Unlock Health welcomes guest author Tom Hespos, Interim GM, Media
For healthcare marketers, reaching younger patients like Gen Z is about to get a lot more difficult, unless you understand the fundamental shifts underway in their digital media consumption. What’s more, these shifts aren’t being driven by what you would suspect. It isn’t simple ad avoidance, but instead a combination of factors that includes an acute awareness of platform rot.
Algorithm fatigue is driving ad avoidance
Historically, ad avoidance has played an outsized role in media consumption. That is, people tend to migrate away from platforms where ads overwhelm content. It’s not a new concept. In the pre-digital days of media planning, agencies monitored advertising-to-editorial ratios in magazines and newspapers closely and factored it into their analyses of engagement with ads. That’s not just because ads have a tougher time breaking through to consumers when a publication has more of them. It’s also because consumers vastly prefer the content to the ads.
The avoidance of placing advertisers in noisy, ad-heavy environments continued into the digital age, especially after ad planners noticed that publishers found the cost of adding incremental ad opportunities to be practically zero. After a period of ad overload, mature digital properties saw outflows of users when they injected more ads into their platforms. Those users typically headed to newer, emerging platforms that were either ad-free as part of their growth strategy, or ones that simply had fewer ads.
Thus, advertisers were often in the position of having to ditch established ad platforms in favor of reaching out to emerging ones to find out their plans and timelines for integrating advertising. Reallocating ad dollars this way allowed advertisers to reach fresh and growing user bases in new surroundings.
This dynamic is still at play today, as ad dollars always follow eyeballs. But the dynamic is less driven by ad avoidance and more by algorithm avoidance.
Put simply, younger people are aware of the algorithm-driven environments that drive ad engagement, and it’s the presence of those algorithms that cause them to abandon platforms in favor of people-driven spaces that allow more meaningful human connection.
Enshittification and its consequences
Coined by author and astute media business journalist Cory Doctorow in 2022, enshittification describes the rot that occurs over time when platforms abuse their users and then their B2B customers (advertisers) to maximize the value returned to investors in the platform.
The pattern has become recognizable to users, who might join a new social network or content platform only to encounter increasing costs of switching away from it, like when the sunk costs of developing content and audience on Facebook or LinkedIn outweighs the benefits of abandoning those platforms in favor of something else. Those platforms also introduce algorithms geared primarily toward ad engagement, which often lead users to continually ask “How come I’m not seeing my friends’ posts?” or “Why am I seeing all this ragebait?”
This isn’t by accident. Many of these algorithms are built to exploit what former Google design ethicist Tristan Harris calls the race for our dopamine. By triggering outrage, anxiety, or vanity, platforms have learned to keep users in a cycle of emotional highs and lows that drive longer sessions, higher engagement, and return visits – even as the overall experience steadily deteriorates.
These same users also ask themselves about constantly increasing ad loads or how their personal data contribute to creepily targeted ads. All are symptoms of enshittification, which younger patients are conditioned to recognize.
Don’t forget about the consequences of enshittification that affect advertisers, too. From increasingly opaque ad pricing to ad policies and specs that change seemingly on a whim, advertisers are often subjected to a wide range of abuses. None is so obvious and persistent, though, as that of the oligopolies that currently have strangleholds on digital advertising.
Over years and decades, advertisers in all categories have been force-fed new expectations concerning transparency, both in pricing and in methods for targeting their ads. When added to the constant fear that established and productive ad formats could be changed or taken away at a moment’s notice, these abuses prompt whispered discussions about how the dominant players got that way in the first place.
Gen Z’s algorithm rebellion is both a challenge and an opportunity for healthcare marketers
There’s good news and bad. Healthcare marketers tired of dealing with the advertising oligopolies are likely excited that younger patients are already attuned to enshittification and are taking steps to avoid its effects.
This migration is part of the post-truth era reshaping how people seek information and whom they trust. It is the embodiment of what authentic healthcare marketing looks like in practice: new channels bring new messengers and new messages, often rooted in shared experience rather than institutional authority.
Gen Z’s rejection of algorithms is reshaping digital engagement, including the apps, platforms, and websites they visit. That said, it begs the question — if they’re headed away from algorithms, where are they going?
You might think that younger patients are moving away from ads entirely. You’d be wrong.
They’re moving to:
- Community-focused spaces. No, not their local YMCA or rec center, but to interest-based communities like Reddit and Discord.
- Creator-owned platforms. Podcasts, Substack, Etsy, and other such places give users more direct connections to creators and thus, more authenticity.
- Less algorithmically-driven networks. Social networks like Bluesky are giving users more choice over the algorithm that governs what they see, promoting more authentic communication.
- Messaging apps. Presenting a challenge to advertisers of all stripes, the group chat has moved to a space its participants can control.
- Social gaming platforms. Think Roblox, Minecraft Realms and even Fortnite, where creators can craft their own games and play them with friends.
- Ad-supported alternatives to streaming subscriptions. This is the exception that proves the rule. It’s not just about ad avoidance, particularly when the ad model extends value to users. This explains the growth of Free Ad Supported Television (FAST) among younger consumers.
You might also think that ad-supported streaming is due to increasing economic pressure, and you’d likely be right. But what do all these vehicles have in common?
They let younger people pick their own content much if not all of the time, rather than relying on algorithms designed to keep users engaged with ads.
The future of algorithm-dodging
When we think of Generation Z, we tend to think of a very young generation, but over 70 percent of this generation is 18 or older. YouTube has formed the core of Gen Z’s digital media experience, with TikTok and Instagram as its most popular social networks. With the overwhelming majority of Gen Z using social media as its main source for information on current events, the influence of those apps is significant.
What’s also significant is that Gen Z is very educated regarding not only the attention economy, but also how algorithms drive their engagement. A recent eMarketer podcast took note of a Harris Poll stat that 83 percent of Gen Zers have recently tried to limit their social media usage, deleting apps, muting or unfollowing accounts or otherwise lowering the volume of social media in their lives.
TikTok, which represents Gen Z’s most popular social network app, is currently embroiled in a political battle in the US that may transfer ownership of its content, data and algorithm to a consortium of US-based investors. Simultaneously, Gen Z’s TikTok usage is showing signs of a plateau. A recent Washington Post article showed deep concerns about how TikTok’s algorithm contributes to addictive behavior. Could it be that the political and health controversies surrounding its algorithm are both playing a role in the leveling off of its usage?
We shall see. In the meantime, Gen Z makes up half of Snapchat’s user base and, according to the eMarketer podcast mentioned earlier, treats Snapchat like earlier generations treated phone numbers.
Everything I’ve mentioned above shows a conscious effort to move away from algorithm-driven social media and into more direct, user-controlled ways of communicating with one another.
What does this mean for healthcare marketers?
Healthcare marketers will need to be cognizant of this shift, monitor it, and think carefully about how it affects the authenticity of their communications. While younger patients are apt to use social media as a primary information source, they can be deeply suspicious of the algorithms driving ad engagement.
Healthcare marketers may find more traction by developing creator-driven content, collaborating with trusted influencers, or exploring sponsored segments that integrate naturally into the experience rather than interrupt it.
If Gen Z withdraws further into apps and environments they control, their media consumption could look very different in the coming years. Marketers relying on legacy social media like Facebook could find there are difficult-to-reach pockets of patients. Some of those patients could be hard to reach at all if they’re moving toward more insular communities and ad-light environments.
This is why it becomes important to reserve test budgets for new vehicles as they emerge. It’s also important to understand that some of these new vehicles might not have ad models as developed as those of legacy social media. They might rely on subscription revenue, for that matter. Clearly, as younger patients think more about their health, they’re becoming more knowledgeable about how addictive algorithms negatively affect it. Perhaps our media investments should reflect that.
Unlock Health is a full-service marketing communications agency that helps healthcare organizations make authentic connections with patients and communities. Every minute of every day, someone books services they need as a result of our work with clients.
