Ninety seconds. That’s the amount of time an algorithm has to convince you to start your next binge-watching session. Lights, camera, inaction. Given its increasing monopoly over entertainment, Netflix seems to have perfected its tantalizing algorithm, seducing millions of people to endlessly consume the rabbit hole of tailor-made TV. “There’s never too much TV,” according to Netflix’s chief content officer. The turnstile success of ever-changing hit series confirms this. But this isn’t about how binge-watching is a health hazard (there are plenty of pieces dedicated to how binge-watching is making us sadder and fatter). This is more about how mass customization is normalizing certain behaviours at breakneck speeds. For example, statutory rape is sexy; feminism is confused and selfish; and suicide comes in a baker’s dozen (more on 13 Reasons Why later).

TV’s culture-defining role has been studied since people first started tuning in, and now a myriad of other variables have been added that alter the nature of the beast. Instead of linear programming, you have options spanning in all directions. Based on your preferences, you can live in a world where popular culture is becoming more accepting and diverse, or you can live in one where tradition is king.  Instead of a week between episodes, you have 15 seconds. The speed of consumption is so high that there’s little time for reflection – no time to digest the onslaught of images and information.

In public health, we’ve long acknowledged the role of our physical spaces in determining our health. We build bike lanes and parks to encourage physical activity; we establish community gardens and tackle food deserts to address malnutrition; we improve road signs and traffic patterns to promote road safety. More broadly, as explored by IHP editorials over the last month, we increasingly push for healthy ecosystems and planetary health as essential elements of health and wellbeing. But what about navigation of the digital space? What are the public health recommendations for wading through digital noise? What about health-sensitive regulations for content creators (reducing on-screen smoking has had some success here)? We’ve gone as far as trying to come up with innovative ways to use digital technology to communicate public health messages or to increase access to healthcare and other social determinants of health (employment, housing, education, etc.), but often these are done in parallel to – and in competition with – glitzier entertainment options.

This is where I’d like to come back to the show, 13 Reasons Why, which follows a high schooler through experiences of bullying, rape, depression and ultimately suicide. I originally considered writing this post while feeling entirely overwhelmed after the last episode. My thought was, if I feel this way, as an adult, how would a teenager, who may be experiencing some of the depicted pain in real-time, feel… Would it be helpful? An ally? A trigger? Or worse, a more concrete option? Clearly, given the storm of articles on the topic in the last couple of weeks, I was not alone in the unease. The controversy has sparked an important conversation around how we talk about mental health in pop culture. The show has the kind of “impact factor” academia dreams of; it’s the most talked-about show on Netflix and has reached millions of young people, some of which could very well be going through their own mental health crises. It simultaneously presents a public health threat and opportunity, which requires careful navigation by educators, parents, health professionals, and young people themselves. While many professionals are quibbling about the various elements of the show deemed as problematic, others are using it to have conversations with schools that were simply not happening.

What’s followed the aftermath of the show’s bulk release also points out the importance of availability and use of public health knowledge in entertainment. Instead of competing for fleeting attention spans, public health advocacy would be better served to embed itself in the improved design of programs similar to this one where there is an opportunity for education on topics affecting population health. The show’s popularity itself is also data to help inform public health policy and programming. Something has resonated with the target audience, and while it may not be a focus group, 11 million tweets is certainly a strong indicator that the experiences portrayed by the show have pushed more than a few buttons worth exploring.