When Mayor Eric Adams declared his health commissioner was “officially designating social media as a public health crisis hazard in New York City,” he pledged the city would take action to protect minors as platforms like TikTok and Facebook push “addictive and dangerous features.”
But despite the language Adams used in his State of the City address last month, New York law doesn’t define a “public health crisis hazard.” Health Commissioner Dr. Ashwin Vasan’s advisory doesn’t imbue the city with any new authority to combat what Adams called a growing mental health crisis. And no new regulations affect how students can use social media, or how platforms can operate in New York, at least for now.
Instead, public health officials say it serves as a call for the public, the administration and lawmakers to take the risks of social media seriously. Gothamist spoke to public health experts about the value of that kind of health advisory and its potential pitfalls.
“The most important thing here is that we are raising an alarm,” Vasan told WNYC in interview about the social media advisory.
It’s not an “emergency” … or an “order”
A commissioner’s advisory simply provides the public with guidance on “urgent health issues of concern,” according to Patrick Gallahue, a spokesperson for the city health department.
The last such advisory Vasan issued urged New Yorkers to take advantage of existing city resources to equip themselves with naloxone, the opioid overdose reversal medication, in response to a growing number of overdoses. Gallahue did not respond to a request for information on whether there was any uptick in demand for naloxone or training following the advisory.
An advisory can’t leverage resources in the same way as a city or state executive order declaring a public health emergency. For instance, Gov. Kathy Hochul’s emergency declaration around mpox in 2022 made more categories of health care professionals eligible to administer the vaccine. An advisory is also distinct from a formal order from the health commissioner, which creates a new mandate for the public to follow. In the first years of the COVID-19 pandemic, formal orders were frequently used to require vaccination, testing and masking in different settings.
But some public health advisories became turning points on health issues, such as the U.S. surgeon general’s 1964 report on tobacco. By the next year, Congress mandated health warnings on cigarette packages, and banned cigarette advertising on television and radio in 1970.
What kind of harm are they worried about?
Vasan’s new advisory offers recommendations on talking to kids about social media and mental health, and setting limits on social media use. He says it’s a “contributing factor” to the city’s “crisis of youth mental health.”
The city’s social media alert comes on the heels of a similar warning from the U.S. surgeon general in May, as well as reports from the American Academy of Pediatrics and American Psychological Association.
Those advisories offer recommendations based on a growing body of research around the effects of social media use on adolescents. For instance, the surgeon general points to research showing that frequent social media use may affect adolescent brain development and sensitivity to social rewards and punishment. And the American Academy of Pediatrics points to a study showing that phone and internet use can negatively affect sleep.
All of these advisories note that social media may have benefits for some children and that more research is needed.
In his advisory, Vasan quotes from the surgeon general’s findings that “while social media may have benefits for some children and adolescents, there are ample indicators that social media can also have a profound risk of harm to the mental health and well-being of children and adolescents.”
The power of the bully pulpit
Urging people to take voluntary action is sometimes just the first step in an escalating series of actions to try to curb a public health threat, said Scott Ratzan, a professor at the CUNY School of Public Health who studies health communication.
Ratzan pointed to the example of seat belts in cars. Although cars were required to have seat belts in the 1960s, people weren’t obligated to wear them.
“We didn’t really get people to use them until we put laws in place,” Ratzan said. “And then those didn’t always work, so then the car manufacturers had to put bells in place. So, all these things are additive.”
Vasan’s advisory comes as state and federal lawmakers are proposing new regulations on social media that could change how kids interact with online platforms. In New York, Hochul has announced her support for legislation that would prohibit so-called “addictive feeds” for young users.
Vasan did not advocate specific legislation in his advisory but rather stated that “all New Yorkers should advocate to hold social media companies accountable and advance reform that protects youth from harmful and predatory practices.”
The amount of attention Vasan’s advisory has already gotten — even without formal power or mandates — is an indication of the “power of the bully pulpit that the commissioner has,” said Dr. Oxiris Barbot, who served as the city’s health commissioner between 2018 and 2020 and is now president and CEO of the United Hospital Fund.
Barbot said she can’t recall issuing any similar advisories during her tenure, either as health commissioner in New York City or Baltimore, but said Vasan is correctly leveraging this public health tool to provide guidance on a public health concern and influence public discourse.
“The scope of the issue is such that we do need to raise awareness and help the public connect the dots,” Barbot said.
But Rachael Piltch-Loeb, a professor at the CUNY School of Public Health who studies emergency responses, cautioned about overusing the word “crisis” to describe public health issues, especially in a post-COVID age.
“Inherently, if we overuse a term that’s meant to ignite concern or panic or raise our alarm bells, that term starts to lose its meaning,” Piltch-Loeb said.
Declaring social media a public health crisis could also erase some of the nuance in how people talk about its impact on adolescents, cautioned Katherine Keyes, a professor of epidemiology at Columbia University’s Mailman School of Public Health who studies social media and youth mental health.
She said there is strong evidence, for example, linking body image issues among young girls with exposure to certain types of online content, but less evidence correlating the amount of time young people spend on smartphones with mental health issues.
Vasan has said he is focused on “harm reduction,” rather than outright bans.
“No one, including our health department, is saying social media should go away,” Vasan said on WNYC.