YouTube Powers Health Information Videos - Dr. Garth Graham

Dr. Rishi Desai: Hi, I'm Dr. Rishi Desai. Today on Raise the Line, I'm happy to be joined by Dr. Garth Graham, director and global head of Healthcare and Public Health at Google/YouTube. A cardiologist, researcher, and public health expert, Garth is well-positioned to help discuss where we stand today with COVID-19. Garth, thanks so much for being with us today.

Dr. Garth Graham: Thank you for having me.

Dr. Rishi Desai: Can you start out by telling us a little bit about yourself and what led you to your interest in medicine?

Dr. Garth Graham: Thanks Rishi for asking me that question. I think I bring a kind of a mix, a variety of different backgrounds both professional and personal. Professionally, I'm a cardiologist by training. I did my med school at Yale and my cardiology at Johns Hopkins and have gone through a variety of different roles in the healthcare industry. I spent a decent amount of time in the federal government where I was a deputy assistant secretary in both the Bush and Obama administrations, and then went back into academics where I was chief of Health Services Research in the Department of Medicine at University of Florida. And then over into corporate America where I first started at the Aetna Foundation but then ultimately, prior to this job, was Chief Community Health Officer at CVS Health. On a personal level -- I always like to throw that in because I think for most of us, our careers aren't defined by just what we've done at work...we bring so much to the table in that equation -- I was born in Jamaica and raised partially in Miami and partially in Jamaica. I have a kind of a mixture of that Caribbean-American Heritage.

Dr. Rishi Desai: Now, you've had a very wide breadth of experiences. I'm just curious how these past experiences helped to prepare you for your current role at Google and YouTube Health.

Dr. Garth Graham: I have long been driven by this idea of community health at scale and how can you empower communities in a variety of different ways. I think goes from kind of my earlier personal experiences both in Jamaica and the United States in the ways in which I think many communities, particularly those underserved communities, can be empowered to make decisions particularly on health and public health. My life and personal experiences have led me to really try to work on this issue of how to address health challenges at scale. The challenge that we're taking on, and I think you and others equally have also taken on, is this issue of how to deliver public health and health information to communities across the country -- and in YouTube's case across the world -- and how do we empower communities to live their healthiest lives particularly through health information and the kinds of things that allow them to make the right decisions at the right time. So for me, the issue of empowering communities particularly with health information has been a life-long endeavor.

Dr. Rishi Desai: There's a lot of confusion right now in communities about COVID-19 and vaccines. Given that, I'm curious what is your vision for health content on YouTube, and specifically, how do you think you can help improve general health literacy and access to good information?

Dr. Garth Graham: In particular, when we think through the issue of getting a community information...I say in public health now, gone are the days when people are looking for information in flyers or on billboards. People want information to be a part of their daily life and to be received as a part of their daily life in the palm of their hands on their phone or through other kinds of ways in which they're used to both receiving information and sharing information as well. And so, what we're able to do is using the power of the platform of YouTube, which reaches two billion people across the world every month, be able to engage people directly with health information in a way that's part of how they are used to receiving information in general about all kinds of non-health-related matters. I think it's a way of reaching people at scale in a way that they're used to receiving their information.

Dr. Rishi Desai: That makes sense and I think patient education is kind of one half of the equation and the way I think of it, the other half is clinical education. Now we know we need to flatten the curve and prevent so many people from getting sick, but what are your ideas on how we help raise the line? In other words, help boost clinical bandwidth and education?

Dr. Garth Graham: So there are two ways I think about YouTube and clinician education. One is clinician engagement. As clinicians, health care practitioners, public health, folks who are interested in and are drivers on public health, we have to remember that delivering information is a part of the role of health care providers. I mean part of our role as doctors is to be teachers. We have to teach the community, deliver that information in engaging ways. Healthcare information that was just in journals and in textbooks and not in people's minds and hearts is kind of the old way of things. I think COVID has allowed us to have the world engage around health and public health. In particular, the world wants to be engaged. People want to know what is Messenger RNA? They want to know what are these new ways of improving health, particularly with COVID? I think that what it shows is that we have to be more innovative about the way we deliver information to patients and make sure it's engaging. 

Now, even for sharing information from clinician to clinician...again, clinicians are people and a part of the community. Certainly, I think we'll continue to see the evolution of how we could make science available in traditional ways -- in journals and textbooks. But the clinician themselves want the information to be available in the palm of their hand and to learn from other clinicians in that way. I think that's where efforts like the ones we've worked together on -- with YouTube and Osmosis -- fit in. The expectation that bench-to-bedside and bench to the community is a decade...I think that's changed with COVID. I think now clinicians want to be able to get the scientific information sooner to be able to make those decisions faster.

Dr. Rishi Desai: You've worked in different industries; academia, government, healthcare foundations, tech, what is your take on how the culture in these different entities helps or maybe impedes how well they work together?

Dr. Garth Graham: Oh yeah, culture. I think to me culture is always a dominant driving force in terms of how things get done. There's a terminology that "culture trumps strategy" and I think that's true. I think in healthcare, there are some good components. In healthcare, we have a culture of putting the patient first and of doing no harm and making sure that things are developed with in the best interest of the patient. I think one of the challenges we face in healthcare is we still have a healthcare-focused way of delivering things. Meaning it's a delivery system delivering care as opposed to a consumer or community-based focus looking at it from the eyes of the people, receiving the information, and receiving care. 

I think where tech has a different angle is tech is very much user-focused. Things are developed from the eye of the user, the eye of the patient, the eye of the consumer. And so somehow, the melding together of those ideas of being patient-centric but looking at it from the eyes of the user is the ideal way in which I think those two industries come together. Certainly, there are a lot of challenges with issues around disparities and equity that go across tech, go across healthcare, go across a variety of different industries that define the challenge, but I think where they come together in terms of solution is this idea of doing a user/patient/community-centric endeavor with an eye toward the best interest of those communities at heart.

Dr. Rishi Desai: YouTube started roughly 20-plus years ago as a place maybe for silly videos and things like that. Now, YouTube Health is at the forefront of how to do medicine more effectively. Do you mind helping me understand how things evolved over the years?

Dr. Garth Graham: I think the evolution of YouTube is a demonstration of the evolution of the power of video. I think earlier on, the concept of YouTube focused on, I would probably say generically, entertainment and ways in which to engage users around entertaining facts and videos that were entertaining. What's evolved though is people realized that video can be used to demonstrate so many things as part of daily life. People go to YouTube when they want to fix an appliance in their house. People go to YouTube when they want to think of ways of educating their children. People go to YouTube when they are looking for all of these different parts of getting visible information that they can act and react to. I think the evolution of YouTube has been part and parcel of the evolution of the power of video. Now, video is being used to translate very complicated pieces of information. Certainly with COVID, a complicated piece of public health and clinical information. I'd say the evolution of YouTube is the evolution of video but also the evolution of people wanting information in the palm of their hands, and so I think that's part of the engine and the drivers for that.

Dr. Rishi Desai: Got it. Given that, I'm curious if you'd be willing to kind of walk me into the future a bit now. What do you see happening in the coming years both here in the U.S. and around the world?

Dr. Garth Graham: One of the interesting things is YouTube delivers video but also delivers us text. What you see is in variations in country patterned usage of YouTube in terms of text and video. You also see YouTube emerging as a primary search engine in many countries as well. I think down the road, what this speaks to is what I kind of alluded to before: the ways in which people are looking for video to answer any question, answer basic questions as they come along. And quite frankly, globally, you see different communities, different people are looking for the kind of video that's engaging to them, that's relatable to them, that delivers information by those languages that they speak, with a culture that they speak. That's where I think the evolution of YouTube and similar entities continue to grow as this idea of engagement and reach and depth in terms of different ways to deliver information.

Dr. Rishi Desai: Now, it used to be that the learner back in the day had to go through an intermediary -- a school to get to learning -- but now a learner can go directly to the learning without necessarily going to school and I'm curious, have you seen that sort of power shift manifest in unexpected ways?

Dr. Garth Graham: Mm-hmm, yeah. I love the way you put it. This shift towards a person-centric approach is what is emblematic in the education example that you just gave. What it means is, we forget often that people are behind all of these things. When I say that I mean we create information and we create structures of delivering educational information, health information, from the organization who's delivering it. But what's happening now is that people are feeling empowered to figure out how to get this information in different ways that the system adjusts to, which is kind of what you see with the education example you just gave. I think it's pertinent for healthcare because for so long in healthcare and public health, we have had a somewhat paternalistic approach to how we address patients, communities, and consumers. Now that they're getting empowered appropriately for a variety of different reasons --technology being one component of that -- we have to think through their needs primarily in terms of how people want to get their health information.

Dr. Rishi Desai: That's a great point and as you know, we're a teaching company. We love to fill knowledge gaps. I'd love to identify some topic that you'd like to educate us on, something that you think everyone ought to know.

Dr. Garth Graham: Yeah. Wow, I love this question. I think in my journey through health and public health, this concept of patient empowerment is the one thing I would want to deliver, particularly to medical students and trainees who sometimes forget as we train them to have them see life through the eyes of the community, through the eyes of the patient. The one thing I would want that audience to understand is patients, communities, users are not looking for you to solve all of their problems. Many times they're looking for you to work with them on their problems and be a partner in sharing information. 

This comes from the old community empowerment model when you look at community health, and community health best works when there are partnerships particularly symbiotic partnerships between communities and infrastructure that's partnering with them and there's a whole bunch of data to show that. The one issue I still lecture at different grad rounds and at different training aspects...I always end with a slide on partnerships and engagement. I think this goes from the community and also at the patient level. When you're seeing a patient, just remember that most times patients are wanting to work with you on their journey for their better health, not necessarily looking for you to be the solver of all their problems. If you have that mindset as you are engaging patients and communities, you'll find that the give-and-take is mutually rewarding on both ends.

Dr. Rishi Desai: There's a lot of ego as you know, Garth, in clinical medicine particularly among physicians. It's been that way for many, many years, and YouTube has actually helped make getting information easier than ever before. I'm wondering whether physicians resent that or whether they appreciate when their patients come in self-empowered with information about their condition. What have you seen?

Dr. Garth Graham: Rishi, I'm old enough to remember, particularly in clinical medicine, the early times when patients would go home and search for answers on search engines. We were resentful of that in medicine and clinical care and we, at least initially, would dislike when patients came in with all the slew of questions from things they had seen online. I know there's a lot that's different now and I think a lot of the younger generation appreciates this concept of patient empowerment, patients having information. I personally love my patients that come in with questions they thought of before because it has them more engaged in their healthcare. 

To answer your question more succinctly, I think the democratizing of information, especially for healthcare, is a powerful way for us to motivate patients by delivering information to them outside of the clinical setting. The ways in which you, your organization, our organization, others deliver information is particularly powerful to improving health outcomes, particularly as we make sure that what they get is scientifically correct, factually correct, and evidence-based information.

Dr. Rishi Desai: I'm going to ask you a very broad question based on the fact that you've worn so many different hats in your professional career. What do you think the COVID-19 crisis has revealed about the healthcare system? What are some key steps that you think could strengthen it?

Dr. Garth Graham: You know, a lot of times that I've been asked this question before, I think people expect the focus to be on how COVID-19 highlighted health disparities. But you and others and people who have been long in public health know that those disparities have been seen in many other disease entities -- practically all major disease entities -- and so COVID-19 has just been a more visible example of that and hopefully motivates us to do better. 

The two things COVID-19 showed me is one, we had not been engaged in communities as much we thought we had and the ways in which community engagement still serves as the backbone of healthcare and public health delivery at scale because we want communities to get information and act on it and do these series of things next to improve population and public health. But in many ways -- as you saw particularly in the U.S. in COVID-19 -- people were confused, they weren't sure about the information, they were making decisions that were not necessarily always in their best interest. I think this idea of community engagement and its importance for public health outcomes is one of the things that's been highlighted by COVID-19. I think that's certainly one way in which tackling those disparities were important. 

The other thing I would say COVID-19 showed was how fast we can move when we need to. Telemedicine for a long time had been moving along at a snail's pace, not on the patients' side, but on the provider and the system's side. Then when we needed to change, we changed as a health care delivery system in weeks to months. People switched around how appointments were so that patients could safely do that from home. That was something that people have been trying to articulate as a vision in terms of the delivery of telemedicine for a long time. I think the surprising thing it showed to me is that the healthcare system is not this mammoth dinosaur that moves so slowly in all cases. It's mammoth but it is probably more like an elephant that can pick up speed when it needs to and so we need to think about that for other components of post-COVID crises, particularly around mental health and other issues that we need to deal with as well.

Dr. Rishi Desai: Got it. I'm going to remember that, Garth. Healthcare is an elephant and can stampede if needed at times.

Dr. Garth Graham: That's right. That's definitely right. (laughs)

Dr. Rishi Desai: We have many students listening who are in the early stage of their careers and I'm curious to get your advice to them about meeting the challenges of this moment as they approach their career in healthcare. 

Dr. Garth Graham: Healthcare has energized students around how important it is to be a healthcare provider and public health leader. My advice for students is follow your passions and that passion that has carried you this far. We train students to focus on their anatomy, pharmacology, and physiology without continuing to stoke a lot of those things that brought them to health and public health in the first place: the passion for changing individual lives; the passion for not just the heart but the patient that goes along with the heart and the lungs. My advice to students is stick with the passion that brought you here because that's a passion you're going to need on the other end when you get out of training to deal with these major public health and healthcare challenges that we're facing. I would say that hopefully there will be a point where COVID is entirely in the rearview mirror. It's unclear when that's going to be given all the global dynamics that we're seeing now, but at the point when COVID is in the rearview mirror, they'll be other problems that are in that front view mirror and that same passion that you're going to need that drove us through COVID, we're going to need that to deal with other challenges on the road.

Dr. Rishi Desai: Well, that's a fantastic point to end on. Thank you so much Dr. Graham for being with us today. That was incredible.

Dr. Garth Graham: Thanks, Rishi. Again, thanks to you all for being a part of the ingredients of change that we talked about, particularly using technology and all of those tools that we need to empower communities.

Dr. Rishi Desai: Garth, that's really kind of you to say. On behalf of the whole team, I really appreciate you saying that so thank you. Listen, I'm Dr. Rishi Desai. Thank you for checking out today's show. Remember to do your part to flatten the curve and raise the line. We're all in this together.