Newspapers and other forms of “old” media face an uncertain future because of withering traditional revenue streams, rising new media technologies, and changing audience expectations. Comparisons have been drawn between the demise of the Roman Empire and that of modern media empires.1 To date, the collapse has been most evident in the United States, where, between 1 January 2008 and 15 September 2009, 46 599 jobs in the journalism industry were lost and 201 media outlets closed.2 The journalism industry lost jobs at almost three times the rate of other industries.2 The number of full-time journalism positions in Australia fell from 8500 to 7500 between 2001 and 2007,3 and more losses are expected (Jonathan Este, Director, Communications, Media Entertainment and Arts Alliance, 20 October 2009, personal communication).

The changing nature of the media landscape brings dangers and opportunities for those concerned with the health of societies and populations. The mass media, for all their flaws, have been a powerful force that have influenced and informed policy, practice and attitudes in the health sector and other spheres. The “fourth estate” has also had an important role in scrutinising society’s powerful institutions, and holding them accountable. Media coverage has contributed to significant advances in public health policy. Notably, according to the Advocacy Institute in the US: “News coverage has been the lifeblood of the tobacco control movement”.4 The demise of the traditional media, therefore, has serious implications if it means fewer resources for investigating important health and medical issues or related matters, such as social determinants of health.

The traditional media are losing their monopoly on news gathering and dissemination as the Internet and related technologies enable a proliferation of new media outlets and applications. These include blogs, wikis and online social media tools such as Facebook and Twitter. The definition of a blog is a fluid one. Originally coined to mean an online journal in which the entries appeared in reverse chronological order, the term is now used to encompass a wide range of Internet publishing, including journalism.5 A wiki is a website that can be freely edited by participants, who can be either the public at large or a defined group working on a project or from within an organisation. The best-known wiki is the online encyclopaedia Wikipedia. Online social networking tools are evolving fast. One of the first was MySpace, where individuals could post information and send other members messages. Facebook has largely overtaken it as the most popular social networking site, whereas Twitter is a newer social networking tool that is possibly the most relevant for journalism, relying as it does on short, real-time 140-character “headline messages”.

The transition from mass media to “masses of media” creates new opportunities. Never before has there been so much media choice or so many adept media users. Anyone with access to the Internet can publish news and views for the world to see. This is a first in human history, and has contributed to the rise of “citizen journalism”. The technology also enables news to reach larger audiences in more ways, and creates new ways of telling stories and engaging audiences. As Mark Scott, managing director of the ABC, stated: “The opportunities to connect and engage have never been more exciting”.1

At the same time, new media have undermined the business models of media institutions. Commercial free-to-air broadcasting remains the main way Australians get their news and information.6 It makes money by aggregating audiences and selling their attention to advertisers, but the audience is fragmenting as more choices become available. Once Australia’s National Broadband Network is complete, and more audiovisual material is delivered via the Internet, the audience will be everywhere at once.

Meanwhile, newspapers, which have been the largest employers of journalists, have seen classified advertising decline as advertisers find the Internet is a cheaper and more efficient way of reaching buyers. Although all newspapers have an Internet presence, so far none of their websites make money in their own right once the costs of providing editorial content are factored in. Companies cannot charge as much for an online advertisement as they have been able to charge for a printed advertisement because there are so many online options. If the price is too high, there is always the possibility that industry groups — for example, real estate agents — might start their own online publication. Indeed, this has happened in the case of car dealers. Hence, over the past few years, Australian newspapers have radically decreased their editorial staff. Industry analysts anticipate that, within the next decade, major Australian mastheads will cease to exist, at least as print products and as major employers of journalists.7 However, there is no evidence to suggest that there is a crisis in terms of the public’s appetite for news and information.

The health sector is exploiting the opportunities offered by new media. Organisations such as the Cancer Council Australia use social media tools to communicate health information and build communities of engaged supporters. Members of the public also use these tools for patient advocacy, to raise funds for medical research and to mount public health campaigns.8 Social media have also helped disseminate critical information during bushfires and other disasters. US academics who analysed the role of new media in President Barack Obama’s election campaign concluded that there were many lessons relevant to public health advocates, including the potential for increasing audience engagement.9 These lessons appear to have been absorbed by those responsible for the Australian Government’s health reform website (http://www.yourhealth.gov.au/), which encourages interaction from members of the public and health professionals.

Health-related blogs compiled by media outlets, organisations, governments, commercial interests and individuals are also proliferating. They open up new avenues to communicate information and disseminate research, and they enable “bottom up” as well as “top down” exchanges. A survey of medical bloggers found that they wanted to share practical knowledge and skills, and their blog ideas were often reported by mainstream media.10 The authors of the survey concluded that blogs are an important vehicle for influencing medical and health policy. At the BlogWorld & New Media Expo held in the US in October 2009, the implications of new media for the health sector were widely discussed. The quality of bloggers’ information is enormously variable, but some, such as Effect Measure (http://scienceblogs.com/effectmeasure/), authored anonymously by senior public health experts in the US, enable more open and incisive discussion about health issues. The Pump Handle (http://thepumphandle.wordpress.com/) is another public health blog with an interest in issues that are “not getting the treatment we think they deserve in the mainstream media”. In Australia, staff at Katoomba Hospital have also harnessed the anonymity available to bloggers to raise matters of interest to their local community (http://whowillspeakforus.blogspot.com/). On the other hand, anti-health interests such as tobacco companies have been quick to seize online opportunities for marketing campaigns, often covertly.11

Meanwhile, media practitioners concerned with the public interest are attempting to develop new journalism models. In the US, several not-for-profit organisations, often funded by philanthropists or universities, commission investigative journalism projects, and some have covered important health issues. The Center for Public Integrity (http://www.publicintegrity.org/) has published investigations into illicit tobacco trafficking and the political influence of the pharmaceutical industry in US politics, for example. Another not-for-profit organisation, ProPublica (http://www.propublica.org/), commissioned an investigation into how hospital staff responded in the aftermath of Hurricane Katrina. A number of health stories are commissioned through an innovative project called Spot.Us (http://www.spot.us/) that experiments with different journalism methods, including the use of community funding and community-sourced news.

Australia has been relatively slow to develop new journalism models, perhaps because the traditional media here have not been as hard hit as elsewhere. However, there are some notable examples, including online publications newmatilda.com, funded by a single philanthropist, and Inside Story, based at the Institute for Social Research at Swinburne University of Technology, which has run lengthy pieces on health issues.12 Both of us helped found and are on the board of the recently established Foundation for Public Interest Journalism (also based at the Institute for Social Research), which will develop and test new journalism models. The Foundation will give priority to issues that are under-reported by the traditional media, providing an opportunity to improve coverage of currently neglected health issues.

New media ventures are not only expanding the range and type of outlets, but are also changing the nature of the relationship between media and their audiences. According to a US journalism academic, the audience has become “the people formerly known as the audience”.13 They are now also collaborators, antagonists and participants. This changes the relationships between professional news gatherers and their audiences in ways that can make them more interactive, open and transparent than they have been in the past. We believe this can lead to healthier public debate than existed in the era when only a few people had privileged access to the means of publication.

However, the new media era involves many challenges and uncertainties, including the need to develop viable and sustainable business models to support journalism that is in the public interest. The proliferation of new media outlets may have some advantages, but it also risks fragmenting public debate — with all the attendant risks that this brings for policy processes and society more broadly. It also raises legitimate anxieties about the quality and reliability of information. Editors have a critical role in new media; in fact, curating masses of material and sifting for quality and importance may be one of the main roles of journalists in the future. There are also concerns about the impact of proliferating digital media on the development of children and young people; there is a need for research to help guide policy in this area.14,15

The new media revolution is underway, but it will be some time until its impact upon the health of our societies and populations is fully understood.