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Category: Inspiration

Public Health – Possible impacts of disinformation

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Intro

The only way we can fight infodemics is with trusted information and better health literacy.

How dangerous are infodemics for patients?

Infodemics are very dangerous for patients. They are the disease of the internet. Unfortunately, it crosses the line from the internet into people’s lives. Misinformation has caused consequences for public health and for patients’ health through, for example, feeding into vaccine hesitancy and vaccine resistance, feeding into mistaken, non-evidence-based beliefs, or even during the pandemic, creating rushes to buy products that were inappropriate and even dangerous for patients.

What are the needs of patients in times of digital transformation?

In times of digital transformation, the first thing patients need is trust. They need to be able to trust that they receive good quality information, that the information and the data they provide to the health system is treated properly, and trust that it is used to improve their life and the life of others like them. So from that point of view, I would translate that from a digital health perspective to how can new technologies, digital technologies, how can they help make things faster, make things better, and bring better outcomes for patients.

What needs to happen at European level to promote a trustworthy information architecture?

Europe needs a trustworthy information architecture at European level. At the moment, we don’t have one. We should get one with the European health data space legislation. And for that to happen, we need to ensure that patients remain involved in the design of the information architecture and the tools that it uses, from electronic health records to all the way to national data boards That control how the data is shared with researchers and developers. And the other thing that needs to happen is a massive investment in digital and general health literacy for patients, for citizens.

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Expert

Anca Toma is the Executive Director of the European Patients’ Forum (EPF) which acts as an intermediary between the patient community and EU policymakers. Anca has over 15 years of experience in European health policy working in policy advocacy, strategic communications, developing and coordinating successful pan-European advocacy campaigns.

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    Design of user friendly health systems

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    Intro:

    A digital health platform has so many opportunities to actually bring health to people.

     

    Why is digital health literacy becoming increasingly important?

    Health literacy is two-sided. On one hand we talk about the health literacy of the public, of people. The other side is about the health literacy responsiveness of systems. So how do we design systems to be health literacy friendly? And when we talk about digital health literacy, we are challenged. Because we see that there are so many barriers for people to find information on social media, on websites and so forth. Many public websites are not designed very user friendly. And it means that people can get lost. It’s important that we recognize that healthcare systems have a say in how we design systems and the way we can help people to gain digital health literacy.

     

    How can health literacy be promoted?

    Healthcare systems play an important role in increasing health literacy of people. It’s important to create a leadership, ownership, management buy-in to implement health literacy as a strategic approach in organisations. Healthcare systems are also important in terms of setting guidelines and standards for use of data, for example. So it’s important to create a good framework for privacy and data security.

     

    How can we create a health literate future?

    I believe the future is health literate. I believe we all have a responsibility to design healthcare systems that are conducive and empower people to take care of their health and well-being. It’s a responsibility of all of us, whether you work in the healthcare sector or beyond the healthcare sector. So it means for the healthcare staff, but also those outside, so meaning teachers, coaches, decision makers, policy makers, journalists: We all have a responsibility and we can all make that difference of making the future health literate.

    Content

    Dr. Kristine Sørensen, President of the International Health Literacy Association, advocates for more people to gain better digital health literacy. To achieve this, she believes that health systems have a responsibility to become more user-friendly. In this video, the health literacy expert outlines the framework for health systems that aim to empower people to take responsibility for their health and well-being.

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      Creating resilience against desinformation

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      Intro:

      We need to be much more critical about what we read and hear in the news and on social media.

       

      What is health literacy?

      Health literacy is a rather new term in the health field. It entails the knowledge and motivation and competencies to find and understand and judge and use information to take decisions in everyday life. So when we are ill, when we are talking about risk factors like tobacco or smoking, when we are trying to stay healthy. But it’s also about how to navigate the healthcare system.

       

      Why is health literacy so important?

      Health literacy is important because those that have the knowledge and motivation and competencies to take care of themselves, they also do well, live better lives, use healthcare systems less. And when we have the skills with regard to health literacy, we are also empowered and we are able to trust ourselves when we deal with information and distinguishing whether this is now true or whether it’s fake news. So in the opposite, if you’re less skilled, it might be difficult and too complex to manage your health and navigate and find your way in the healthcare system. And that can have a detrimental impact. You go often to the hospital, you’re not joining screening systems, you may not know how to eat well.

       

      What does research say about health literacy?

      We know from European health literacy surveys that on average one in two face difficulties in terms of finding and understanding and using information to take action. It means that it’s not only a small proportion of people that are having difficulties, it’s actually a public health challenge that we need to tackle.

       

      Why do so many people struggle with health information?

      During the pandemic we saw how difficult it was for people to deal with health information. We need to be much more critical about what we read and hear in the news and on social media. We know that we are also faced with myths, conspiracies and people need to be able to understand what is fake news. However, we are also very challenged because sometimes fake news comes also from people we actually trust. And this is a challenging time when health is dealt with all over in the news and in social media.

       

      How can we tackle this problem?

      We can teach health literacy and digital health literacy in schools. We can ask journalists to have a more prominent role in how health is being presented in news. We can ask leadership in companies, in public and private sectors to deal with health literacy at work, because health literacy is relevant for all of us. And we need to make sure that we have access to credible information and timely information and relevant information. And a way to do that can be to establish a health data platform. So a digital health platform has so many opportunities to actually bring health to people.

      Content

      Those who want to inform themselves about health topics often feel lost in the jungle of information. According to surveys, many people do not have the necessary health literacy to distinguish fake news from trustworthy information. In this video, Dr. Kristine Sørensen, President of the International Health Literacy Association, explains why health literacy is important and how a national health platform can contribute to improving health literacy.

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      Ecosystem design: Benefits for all

      To thrive in today’s market, digital platform operators need to consider the interests of all ecosystem participants. By delivering benefits and creating advantages for everyone involved, they can unlock the potential of network effects and scalability. This principle holds true even for a non-profit national health platform.

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      Health literacy and infodemics

      Making healthy decisions requires access to accurate information. Health literacy involves a range of skills that enable us to effectively navigate this information in our daily lives. In an era where information is abundant, and digital platforms offer seemingly unlimited access to knowledge, many people find it challenging to sift through the overwhelming volume of information they are confronted with.

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        Managing the risks of platform economy

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        If you think of that, the risks in healthcare get much more magnified and amplified compared to the risks that we’ve seen in less sensitive industries like social media and health and e-commerce.

        Could public platforms be part of the solution?

        I absolutely believe that in healthcare in particular, public platforms are very important. In healthcare, today data is fragmented across many different legacy institutions, much like in banking. If you look at what happened in India with the rise of the India stack, a common public infrastructure was created for different stakeholders across the financial services sector to work together.

        A similar approach would work in healthcare, where legacy institutions need to work in coordination with new startups coming up, and large public digital infrastructures provide the common mechanism for enabling and achieving that coordination. So I believe that even if it hasn’t happened in certain other sectors, in healthcare I would absolutely advocate the creation of public digital infrastructures.

        What can be achieved through statutory regulation?

        The potential disadvantages of the platform economy can be to some extent averted through statutory regulation. Because today the platform economy is operating in the wild west. There are no regulations in terms of what can be done with the data that’s being harvested. So regulation does have an important role when we start seeing too much concentration happening in a certain industry or too much power being taken away from individuals.

        But at the same time, it’s important to ensure that regulation does not stifle innovation, that we create counterbalancing value for innovation in the form of public infrastructures, in the form of standards through which companies can better coordinate with each other. So it’s important that we don’t take a pro-regulation only hat approach to this. We counterbalance it with the right capabilities for innovation.

        Should national health systems compete with the private sector?

        National health systems competing with private sector players would prove counterproductive for the healthcare ecosystem. To solve problems in the healthcare ecosystem systemically, you need national health systems to create the right public goods around patient data, but also need to incentivize private players to create the right diagnostic capabilities while using that data.

        Content

        Expert

        Sangeet Paul Choudary is author, advisor, and Founder of Platformation Labs and he is a prominent advocate of individual rights in the platform economy. His best-seller “Platform Revolution” is a Forbes “must-read”, his work on platform economy is ranked among the top 10 strategy articles published in the Harvard Business Review. He is ranked a top business thinker by Thinkers50 Radar (2016) and Thinkers50 India (2015). For his contributions to the field of platform economics, Choudary was named a Young Global Leader by the World Economic Forum in 2017.

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          Trusted Health Ecosystems – TRAILER

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            The power of platform economy in the healthcare system

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            In healthcare, that could take the role of capturing diagnostic power and essentially controlling the patient journey and controlling doctor access to the patient journey based on that data.

            What are the differences between platform economy and traditional business models?

             The platform economy refers to the sum total of social and economic activity that is mediated by digital platforms. Digital platforms are different from traditional business models. Traditional business models are what I call pipelines, which create a product, ship it down, and provide it to the end user. Digital platforms create an infrastructure which allows external parties to come together and create and exchange value with each other.

            Now, the reason this is important is because in a traditional pipeline economy, your ability to create value was restricted to your access to  resources and to labor internal to the company. In the platform economy, your ability to create value is determined not by the sources internal to you, but by your ability to leverage resources external to you, which means that you now benefit from what is called demand side economies of scale.

            How can healthcare benefit from platform economy?

            Healthcare is uniquely positioned to benefit from the platform economy. And to understand that, we need to think about the healthcare value chain. There are three distinct positions where platforms can come in and add value. For the physicians and the doctors, platforms can create diagnosis augmentation. They can provide infrastructure that can help doctors make better diagnosis and perform surgery better. Closer to the patient, platforms can serve as a way to act as a custodian of patient data in an aggregated format. And in between the two ends of that spectrum, as healthcare APIs increase, platforms can create a strong integration role in resolving these healthcare APIs across the ecosystem.

            What are the risks of platforms entering the healthcare market?

            There is every likelihood that platforms entering healthcare could lead to the same data monopolies that we’ve seen in other sectors. And the reason for this is that platforms capture value by extracting and capturing data and creating monopolistic control over data at scale. This is even more important in healthcare because a significant amount of value created in healthcare is created through data-driven diagnosis and data-driven patient care. So platforms are in every way incentivized to capture data as they enter healthcare and to create large data monopolies.

            The counter to this is to ensure that on the one hand, we create the right regulatory forces to counterbalance these kinds of risks, but more importantly, ensure that alternatives like creating public infrastructures are set up in a way that innovation is not restricted because of this regulation. So in order to counter digital platforms, we need a combination of both of these aspects.

            In the future, who will control patient flows?

            I believe it is very conceivable that future patient flows will no longer be controlled by traditional healthcare institutions. As the world gets more connected, we need to realize that healthcare today is very fragmented. Patient data itself is fragmented across different institutions. Naturally, as the world gets more connected, we would see more of concentration of this patient data and more of interoperability. So at this point, we have two choices, whether it’s large multinational companies that will enable that interoperability, or whether it is public digital infrastructures that we create that will enable that interoperability across different systems.

            Content

            Expert

            Sangeet Paul Choudary is author, advisor, and Founder of Platformation Labs and he is a prominent advocate of individual rights in the platform economy. His best-seller “Platform Revolution” is a Forbes “must-read”, his work on platform economy is ranked among the top 10 strategy articles published in the Harvard Business Review. He is ranked a top business thinker by Thinkers50 Radar (2016) and Thinkers50 India (2015). For his contributions to the field of platform economics, Choudary was named a Young Global Leader by the World Economic Forum in 2017.

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              Digital health – The future of health systems

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              Digital health is a key enabler of efficient, high-performing health systems. So what a national health platform does is set the rules of the game.

              Can digital health enhance national health systems and what role can digital ecosystems play?

              WHO is extremely excited about digital health as a catalyst to strengthen health systems. Many health systems struggle with limited resources to achieve large ambitions. And without tools like digital health to optimize how those limited resources are allocated, how services are delivered on time to those who need it the most, the resources are misspent. And so digital health is a key enabler of efficient, high-performing health systems.

              How should national health systems shape digital transformation?

              So it’s absolutely critical that digital transformation not happen in a chaotic manner. Over the last two decades, we’ve seen billions of dollars be spent in a discordant way, not achieving the levels of impact and scale that we’ve hoped for. So national health systems and governments need to have a clear vision of where they want the countries to go, as well as an architected plan or roadmap for how that transformation occurs. Once that architectural blueprint is in place, then there is scope for many actors to help advance the goals of that blueprint.

              How important are quality, truth and trust in designing digital health care landscapes?

              Those are three very important words, quality, truth and trust. Quality means making sure that the content and the standards on which these systems are built are the gold standards, and that’s the role of organizations like the World Health Organization. Truth and trust are things that have been eroded significantly over the past decade with the advent of misinformation and disinformation, fake news, et cetera. And so it’s absolutely critical that we leverage tools like digital health to make sure people have access to truthful, reliable information on which to base the health care decisions they are making.

              How can national health systems prevent data monopolies and loss of control?

              The national health systems and governments have a strong responsibility to ensure that the sovereignty and privacy of individual data is always protected. The importance of data ownership by individuals and the decisions as to how that data is used must always reside with the individual from whom that data comes. However, in large systems, it’s important that government sets the rules of engagement and the parameters or boundaries within which tech sector and other industry and private sector partners can play so that they support the mission of the public health system.

              What role could a national health platform play in the personalized and human-centered health care of the future?

              So what a national health platform does is set the rules of the game. It sets the boundaries and the guardrails within which all of the different actors can play together. By setting the vision, by setting the architecture, by selecting the standards, what we do is we enable all of these different solutions and innovations to thrive, not as separate innovations, but together as an interconnected system, ultimately keeping the patient or the individual at the center of all of the different pieces.

              Content

              Expert

              Dr. Alain Labrique is Director of the Department of Digital Health and Innovation at the World Health Organization. He is the founding director of the Global mHealth Initiative at Johns Hopkins University and editor-in-chief of the Oxford Open Digital Health Journal. An infectious disease epidemiologist and population scientist, he was a professor at the Johns Hopkins Bloomberg School of Public Health until September 2022. Labrique was the lead author of the 2012 Bellagio Declaration on mHealth Evidence and has authored more than 150 publications in top-tier journals, as well as numerous book chapters and technical reports on digital health.

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                Disinformation in the healthcare sector: Brave new communication world

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                Everything is different. This means that all areas of society have to learn and change, and adapt to the way technological disruptions are shaping this new world of communication.

                How do people stay well informed in the digital age?

                Digitalization has turned the concept of how we inform ourselves and communicate entirely upside down. Society isn’t adapting quickly enough. People still lack the information and communications skills they need to really master these interactions.

                This is first of all a democratizing process, because many more people today want their voice to be heard, and want to be a part of the discussion. And they can do this. But this complete change in the communications landscape also introduces entirely new challenges in terms of regulation, in terms of responsibility, in terms of who the relevant actors are.

                That makes it difficult for us as a society to react quickly enough, because the technological disruption is simply gigantic, and is happening very, very quickly. These days, you can’t expect just to clean up after things by putting together good regulation and approaches, because by that time the world is already changing again, and new things like AI, ChatGPT and Midjourney are all becoming relevant.

                And that leaves society overwhelmed. So almost all social systems have to learn and adapt very, very quickly, whether that means the education system, the political system or the healthcare system. All of them are suddenly part of this public sphere, and of course once there, they have to learn how to communicate professionally and inform people in a way that brings them along. But it’s really not easy to navigate this huge flood of information, and find your way from A to B without somehow falling for or getting stuck on advertisements or disinformation or cat videos, or whatever.

                Can platforms shield against disinformation through quality mechanisms?

                Platforms can make the most important contribution to protecting people from disinformation. If we remember back to the pandemic, there were suddenly completely new information offerings from the various platforms.

                On Google, when I googled COVID-19, a sidebar suddenly came up that gave me quite a bit of relevant information about the pandemic. For example, what the incidence was in my country, or how many people had been vaccinated, or where I could find relevant health information. Google did a good job there of sort of taking me by the hand when I was trying to google information.

                Other platforms approached this differently, sometimes less well. For example, Instagram flagged any post that contained the words “corona” or “COVID-19” in any way, and said, “Watch out, this is about the coronavirus.” Other platforms like YouTube tried to do a better job of curating what showed up in response to keyword searches.

                The moment the platform decides to help people, maybe by curating certain content or adding a separate piece of information that assesses the quality of a source, that’s a huge help. This could be information about the source, explaining why the source is trustworthy, or additional information and links. The question is, how much do people trust this platform, so that we actually have a different outcome.

                Ideally, we’ve learned a lot from the pandemic, and now actually know how to think about all these issues beforehand when building a new platform, for example. For instance by setting up a quality system that determines beforehand what sources are even allowed to be included. This means thinking about a set of rules beforehand that clearly say: This is trusted information, and this is just disinformation that has no place on our platform.

                I think we can learn a lot from what Google has done, and from how YouTube has labeled sources, and from how other platforms have done things like provide additional links. We can use these ideas to be able to offer genuinely high-quality information even in a new communications environment.

                So yes, platforms have a critical responsibility with regard to whether people are leaving the platform informed or disinformed. It has to do with the way they prepare this information, with whether they’re thinking about how the information ecosystem can be secured or curated, and about what additional information they can provide so that users can better decide whether this is a trustworthy source, or just some disinformation crap that they’d be better off avoiding.

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                Expert

                Alexander Sängerlaub is the Director and Co-founder of futur eins. He takes a holistic approach to digital public spheres and explores how the utopia of an informed society can be achieved. Previously, he helped establish the “Strengthening Digital Public Sphere” department at the Berlin think tank Stiftung Neue Verantwortung, where he led projects on disinformation (“Fake News”), fact-checking, and digital news literacy. He studied journalism, psychology, and political communication at the Freie Universität in Berlin.

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                  What are digital ecosystems?

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                  Intro

                  These are companies that have dramatically changed whole industries, and even entire areas of life.

                  What is meant by a digital ecosystem?

                  While the term “digital ecosystem” may not be immediately familiar to everyone, we’ve all encountered real-world examples of such ecosystems that have significantly transformed various aspects of our daily lives. Think of Uber, Airbnb, and Amazon Marketplace – these are all names we’re acquainted with.

                  Let’s take Airbnb as an example. On this platform, we have private hosts offering accommodations to fellow private individuals. And right in the middle of this interaction, we find Airbnb, playing a crucial intermediary role. This intermediary role is, in fact, the defining characteristic of digital ecosystems, and it’s a common feature shared by all of them.

                  This intermediation takes place entirely in the digital realm, and the platform becomes the technical core of our digital ecosystem. To effectively serve the voluntary participants, this digital ecosystem and its platform must be highly scalable. You see, these voluntary participants all expect to gain benefits from being part of this digital ecosystem, and this dynamic sets a self-reinforcing cycle in motion. More and more providers join, attracting more and more consumers. This, in essence, is what gives rise to the frequently mentioned network effects that underpin all business models in the platform economy.

                  What’s new about digital ecosystems?

                  Digital ecosystems thrive not by introducing entirely novel concepts but by elevating existing ones to new heights. This approach holds significant appeal for consumers as it grants them access to a broader array of offerings than ever before. For providers, it’s equally enticing, offering access to a vast consumer base without the burden of bearing market development costs themselves. Naturally, for the operator of the digital ecosystem, it also proves highly profitable.

                  Yet, in the public sector, the presence of successful digital ecosystems remains notably scarce. Especially within government agencies, there’s a dearth of prosperous examples. It’s imperative that we harness the potential of this successful paradigm for public sector entities and leverage the capabilities of the platform economy accordingly.

                  And what are the risks?

                  Certainly, where significant benefits abound, risks often lurk in the shadows.  Typically, a digital ecosystem is launched in one country, and its operators work diligently to expand it further within those borders. However, due to their inherent scalability, the potential for rapid international expansion looms large. Consequently, there exists a certain peril – namely, the prospect of international giants entering the German market with ease, rapidly gaining dominance, and then dictating the ecosystem’s rules within. And if the ecosystem is really big, and becomes very established, and there aren’t many alternatives, then of course that creates the risk for other participants that they too will no longer have any real alternative.

                  How can ecosystems be regulated?

                  The risk of abuse of power is relatively difficult to counter. After all, companies typically build digital ecosystems within the framework of applicable laws, progressively achieving remarkable success. Nevertheless, the issue of power concentration persists, prompting efforts, particularly at the European level, to establish a regulatory framework that curbs excessive centralization of power.

                  The other risk is more at the level of market dominance, which can be addressed by trying to encourage the emergence of more digital ecosystems in Germany, and thus creating a natural counterweight to the international players. One additional aspect to note is that especially if the state also acts to provide support, it can have an influence on both the regulatory conditions and the values that are embodied in a digital ecosystem of this kind.

                  Are all digital ecosystems focused on making profits?

                  These entities do not necessarily have to prioritize profit above all else.  We’re all familiar with examples like Wikipedia, which enjoys widespread usage, or Better Place, a donation platform that sustains itself through contributions. Another avenue to explore is seeking suitable sponsors, or even having the public sector assume a sponsorship role. In this manner, a digital ecosystem can be conceived and operated.

                  Content

                  Expert

                  Dr. Matthias Naab, co-founder of Full Flamingo, an eco-tech startup, aims to leverage the power of the platform economy for the greatest possible impact on sustainability. Before 2022, he held a senior executive position at Fraunhofer IESE, where he played a pivotal role in developing and overseeing the field of “Digital Ecosystems and the Platform Economy.”

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                    What is platform power?

                    Dr. Michael Seemann
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                    Platforms. We all use them every day. Instagram, eBay, Uber, Wolt, Airbnb … Platforms are useful because they organize communication, coordination and transactions, and thus make all kinds of tasks easier. But if we’re honest with ourselves, we also often feel uncomfortable with our dependence upon them. In the following article, I explain various aspects of platform power and its implications.

                    Platforms have power. Few would disagree with this truism. But there is often dispute about exactly what kind of power they have. For example, there is the issue of economic power. Platform companies often have vast amounts of money and resources that enable them to implement their ideas. In addition, they have market power. Platform companies are often described and analyzed as monopolies, or at least as actors that dominate their markets. And finally, platforms have data power. They collect mountains of data about us and our behavior, and about society as a whole. In addition, they can increasingly be said to have political power. Their lobbying corps are among Brussels’ and Washington’s largest, and they can often influence political discourse through their algorithms.

                    All of these analyses are correct. But it seems to me that these areas of power are themselves only the effects of an entirely different power. My thesis is that platforms have their own, very specific power, and that all these other forms of power derive from it

                    Platform power

                    I am referring here to “platform power” (Seemann 2021): a power held and wielded only by platforms, and which can be explained only by their very special structure.

                    Platform power consists of two parts:

                    1. Network power, which draws individuals, institutions and other participants into the platform and binds them to it.
                    2. Control, which allows platform operators to influence everything that happens on the platform.

                    Network power is actually just another name for “network effects.” This term from the field of economics describes the circumstance in which actors always prefer the network that itself contains the greatest number of other actors. We all have seen how this works: A social network with no one else in it is not very appealing. To have value to me, a network must allow me to communicate with others. The value of a network is therefore directly related to its size.

                    However, this effect can also be described as a form of power (Grewal 2008). My decision to join one network or the other is not completely free, as it is strongly influenced by these network effects. At the same time, it’s hard to leave a network in which I’ve already built a lot of relationships. This effect is also called “lock-in,” because in a certain sense it prevents departures. Network effects thus draw people into a network and keep them there. For this reason, it also makes sense to speak of “network power.”

                    But network power long predates digital platforms’ arrival on the scene. Most of us learned English as our first foreign language, for example. This is partly because it is so useful to be able to speak English, given that English is the language spoken by the greatest number of other people in the world. The network power of the English language, one might say, is greater than that of French.

                    Network power exists everywhere in our lives. Gestures, languages, customs – all have network power because they rely on there being a sufficient number of other people able to recognize and interpret them. Platforms too have network power. But while no one is able on their own to control, change or exclude people from languages, gestures or customs, Instagram and Uber can determine who is allowed to access their networks and what people can do there.

                    This is where control, the second factor of platform power, comes into play. Platforms are technical infrastructures that give their operators many opportunities to exercise control. Simply by designing the platform’s features, operators can determine which things are possible on them and which are not. They also have the ability to control what interactions happen on the platform via the search, recommendation or matching algorithms. And they can even decide to exclude certain people, or reduce their opportunities for interaction. Put these two things together – network power and the ability to exercise control – and a new form of power emerges: platform power.

                    The graph grab

                    Every platform faces an initial challenge: To be attractive to users, the platform must acquire network power. To do so, it must attract users. This is a chicken-and-egg problem that is difficult to solve. In the past, platforms have solved the dilemma by incorporating existing networks within themselves. Google, for example, sits on top of the world wide web, WhatsApp imports its users’ contacts by uploading their address books, Uber initially poached cab drivers, and Facebook went from campus to campus in its early days persuading students at elite universities to join its platform.

                    The trick of integrating existing networks into your platform in order to make them the basis of your own network’s growth is what I call “graph grabbing” (Graphnahme). A graph grab of this kind conducted by profit-oriented platforms could pose a serious threat in the healthcare sector. I have developed a plausible scenario for this elsewhere (Seemann 2022).

                    The politics of platforms

                    It is no longer possible to understand today’s politics without taking platform politics seriously. Google’s past involvement in China, Facebook’s influence on the U.S. elections, Elon Musk’s purchase of Twitter: Platforms are political, even if they have long wanted to give a different impression. Even the incorporation of another set of networked relationships is a political act. Imagine if a private platform could gain similar control over the healthcare system, for example.

                    The business model

                    However, platform power is not only a source of political order-making; it is also the foundation of all platform business models. In one way or another, every platform business model uses network power and control as leverage to make certain user groups pay – whether by limiting access to features or by limiting access to other users. This is evident when Uber or Airbnb collect commissions, or when Amazon takes fees from merchants, for example. But even the advertising business model only represents the toll that advertisers pay to the commercial platforms in order to be allowed to reach the user base.

                    Enshittification

                    For-profit platforms face a contradiction here. On the one hand, a platform always wants to grow, because growth is the way to achieve platform power and thus usefulness. To do this, it must be as open as possible, and provide everyone access to everything. On the other hand, a platform usually also wants to earn money. To fulfill this goal, it must close itself off and limit access, because otherwise no one will pay the tolls. As a result of these conflicting dynamics, every platform goes through multiple phases.

                    In the early phase – that is, shortly after the graph grab – a platform is focused on growth. In this phase, platforms try to be as useful as possible to everyone in order to acquire platform power. The platform finds its business model only once a significant number of people have joined and begun using it. The operator then determines the bottleneck points where it wants to exact tolls, and starts to close them little by little. As growth levels off, these access points are increasingly closed off, and tolls are collected in an increasing number of places. In the next phase, the platform is then concerned only with extracting the greatest amount of profit possible from the increasingly dependent community. Little by little, user options narrow, overall usefulness diminishes and use of the platform becomes increasingly expensive. Science-fiction author Cory Doctorow and net activist Rebecca Giblin call this process “enshittification” (Giblin & Doctorow 2022).

                    The ambivalence of platforms: Usefulness is power

                    It is incredibly difficult to get people to establish a common standard. In sociology, this is referred to as the “problem of collective action” (Olson 1965). Once a common communication standard has been established, all communication participants benefit from it. That is the great merit of platforms. Therefore, we can’t forget: Platforms are useful for the same reason they are powerful.

                    Platforms are a concept for organizing human interactions in which network power can be combined with control. Platform power is the foundation both of platforms’ increasing political influence and their business models. Since most platform operators are capitalistic companies, they look for ways to skim off the added value they generate. To do so, they must inevitably limit access to interactions, and reduce the platform’s usefulness.

                    Platforms are useful, and are dangerous precisely for that reason. Platforms should not be rejected as a matter of principle, but users should be very careful about which platforms they depend on. Especially when it comes to sensitive social settings such as healthcare.

                    Bibliography

                    Giblin R, Doctorow C (2022). Chokepoint Capitalism: How Big Tech and Big Content Captured Creative Labor Markets and How We’ll Win Them Back. Boston.

                    Grewal D S (2008). Network Power. The Social Dynamics of Globalization. New Haven.

                    Olson M (1965). The Logic of Collective Action. Public Goods and the Theory of Groups. Cambridge.

                    Schmitt C (1950). Der Nomos der Erde im Völkerrecht des Jus Publicum Europaeum. Berlin.

                    Seemann M (2014). Das Neue Spiel. Strategien für die Welt nach dem digitalen Kontrollverlust. Freiburg.

                    Seemann M (2021). Die Macht der Plattformen. Politik in Zeiten der Internetgiganten. Berlin.

                    Seemann M (2022). Die Graphnahme der Gesundheit. Ein Planspiel zur möglichen Plattformisierung des deutschen Gesundheitssystems. Baas J (Hrsg.). Gesundheit im Zeitalter der Plattformökonomie. Ziele. Herausforderungen. Handlungsoptionen. Berlin. 50–58.

                    Author

                    Michael Seemann studied applied cultural science and received his Ph.D. in media science in 2021. In 2010, he launched a blog focusing on the loss of control over data on the internet, and in 2014 published a book on this topic under the title “Das Neue Spiel” (The New Game). His second book, “Die Macht der Plattformen ” (The Power of Platforms) was published in 2021. In 2016, he served as an official expert for the Bundestag on the topic of platform regulation. He delivers regular presentations on topics including internet culture, platforms, artificial intelligence and the crisis of institutions in an era marked by the digital loss of control.

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