are designed to be addictive.”

The article recommends delaying exposure to digital devices as long as possible: “While policy makers have not reached consensus on the age of internet childhood (i.e., the age threshold where children can use online services without parental consent), there is growing agreement that the current default of 13 years as a minimum to sign up to social media platforms is inadequate.”

Citing a recommendation by the U.S. surgeon general, the article also calls for health warnings on device packaging, digital apps and social media platforms. And health promotion campaigns can encourage parents and caregivers to delay providing that first phone or tablet, while also recommending other ways to teach and entertain their kids.

Six strategies for kids who are already users

As for the billion kids in the world already glued to their phones, the Lancet article offers six strategies:

• Put default time limits on all devices, games and apps.
• Put a tax directly on devices, games and specific apps, or on the profits of the companies that produce them.
• Establish “device-free spaces,” like smoke-free spaces. These could include classrooms and other public spaces used by children.
• Implement a comprehensive digital education that teaches children the benefits and drawbacks of time spent online.
• Encourage parents to ditch their phones when around their children; by interacting more with their parents, the kids themselves may be more likely to stay offline.
• Make alternatives attractive by creating recreation and socialization programs that are “available, affordable and appealing.”

This all makes a lot of sense. It also sounds very performative, a public display of goodwill with little real effect.

Addiction-producing industries like tobacco, alcohol and gambling know that their victims will always be their strongest supporters. Politicians know that catering to vice (like permitting booze in public parks and grocery stores) wins more votes than catering to virtue.

Only when governments get serious about the hazards of digital media, as Brazil’s has with the social media platform X, can we hope to force Big Tech to put serious limits on the junk they push out to kids.

What about the adults?

And what about so-called adults, who supposedly have the maturity to resist the damage done by the digital determinants of health? Early in the pandemic, people drank bleach, consumed ivermectin and avoided vaccinations because online sources told them they should. Countless more decided not to trust any online advice at all.

A U.S. study estimated that in the 15 months between May 30, 2021, and Sept. 3, 2022, at least 232,000 Americans could have survived COVID-19 infections if they had accepted vaccination against the disease.

No doubt tens of thousands more have died since then, not to mention the children who have contracted preventable diseases because their parents chose not to have them vaccinated against chicken pox, whooping cough and measles.

Protecting adults against their own gullibility is now a strategy no sensible government would dare to adopt. It would only result in more protests about a “nanny state,” more harassment of health-care workers, more grief for politicians.

Still, neglecting the digital determinants of health is very much like allowing norovirus in the drinking water. Contamination just offloads the consequences on the victims and their health-care workers, when clean water would prevent anyone from falling ill in the first place.

If we could detox the digital media, the kids (and we) could use them much more usefully and happily.

By an odd coincidence, I vaguely anticipated this problem in a science fiction novel I wrote 40 years ago, in which people with problems turn on their tablets and consult with “turings” — artificial intelligences that look like people, listen sympathetically and offer good advice and encouragement. The AIs are the property of corporations, though, so their advice is unreliable.

But imagine a well-designed, unhackable AI in your kid’s phone, one that even looks and sounds like a kid, who’s the gatekeeper to digital media. It could encourage interacting with positive educational and entertainment sites, discourage dangerous sites and behaviour and be your kid’s constant companion.

The hazard, then, would be that your kid starts criticizing you for the dubious ways you use your own phone.