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Unlocking inequalities with social media: Equality in cardiovascular care



Welcome to another of our Learn with Nurses sessions! Our discussion tonight is a fascinating topic and related to medical professionals. We will be hearing from Beth and Lucy from White Swan, a charity that was inspired by a rare form of Parkinson's dystonia diagnosis and how it transformed the life of the family affected. During this session, we'll learn about how Black Swan Data, was able to use technology to pull data from blogs and forums on topics of health to predict trends in consumer behavior, and how they adjusted the same process to look for answers to an individual's health issues. We'll also hear about White Swan's latest volunteer project, a cardiovascular research project focused on equity and access to healthcare. There will be no slides, but at the end, everyone in attendance will receive a certificate for participating and for their revalidation. Join us to learn more about this astounding volunteer project!


Presented by Michaela Nuttal with guest speakers Beth Fordham & Lucy Bell to discuss Equality in Cardiovascular Care

- High level description of what our methodology and technology can provide above traditional market research.

- Why we decided to tackle this subject:

- Cardiovascular diseases are estimated to take 153,000 lives in the UK every year, and 17.9 million lives globally

- There is a proven disparity in quality of cardiovascular health because of social determinants of health like, sex and gender, and neighbourhood poverty, a root cause of which is inequality and bias.

Learning objectives

Learning Objectives: 1. Explain how Black Swan Data's technology enables companies to predict consumer behavior. 2. Identify the story of how White Swan was inspired to begin as a charity. 3. Recognize the various volunteers, trustees and personnel involved in the White Swan charity. 4. Describe the project that White Swan designated to investigate cardiovascular health inequalities. 5. List the various disparities in access to healthcare across different regions in the world.
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Computer generated transcript

The following transcript was generated automatically from the content and has not been checked or corrected manually.

and I'm silent. Yes. Welcome everybody to another of our learn with nurses sessions, another of the in conversation. My name is Michaela, not all. I'm a nurse and founder here at Linwood Nurses. And we have got Really I'm really excited about this session tonight. Um, and it's a really interesting topic. And when I heard from Beth and Lucy about their organization, I just knew that this was excuse me, coughing away something that would be perfect for one of our in conversation sessions, as usual. And for these sessions, there is going to be no slides, so you would just need your ears. A thorn will also be recorded and available, um, to watch or to listen even or watch at any other time. And it will also be readily available for anybody else to watch or listen to. So if you've got colleagues and you think, well, that was really interesting to be able to just send them the link and they'll be able to come and watch it. At the end of our session, we'll have the usual evaluations. All three medal and you're all into medal now. So hopefully you know what that evaluation is all about. Remember that. Well, the toggles already across, so you'll be able to get your certificates for this. There's a space for revalidation, so you can do a little bit of reflection. And, um, yeah, this will be recording will be available for you. So I'm going to sit here quiet for a little while, although I will be jumping in with some discussion's and some and some questions and stuff. Um, but I'm going to hand over to now to Beth and Lucy from White Swan. And I'm going to leave it to these guys to introduce themselves and tell you a little bit about the organization. Now I am going to just put myself on mute, and I'll turn my camera off for a couple of minutes and then I'll jump back in so people can just see you too nice and big on the screen. Okay, you guys. Thank you. Thanks, Michaela. And thank you so much. Inviting us to join. It's been, um, yeah, great to be involved. And we learn a bit more about us. So we'll do quick intros first. And then I'll talk to you a bit About how White Swan came about. So I'm Beth, and I'm the operations director, so I'm responsible for the day to day running of the charity. Um, we have our trustees and our CEO, um, and data scientist as well. And, um, Lucy who I will hand over 22 in tray now. Yes, sir. I am Lucy and I'm an insight consultant at White Swan. So I volunteered, started volunteering for White Swan and then eventually decided and had the opportunity, um, to go full time. And, um, I work as an analyst and consultant on their projects that they do for, um, charities, Um, and lots of other different groups. Cool. So White Swan became a charity in 2018 and the inspiration behind it Was that a a guy called Steve King who's the CEO of a company called Black Swan Data. His sister had been done well for a long time. Um, suffering a lot of symptoms. Um, that had just the doctors couldn't get to the bottom of and the she'd been through countless tests, misdiagnoses, um, thinking they found the answer going onto some treatment, turning out that, you know, that didn't help. And Steve and his family were told to prepare for the worst. Really? That Julie Julie King was just, um you know, her prognosis wasn't good. And, um, you know, and and things weren't looking good for her, she wasn't able to look after her kids and things like that. Um, and Steve, as the CEO of Black Swan, um, thought he could do something about this because the technology that Black Swan have developed, which is a commercial organization, you know, a normal business, not a charity, But they can ingest millions of, um, social data conversations. So all of the data that's freely available on Twitter and read it And, um, some more medically focused blogs and forums like Health Unlocked and MacMillan Cancer Forum. Lots of the sort of more specific forums. Black Swan can access all of that data and pull it in. And the way that blacks one use it is to predict to predict trends in consumer behavior. So they have clients like Pepsico or, um, Proctor and gamble who want to know what flavor of, um, soft drink or what flavor of crisp or what ingredients someone might really want in their shampoo by looking at the conversation that's going on online and what's trending in online conversation and that helps companies like that get ahead of developing those products. So if it takes six months or a year to develop a new type of crisp or flavor of tea, they want to get ahead of their competitors. So blacks ones use case for all of this social data is to help predict trends in, um, consumer in consumer behavior and consumer needs. Um, but Steve thought I've got access to all of this online conversation, and I know a lot of people talk about their health online. Maybe I can use that same process, albeit looking for different conversations and drill down and use some of the techniques that Black Swan have developed to start to look for answers for Julie. So he went back to Wales. He's from West Wales. He went back and stayed with Julie for a month, writing down in the kind of quite a rudimentary way everything that she felt everything that made her feel better. Worse, she found that she could take a nap in the afternoon, and that would help her get through the second half of the day better and really trying to understand what it was that kind of brought on symptoms and so on. And then he used that data to go and search for similar conversations online. So looking at where groups of patient's were talking about that same kind of set of symptoms and after a lot of kind of cleaning up and, you know, going back through the data, he started to narrow down to two conditions that kept coming up as as sort of similar to what Julie was experiencing and things that she hadn't been tested for before. And she they went back to her doctors who were really open minded about trying out tests for these two things. And it turned out she had a really rare form of Parkinson's Parkinson's dystonia, which is sort of an early onset Parkinson's, which is why it had been missed, because at that age it's not the sort of thing that you would be looking for. She was only in her early thirties, um, and and so she was on treatment within a couple of weeks and, um, you know, started to improve and and over time sort of was is back to looking after her Children. She's climbed Snowdonia Run triathlon. She's recently got really into CrossFit, and she's just living well with her condition. Managing it through treatment and and lifestyle and, you know, completely transformed her life. Um, and so this was a you know, a huge thing for the King family, obviously. But we thought that being able to do that for Julie, we might be able to do it for other people as well. So that was the inspiration behind the start of White Swan, which was sort of a charitable offshoot of Black Swan. Um, And when we started, it was just a small team of volunteers. So about 30 people who were mainly black Swan employees that have kind of gone along on this journey, Um, and became white Swan volunteers initially, Um, and then over time, we've now got about 100 and 40 volunteers, so they range from data science and technology people, because that's sort of the world that we work in. But also some, um, healthcare professionals, marketeers, finance people. We draw on lots of different skills to help us run the charity and as lean away as possible. Um, so that we can use any fund we res to feed back into helping other people like Julie, who have had rare, rare conditions that they're finding it differ to find diagnosis for but also doing some work around understanding the patient journey better. So because we go out and listen to what's being said. Rather than going and asking direct questions, which you might do through traditional market research, we can some answers acting. So we'll just go and take a whole bunch of conversation relating to a particular condition, for example, a group of conditions. And then because the data is so vast and it's from so many people covering so many different topics, we can start to see how there's trends that bubble up in that or how there's kind of clusters, a conversation that that give us insight that you might miss if you were trying through other routes. Um, and it gives us just the true patient view as well, which again, um, you know isn't always sort of easily represented through traditional academic research or or market research. You get a good range of people people's views. Um, so today we're gonna talk through, um, a pillar project that we've been working on very recently, which I think, um, with Michaela was particularly interested in when we when we first spoke a little earlier this year. Um, so there's some initial findings from that that Lucy's going to talk through because she's been leading the project, and it's a project that's been, um, conducted by some of the volunteers as well. So it's been a real team method Just before Lucy jumps in, I just wanted to say thank you for sharing that story because that was that just gets to you. And I think people don't underestimate No, we don't. Yeah, we underestimate the real value of what can be got from yeah, in a different way. So that's right. And we know not every message out there is perfectly accurate or perfectly relevant. There is no and we know we're very open about that. But the technology that we have helps us to clean out that noise. So, you know, we know that it's a different approach. It's not as clean sometimes because the volumes are so huge, you can still see the trends exactly and narrow down to those. So yeah, fantastic. Sorry. Lucy over to you. So, um, first of all, why we chose cardiovascular, um, and equity. So we started off investigating what our next volunteer project could be, and we wanted it to be an area where a piece of work like this had some real potential to make significant impact. Um, and also 11, which are volunteers would potentially feel really invested in want to champion. Um, And so from recent news and journals into have the qualities, particularly in the US, which is where we started. We decided that cardiovascular, uh, conditions was an area where a piece of work, you know, could actually make quite a big impact and perhaps compared to working another condition. So we know that across geographies, uh, inequality, um, in access to healthcare really is is a major concern. And although, um, particularly place that the UK and the US health indications of life expecting an in for mortality have improved the most, um, some groups do experience a disproportionate burden of preventable disease, a death and disability compared with other groups. And we know that cardiovascular disease are estimate to take a 7.9 million lives each year globally, and in the UK More specifically, 153 100,000 deaths each year. Um, and that the leading cause of death both men and women. And within this there are some sex and gender differences and diagnosis and treatment, which is partly the presentation of symptoms, probably Tobias. And also some historical mess of training. Um, because training was really developed using the white male physiology. Um, so we do know that some of this is being improved. So the BBC round report, I think, earlier this year, um, showing that three d diagrams women's bodies were now being put into medical training. Um, so medical students were actually learning about, you know, female bodies and male bodies and the difference in the anatomies. But, um, from talking to Mikayla and what we've heard, they're really there really is still quite a way to go. Um, and it's a It's recognized that women are more likely to die from a heart attack than men, even though men stuff with more heart attacks, at least in the U. S. Where that research was done, Um, which is a stat that highlights the kind of disparities we see in care for men and women. So at the first stage of the project is looking at what the statistics are telling us. So when we've done this analysis, um, from the statistics, we can form a lot of questions and discussion points, which we then go in to do, uh, like a more in depth analysis to say Okay, so how can we answer these questions? And what insights can we give, which can help practitioners to, you know, improve improve? What's going on? Essentially, Um, So what we decided to measure was gender, location and income level in the UK as well as aid and social conversations. Um, and this is this is measuring not just patient's conversations on social media, but specific conversations about the patient journey. So that would be conversations about going for a test, having a diagnoses or going into surgery or taking a medication. Um, I think the only area which we found to be a bit less insightful was age because simply because the older people get the more like they are to suffer with these types of conditions. Uh, so, you know, cardiovascular conditions in general and then more specifically, the ones, for example, we've got here for you today. Hypertension, coronary heart disease and heart attacks. Um, we did, uh, from one interest, interesting insights, which we thought, you know, that people would quite like to hear. Um, and that was from around 16 years of age to 20. We do get conversations from people's kids and grandchildren actually going online and saying, Oh, my, my dad and my grandparents, um, potentially my mother, you know, they're in hospital, this things going on, Um, but it was quite nice that we saw that they were going out there and saying, like, What should I do? How can we help? Um, so how does this work? So we what we do is we use provider That helps to identify, um, and quantify conversations that belong to particular groups. And they're they're very well known, at least in the social kind of world. They're called demographics pro, and they can help us, like identify, um, like anonymized. Which sections of the nominees data a men or women? Or, for example, which section lives in the east of the UK or which lives in the Midlands? So from that we can get, like, the raw percentage which people may have seen on some of the information that came that came out about this webinar. Um so, for example, 62% of conversations about the cardiovascular care patient journey are estimated to be written by men versus only 30% by women. Um, and what we want to do is make sure that statistics contextualized So in the world of online data, how significant is that statistic? Um, outside of that world, in terms of, like, the whole UK population. Um, how relevant is that? Um, And to do this, we use a method called indexing. So we essentially measure how frequent these conversations are. Um and that helps us to understand how important those differences and those statistics are. Um, And to make and to identify, you know, in the context of what goes on on social media, how important that statistic is, and in the context of what actually goes on the UK population. How important is in that context as well, I think for this analysis, we used department work and pensions, census data, uh, to sort of compare and contrast to compare with the social data so quickly on to what we found. So we've got the first area, um is gender and three areas of gender location income level. So first area as gender. So when we have had an indexing analysis, we saw that the high rates of men talking about the cardiovascular patient journey is indeed very significant. Um, and is significant significant across cardiovascular care as a whole and also individually in hypertension, heart attacks and coronary heart. These conversations. So generally, on Twitter, which the site we can source the demographics from, um, there is a 52 male, 48% female online population split. And in the UK, the population spit is 50 50 male female. Um, so when we look at who was talking about it on social media on Twitter, we when we see that there's 60% male and only 38% female, um, And to remind people that this is people actually talking about having gone to surgery, going to test, they're doing their diagnosis, getting a diagnosis, um, we immediately start to think, Well, what can this information tell us? And keeping in mind that cardiovascular conversations are some of the biggest killers of men and women, we want to ask Women not receiving care of women not being diagnosed. Um, how should we be educating people about this? Um And also, um, like what? Other questions should be asked the data further, what insights from the data could help. And also talking with experts like Michaela to see a case of what actions could improve things. And also do these statistics Validate What? Um what ex? What health professionals are actually seeing, um, when they're talking to patient's from their experiences of being in healthcare, um and yeah, and those type things. So I think you're on your own meat, Michaela. Of course I was. Of course I was so many. Wish they could do that. So I'm just I and I was just sitting there thinking I was scribbling down thinking that's quite astounding to pick that up, that that those numbers of 38 68 38 62 versus the 50 50 split. So and part of the thing is because women aren't talking about it. I don't think it is because we talk about everything. So So you know, if anything, it's probably even even worse than what it could be and I can see that does put that that surprises her. And I'd like to I mean, whilst I'm going to call, please, People use that chat function to pop your comments in as well. Now, not everyone can put the comment because they haven't verified their account in advance. Have you, Chris? You can't talk back, so it's great because it just certainly message I didn't verify back out, so I'm not use the chat. So So. But yeah, that is So So what were the sort of things they were talking about, or is that going to come up a little later or, you know, were they? Yeah. Tell me a bit more. Yeah, that's the That's what's going to come up later. OK, sorry. Sorry. So when we when we go into the next stage of analysis, we're actually going to deep dive in the data and see what people are actually talking about. Um, we're at the stage now where? Where? We've identified the questions that we want to ask of the data. And we've seen these interesting statistics, and we need to do a bit more to, um, you know, provide those actionable insights that we think people actually really, really need, You know, from this from this type of data. Yeah. And I guess it just reflects what is happening out there in clinical practice as well that the pathway that that that people are going down be that male or female of clearly two very different pathways that we know about. And Marys Marys on the on the chat Tonight Mary's joining us and Mary is an amazing, um, person, amazing woman who has a who who who has a a big pash in for this, Um, so and and yes, So look, Sara's on there as well. There's quite a few people on the they all know each other when they're chatting away because actually, when it comes to women, um, and inequalities, there is quite a quite a a driving force that's happening in a very small way. In the UK, you go to Canada's Australia. There seems to be a little bit more well established, whether that's to do with the more traditional cardiovascular diseases that you were talking about, some of these more. I want to say interesting ones, but it's misdiagnosis that can go on with women. So Um, that's right. And I think I mean the fact there's a question about slides. I think there is a lot of data to unpick in here, so it's absolutely, you know, this will be going into a published report that will be share ing. So it's great to kind of have this connection with everyone on the call because we can follow up then with, you know, with the report and the deep dives that we'll have in that. And, you know, if anyone wants to sort of reach out and be in contact. But that's why we developed that you are the one. You're the clinical experts, you know, we're just looking at the data and seeing what it's telling us. So we'd love to have any feedback. You know, the fact it's surprising is really interesting to us because you can help us then kind of uncover. You know what? What was your sort of what we What did you think you'd expect to see and then we can see what you know, why that's not coming through. So be great to connect with anyone who's interested into working through it with us. So tell me, Lucy you carry on? I jumped in. Well, our next. Our next area of insight is location. I didn't know Was there anything, um, anything more related to gender which you wanted to can Only that I want to pick up it. Well, because that my little brain now moves on two lots of other things comes. What about this? And what about that? And I just almost have to like a calm yourself down. Okay, you know, it will. Will the the report will come out, but I think that's startling for now. Just these. This the fact that it's been is it the fact that there's just this massive difference massive difference in just the noise that's out there? That's what you've got to, isn't it? The noise and people making conversations out to it before you get that deeper dive which I think will be really Thanks, Joe, I've known her for a long time. She knows I get very good, and I get I do get with public health and cardiovascular disease is my background. And so that's why um that's why I'm there. Um, no, I think given time, let's crack on and do, um let's do the next bit location. So we found this next part very, very interesting as well. So the results across the whole of cardiovascular care and also across heart attacks, hypertension, coronary heart seeds were quite, um, distinct. They're quite different. Um, So what we did was we group cities and towns into regions. Um, because, unfortunately, the UK we can't get data at a regional level, um, and then compared these results with higher income regions and lower income regions, um, in the UK And we did that using the government census data. Um, And from that, we found that conversations on social tend to be from more wealthy regions. So regions with fewer people, um, in the lower income margin. So overall, there were significant frequencies of conversation in, um about the patient journey in the East London, South, east Scotland and Northern Ireland's. But there were less frequent conversations in the northeast, northwest, Yorkshire and Humber, the East Midlands and the West Midlands and Wales. So in summary, that means that people from areas with higher low income rates are less likely to talk about receiving care. And from there were thinking that Does this mean again are. They're not receiving the same level as care as other areas in the country. Um, with people in the higher income groups. Um, and as with gender information, it kind of creates a It does create these all these questions, which we want to go into the data, you know, analyzing the data further. And when we had a look at the specific conditions there. So there's a positive statistic in the context of what we saw across cardiovascular that in the Northeast, that is a good index in heart attack care. Um, but then when we looked at hypertension, we can only see a good index for London in the Southeast and in chronic heart sees we only see a good index for London, the South Eastern Scotland. So from our sort of knowledge of areas in the UK, we know there's some assumptions based on diet the further north you go. So maybe people I would have expected the North perform the worst in the indexing analysis. Actually, it's the Midlands, both East and West Midlands, where we saw the worst indexes, Um, both of which have high populations living on low incomes. Yeah. Sorry. Carry on sorry, I'm going to back to jump in, but I wait, go for it, Go for it. I was just thinking so So if I put my cardiovascular hat on and and starting to think about the data, you're you're you're saying there so we know that the more north you go, the more cardiovascular disease there is. But also often there's more intervention and intervention. I don't just mean like cardiovascular intervention, but but there's more. There's more investment. There's more different things going on in those areas and certainly, you know, we've got some good friends. Joe and I've got some good friends both in the Northeast and the Northwest that have had very long steeped, um, ongoing cardiovascular care there, centers and practice. I mean, there was so many elements that could overlap with this good care, whether it's to do with yes, they're all different stuff that's there. But interesting that Birmingham isn't isn't following that sort of trend, either that it's that it's going a different way. Scotland. I want to say Scotland and I definitely that in an awful way. But they had the first. They were the first to do the smoking ban and then the first to see their stopping smoking, so that might have a bit of a you know, you might do something interesting there. Now, I think overlying um deprivation, which is which are really No, it's we know, you know, you're four times more likely to have a heart attack for exactly, Mary. Sorry. And we I mean, we're listening to looking at the chat as well, but, you know, in, um, in I've lost my brain threat. Then what was I talking about? I got distracted by Scotland. Oh, I know. So with desperation is, um, as Joe was putting here often there's there's a lot of more investment in different areas for different initiatives going on. Um uh, in areas where they're they're more deprived, so that may have an influence. But also there are other extra things that that also things like, um gp practices. Have they? We know we know that the more the more single handed GP practices are that the more challenging it becomes for them to be able to provide that all round care for people. Oh, Joe is getting on the role. Internet Internet connectivity in areas with responses. Sarah's surprised by the results for London. So, yeah. Are you Do you want to have a little think about some of these comments that are going in? I don't know. Beth. Lucy. Do you wanna Yeah. I think internet connectivity is a good thing to overlay. I think any of these, um, data points of kind of easy to pass across it and just start to see whether we can see any trends between them. I think the investment, um, you know, long term investment improving these things. It could definitely be a factor for the Northeast if those programs are in place. Um, and yeah, again London, Um, performing better? Um, yeah, very high population. So Birmingham and London being very different. But like you said, the income level is very, you know, different as well, in some cases. So yeah, I think it's digging into these things in more detail now is, And I think London isn't We Could we think of London is a big lump, but actually, it's so diverse. You've got populations that are really transient. To move I/O, you'd get burrows in London where people never move out of it. You know, you get this whole you get a whole mixture, don't you? When in London. So it's almost digging down. Yeah. Now there was something else. And I'm trying to get my brain to remember what it was. So you were talking about So you saw a difference in blood pressure care. So you thought it was really good. You said it was a heart attack. Care was good up in the Northeast. Yes. So And I should be telling all my colleagues in the Northeast because that will be really they'll be really happy in that one and that actually, if you think of some of the some of the centers, um, that they're up there, that that might be. But also, there's been a lot of initiatives in primary care for the follow up, which makes it influence as well. It's not just about the centers. It's about all of that wrap around care, cardiac rehab. Also. So BP in London and the Southeast Now, what was the timescale? You were looking back to that I was thinking about that, Joe. It's all down to are met. We might have to tell himself at that. Says it is an amazing GP up in the Northeast, has really been passionate about cardiovascular disease. He was a GP GP with special interest and called professor arm it. Now. So again, we'll look for his name we can look at if he's trending against the data because you know he's And that's what I'm wondering if when you get someone that is really powerful and passionate about what they're doing that can drive. And he has been there for years. I want to say decades, you know, banging the drum, moving it forwards. So that might influence what's going on around them for sure. So but BP more in London, in the Southeast? Was that so? When you say southeast, that's the whole of south East England, not southeast London. You mean yeah, whole of southeast England, Um, and London. Okay. And that's an interesting one. So if my brain starts to think about that, I think and remind me of your timescale, you've been looking about this for two years. Two years. Okay, so two years. So I guess for me that the thing I'm thinking about with with BP is we've had to We've got to quite significant to this, you know, gloves that are big enough. So you've got Shahid Ahmed, who is the national clinical director for N H. Yes, England for cardiology, and his big passionate is hypertension, that's all. That's what he wants to get, right? So although it covers England, his main patches southeast, so there might be a lot of that being driven through that way. And then we also have Helen Williams, and she's a cardiac pharmacist and she is his clinical adviser. But she's also she's basically covers southeast London, and she's been actually been power of passionate about a lot of stuff. But also she's been doing masses of work in London, particularly in Lambeth and Suffolk, getting people getting people engaged one in different initiatives, running virtual clinic. So really, that's spearheading what could be done. So that may have an influence, too. So someone wants to know. Does having a highly motivated clinician clinician staying in one area make a difference? Uh, it's certainly something that we could look at because it's the type of conversation that people will be talking about, and and we've We've done quite a lot of work in cancer care. Um and we found that the same names keep coming up in the, you know, when we've looked at the sort of sentiment towards care. Um, you do see the same names coming up across the board, even people who have been sent across the country to certain people because they've heard of them and everyone's exchanging names in all these forums. So there is, You know, there are ways that we can tie it back to people, I think, naturally having that, uh, sort of inertia when you've been building on a program for a long time and you've been there, then you know, you would expect that that it would improve. But that's something that we could certainly look at when we come to look at and in the actual data itself. What we do is we only send over individual ideas, so anonymized ideas. So each post that they measure it on is from a different person. So So all of those posts that all from different, different people, So there could be one from those great influences. But, um, as you put it in the commodity setting, But those you know, those people that have really gone out of their way to and passionately push this forward for the benefit of people. Um, but actually, when we're looking at the data there, just that one person, at least in this type of analysis, um So what we'd what we'd do is, um, like Beth was saying, Well, look into it further, we'd have a look at, um, them as sort of an influencer and see how they're impacting, um, you know, accounts around them and how engaged people are with them, how they rank compared to, you know, these other people that, um, are going out of their way to help people and raise awareness And that type of thing, Yeah, yeah, and I mean, I'm lucky the way that you're saying it, they just they count as one. But actually it's the influence. It might be the influence that they're having not necessarily in social music, but the influence that they're having the clinical environment. And that's why I think what you're saying is that patient will get exposed to that to that varies. And we know I'm sure that actually I mean that if someone good stays in the same place, it improves, and it improves. If someone rubbish stays in the same place, then it's not going to improve. So it's not just about how long somebody sits on a seat fall, I suspect. And you can almost have the flip side of that. If you're in an area where and I'm not, You know, not everybody can be the most amazing person, Can they? You know. So you're always going to get that spectrum that you might be. It's going to sound awful stuck with somebody else, But you know what I mean? I think you know what I mean. So, uh, neatly for me, she interprets my my jibber individuals can block progress. Yeah, And systems, I would say as well and systems can block progress. And I think, you know, you've done this now, during during what's been the middle and tail end of the pandemic. So we will have seen, you know, I wonder if we'd have seen sort of different had Yeah, we know that it's an impact. So we've got a couple of minutes left. So before we were so Lucy, anything else for us from this? So the last stop of, uh, inside area that we looked into was income level more specifically. So what we can do is we can get data that tells us within certain bands, Uh, what the what? We estimate to be the share of, um, income levels across a group of people that we send off for demographics. Um, and within that, we saw that overall, only 9% of conversations online. Well, for those in the low income threshold, So that's below 60. That's in the bottom. Yeah. Are generally, 49% of people on Twitter are in the lower income threshold. Um, now then, if we look at the real world sort of sense of example, we'll see 80% of people in the UK live at the lower income level. 18 18. Yeah, 18% live at that lower income level. So while, um, the difference isn't as significant as we might think. If we're just looking at the Twitter data, the 18% is still double the 9% of conversations that we're seeing. Um and I mean, it's another sort of quite difficult, upsetting statistic, Um, that people on incomes are more likely to potentially live in health poverty. Again, it throws up those questions So, um, like all the other areas we've been investigating, Um, And when we go into the deep dives, we'll try, uh, and answer questions about them. And we'll also bring about insights which can help clinicians to Axion ways to improve these kind of areas, Be it like an individual level or or at a group level. Wow. So it really goes against everything we think of now in in or that we know of in the context of inequalities and inequity to healthcare. So So whether that's gender, socio economical status, we're seeing location. Now I wondered, Are you going to look? Are you able to look at? Because it's a big thing at the moment about health literacy and that has health. Literacy really affects that. You know, the worse your health literacy is really affects your ability to navigate the system and make decisions about your own health and get two appointments and find out. You know, all of that. Um, so is there a way of looking at now? I'm not sure how you'll be able to look at health literature. I don't know if we're something where maybe English is in the first language We know that will affect where we think there's a whole range of things. Uh, Joe's put down different languages. I beat you to it that time job. But yeah, I think that again because we know that that really makes a difference and how people can access access care. We do have a language data, and the thing is with social media, particularly when it's on Twitter. If you're doing like a short form post or something, your difficulties in language may not necessarily come through. Yeah, and it may be, you know, more, uh, more colloquial language as well. Um, I mean, we do look at different languages to see if someone's speaking or writing, for example, on the site, like Twitter in a different language. So there are some possibilities around it. Um, I think we just have to look into the data bit more and see exactly how and why we can do certain things and what we can't do certain things because I could probably say, now we can find a way. I'm 98% sure that we can find a way, but I'm not 100% sure that we can find a way. Uh, yeah, but yeah, we can look. And we can look at the words that people are using, um, as well. And the things that they're mentioning. So, you know, transport availability, you know, even GP availability, whether that's a barrier, and and that's where the location part comes up as well. And whether that correlates with certain areas and therefore certain income groups. And it's all just a snow. And, uh, you know, a bad snowball effect that, you know, all these things come together for the same people and that they're they're suffering all of these sort of setbacks. Um, but yeah, that's I think the fact that figure is so stark that, you know, even though there's a lot of people those brackets on Twitter and 18% of the UK in total, only 9% of the conversation was from those groups. Well, ladies, this has just been in credible. I'm looking at the time now. This has been amazing. Um, I'm gonna before I wrap up. Is there anything else from you guys you'd like to be able to share? Um, in the last moment or two, I think. Well, yeah. Thank you for the opportunity. Um, there's Yeah, there's a lot to unpack. I know there's lots of numbers and things are flying around, and so I know it's recorded, but we would love to stay in touch and and share, um, the results of this as they develop. And I I think so many great ideas from from you, Michaela and from the chat. But, you know, we we like I say we we you know, we only there to produce the results. We need experts to tell us how to interpret some of these, so and and then we can go back and ask more questions of the data. So I would love to keep a dialogue going and how How? Well, Well, first of all, I'd love I'd love you to come back, you know, and and talk to us again, if that's OK, So whether we do it like a like a recorded session or one of the other ones with slides and stuff to do that results when you've had a little deep, deep slide, I also know you've done good stuff on those fibromyalgia I think was home. I'd love you too, to come back and do something on fibromyalgia for us, if that's okay, and yeah, and that's partly because I've just been today working with a load of physios about long covid and pots and a lot of vegetable got easy s and EDS a fibrate. So it's all all a little link that goes on there and for the guys on the court. If they want to keep in contact with, they just jump on social media and find you that way. It is that the best way to connect? Yeah, we're white. Swan number four. Good on Twitter. Um, I think the details are on there, and we're on LinkedIn as well. Um, whites wander org dot UK. So, yeah, any of those routes, please d connect with what we can also do is part of the joy of this medal platform of which is just fantastic is Have you got any documents? You think? Well, this is It's a really good report. This is a really good document picking them over to us. We'll upload that into the catch up content. It's called and people can just download that. And in fact, for anyone that's joined us, they'll get it every time we upload up something for you? Um, they'll get an email pin data to say something new has gone in. So this is a great way we can stay connected as well. Okay, It's now 7 41. So I'm trying to be really good at it all. Although I think I could ask you questions all night. So a huge thank you. Beth and Lucy. I just fell in love with right swan as soon as I heard the story. And then it got even more when I heard about it. Cardiovascular disease and inequality. So absolutely brilliant. And thank you to the guys on the chat because it's been much more. It's lovely when it comes alive. Now for when people are watching the recording, you won't be able to see the chat, but you'll be able to hear that we're having discussions about different stuff. And, uh, I probably should have said we must read the questions out for when it's been recorded. But hey, that's another time. We'll get used to that. So thank you very much, everybody. Thank you. You guys. And I'm going to press the stop. Stop going. Live button. Now.