A child watches videos on a mobile device in Burhanpur, India. © 2019 Danish Mansuri, Image Courtesy of Photoshare

The New Norm of “Constancy” and Global Public Health

We are beyond the tipping point. We now live in a world of constancy. 

Digital media are a pervasive and unceasing part of our modern existence. On a continuum from background (but always on-call) to simultaneous use of multiple screens, digital media’s presence pervades the lives of more than 80% of humankind. 

As health communicators addressing health promotion and disease prevention, we must acknowledge constancy as the new norm—and see it as an opportunity. 

Constancy affects human development, social interactions, and health behaviors. Information is always easily available. One is never beyond reach; communicating with loved ones, acquaintances, and even strangers is always an option. 

Constancy differs from previous ways we’ve thought about media in terms of health communication research and programs. In the past, public health interventionists and academics regarded the 3 Cs—consumption, content, and context—in creating and examining media. It’s no longer appropriate to consider these separate constructs.

In the past, we might consider how much time a person spent watching television or how many days a week she or he read a newspaper. Today, media multitasking makes it practically impossible to quantify the amounts of media people consume. What does it mean when a person is concurrently watching 2 hours of video, while texting and using social media? As message content and delivery are customizable, we cannot assume that everyone will receive identical content. Even when using the same fitness application to track daily steps, an 80-year-old grandmother and her 20-year-old grandson will receive different messaging and feedback. 

And, the ubiquity of smart technology makes it possible but not yet practical to know where and when people are exposed to communication, and whether it’s risk- or health-promoting. Assumptions, however, would have to be made on whether people actually received a particular message. For example, you could have GPS data on the number of people walking by a point-of-purchase display for Coca-Cola, but would you assume they all saw that display? Context matters, but how will practitioners consider the co-viewing experience if adolescents are creating TikTok videos with online acquaintances from another country? 

Prior public health initiatives have focused on message delivery through clear and distinct communication pathways. In the past, women would watch a telenovela infused with maternal and child health messages in their homes and maybe receive companion outreach print material in a local clinic. Even when multiple approaches have been employed, practitioners would concentrate on specific platforms and the timing of sent and received messages.

In the new norm of constancy, initiatives can reach individuals as often as necessary, with personalized messages, any time of day or night, in any location. Barriers no longer exist. As digital media are now ubiquitous and always available, interventions can have impact at various levels in every conceivable environment. 

When responding to global health threats, whether acute or chronic, public health officials and health providers must recognize the presence and role of constancy. An additional benefit is that the phone in one’s pocket is a public health tool. It can warn, reveal, and signal changes in well-being. If multiple alarms are triggered in a given locale or populace, health officials can be notified of emergency or trending health concerns. As devices are always around, public health researchers should modify protocols and measures to take advantage of this tool. For example, studies can more easily collect data on everything from frequency of social interactions to exposure to environmental irritants. 

In the development of successful and effective social and behavior change communication, practitioners must rethink the creation and dissemination of messages, acknowledging that constancy will alter message reception and effects.

Available technology can help individuals and communities improve health behaviors. That a screen is always within reach should also alter how health interventions develop and occur. Finally, public health research protocols and measures must also consider constancy. For example, now it is easier to collect and unobtrusively transmit population data in real time.

As I discuss in a Health Education and Behavior paper published November 21 that introduces the concept of constancy as it relates to children, media, and health, this new always-on world has significant implications for global public health. We should use constancy and personal technology to improve personal and population health. 

The challenge is to understand if, when, and how digital media are being used and messages are being communicated. 


Dina L.G. Borzekowski, EdD, EdM, MS, is the interim director of the Global Health Initiative and a Research Professor at the University of Maryland’s School of Public Health. Dr. Borzekowski’s research focuses on children, media, and health. She has conducted research in more than 30 countries.


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A child watches videos on a mobile device in Burhanpur, India. © 2019 Danish Mansuri, Image Courtesy of Photoshare