Why X is not a good place for healthcare engagement

'Go to where people are' is one of the soundest pieces of advice you will hear from public engagement experts. The idea that you can reach seldom heard communities, understand their experiences and talk to them about things like vaccination and healthy lifestyles by avoiding their spaces is for the birds. Social media broadcast campaigns, bus shelter ads and so on may play a very small part, but they are largely reaching people who are already engaged.

So where does this perspective sit when talking about digital spaces? There is an argument that opting out of X (Twitter) is vacating a space where you could challenge misinformation - an online equivalent of refusing to go to a housing estate, travellers' site or religious setting where you may feel unwelcome. I don't think that argument stands up.

Refusing to go to a physical community is refusing to meet people in their lived environment. Deciding not to be on X is refusing to participate in a privately owned, algorithmically manipulated space where the loudest voices are often the least representative and where harassment, distortion and bad‑faith engagement are routine.

Those are not equivalent. One is about avoiding people. The other is about avoiding a dysfunctional communication channel.

There were great opportunities on Twitter in its original form. It was a place where you could reach people, where misinformation could be challenged and there were proper rules of engagement. It's now X, a highly polarised, adversarial broadcast platform, algorithmically skewed towards outrage and misinformation. On vaccines and other areas of public health policy, X has entrenched conspiracy communities, influencers who monetise outrage and coordinated disinformation networks. Posting here simply leads to what you say being amplified to those groups and then shouted down.

Refusal to engage on X is not about distaste - though distaste may be valid. It's a strategic decision to avoid engagement that would most likely be counter-productive.

If you want to 'go to where people are' online, there are spaces where you can engage and persuade more effectively. I'm thinking of Instagram or TikTok (where visual storytelling works), local Facebook groups (where community norms matter), WhatsApp/community messaging channels, YouTube explainers and partnerships with trusted local influencers.

Our responsibility is to engage where people can be reached effectively, safely and with integrity. X no longer meets those criteria. We should prioritise platforms and communities where dialogue is possible and trust can be built.