The cultural specificity of digital health technologies

Digital health technologies configure a certain type of practising medicine and public health, a certain type of patient or lay person and a specific perspective on the human body. The techno-utopian approach to using digital health technologies tends to assume that these tacit norms and assumptions are shared and accepted by all the actors involved, and that they are acting on a universal human body. Yet a cursory examination of surveys of digital health technology use demonstrates that social structural factors such as age, gender, education level, occupation and race/ethnicity, as well as people’s state of health and their geographical location play a major role in influencing how such technologies are taken up among lay people or the extent to which they are able to access the technologies.

An American study of the use of some digital health technologies using representative data collected by the National Cancer Institute in 2012, for example, found no evidence of differences by race or ethnicity, but significant differences for gender, age and socioeconomic status (Kontos et al. 2014). Female respondents were more likely to use online technologies for health-related information, as were younger people (under less than 65) and those of higher socioeconomic status. People of low socioeconomic status were less likely to go online to look for a healthcare provider, use email or the internet to connect with a doctor, track their personal health information online, using a website to track to help track diet, weight or physical activity or download health information to a mobile device. However they were more likely to use social media sites to access or share health information. Women were more likely than men to engage in all of these activities.

While there is little academic research on how different social groups use apps, market research reports have generated some insights. One report showed that women install 40 per cent more apps than men and buy 17 per cent more paid apps. Men use health and fitness apps slightly more (10 per cent) than women (Koetsier 2013). A Nielsen market report on the use of wearable devices found that while men and women used fitness activity bands in equal numbers, women were more likely to use diet and calorie counter apps (Nielsen 2014).

As these findings suggest, gender is one important characteristic that structures the use of digital health technologies. The digital technology culture is generally male-dominated: most technology designers, developers and entrepreneurs are male. As a result, a certain blindness to the needs of women can be evident. For example, when the Apple Health app was announced in 2014, destined to be included as part of a suite of apps on the Apple Watch, it did not include a function for the tracking of menstrual cycles (Eveleth 2014). Gender stereotypes are routinely reproduced in devices such as health and medical apps. As I noted in my study of sexuality and reproduction self-tracking apps, the sexuality apps tend to focus on documenting and celebrating male sexual performance, with little acknowledgement of women’s sexuality, while reproduction apps emphasise women’s over men’s fertility.

App designers and those who develop many other digital technologies for medical and health-related purposes often fail to recognise the social and cultural differences that may influence how people interact with them. Just as cultural beliefs about health and illness vary from culture to culture, so too do responses to the cultural artefacts that are digital health technologies. Aboriginal people living in a remote region of Australia, for example, have very different notions of embodiment, health and disease from those that tend to feature in the health literacy apps that have been developed for mainstream white Australian culture (Christie and Verran 2014). It is therefore not surprising that a review of the efficacy of a number of social media and apps developed for health promotion interventions targeted at Aboriginal Australians found no evidence of their effectiveness or benefit to this population (Brusse et al. 2014).

Few other analyses have sought to highlight the cultural differences in which people respond to and use digital health technologies. This kind of research is surely imperative to challenge existing assumptions about ‘the user’ of these technologies and provide greater insights into their benefits and limitations.

My publications for 2014

This the list of my publications that came out in 2014. If you would like a copy of any of the articles, please contact me on deborah.lupton@canberra.edu.au.

Books

Lupton, D. (2015) Digital Sociology (Routledge: this  has a 2015 publication date, but actually was published in November 2014).

Special Journal Issue

Editor of special issue on ‘Beyond techno-utopia: critical approaches to digital health technologies’, Societies (volume 4, number 2), 2014.

Book Chapters

Lupton, D. (2014) The reproductive citizen: motherhood and health education. In Fitzpatrick, K. and Tinning, R. (eds), Health Education: Critical Perspectives. London: Routledge, pp. 48—60.

Lupton, D. (2014) Unborn assemblages: shifting configurations of embryonic and foetal embodiment. In Nash, M. (ed), Reframing Reproduction: Conceiving Gendered Experiences. Houndmills: Palgrave Macmillan.

Peer-reviewed Journal Articles

Lupton, D. (2014) ‘How do you measure up?’ Assumptions about ‘obesity’ and health-related behaviors in ‘obesity’ prevention campaigns. Fat Studies, 3(1), 32—44.

Lupton, D. (2014) The commodification of patient opinion: the digital patient experience economy in the age of big data. Sociology of Health & Illness, 36(6), 856—69.

Lupton, D. (2014) Precious, pure, uncivilised, vulnerable: infant embodiment in the Australian popular media. Children & Society, 28(5), 341—51.

Lupton, D. (2014) Quantified sex: a critical analysis of sexual and reproductive self-tracking apps. Culture, Health & Sexuality, online first, doi: 1080/13691058.2014.920528.

Lupton, D. (2014) Data assemblages, sentient schools and digitised HPE (response to Gard). Sport, Education and Society, online first, doi: 1080/13573322.2014.962496.

Lupton, D. (2014) Health promotion in the digital era: a critical commentary. Health Promotion International, online first, doi: 10.1093/heapro/dau091.

Lupton, D. (2014) Apps as artefacts: towards a critical sociological perspective on health and medical apps. Societies, 4, 606—22.

Lupton, D. (2014) Critical perspectives on digital health technologies. Sociology Compass, 8(12), 1344—59.

Editorials

Lupton, D. (2014) Beyond techno-utopia: critical approaches to digital health technologies. Societies, 4(4), 706—11.

Other Academic Publications

Lupton, D. (2014) Risk. In Cockerham, W., Dingwall, R. and Quah, S. (eds), The Wiley-Blackwell Encyclopedia of Health, Illness, Behavior and Society. New York: Blackwell, pp. 2067—71.

Lupton, D. (2014) Feeling Better Connected’: Academics’ Use of Social Media. Canberra: News & Media Research Centre.

Itinerary for my trip to England in January 2015

Next month I will be visiting England to give talks and meet colleagues. It’s a whirlwind visit, with 8 talks at 7 universities in five days. The itinerary and further details are provided below for those who might be interested in coming along to any of the talks.

Monday 12 January

  • 10.30 am—3.00 pm: NSMNSS Knowledge Exchange Event, London: Speaking on ‘Using social media for academic work – possibilities, benefits and risks’. Further details here.
  • 5.00 pm—6.30 pm: Seminar at UCL, London. Speaking on ‘Fabricated data bodies: reflections on 3D printed digital body objects in medical and health domains‘. Venue: Daryll Forde room, Department of Anthropology, UCL.

Tuesday 13 January

  • 2.00 pm—4.00 pm: Sociological Perspectives on Digital Health event, Warwick University. Speaking on ‘Critical digital health studies: a research agenda’. Further details here.
  • 5.00 pm-7.00 pm: What is Digital Sociology? event, Warwick University. Speaking on ‘What is digital sociology?’. Further details here.

Wednesday 14 January

  • 9.30 am—12.00 pm: Workshop at the Department of Primary Care Health Sciences, Green Templeton College, Oxford University. Workshop topic is ‘Theorising and researching medical and health apps and wearable self-tracking devices‘.
  • 5.00 pm—7.00 pm: Digital Sociology event, Goldsmiths, University of London. Speaking on a panel on ‘Digital sociology, digital cultures, web science, data science  … what’s the difference?’. Further details here.

Thursday 15 January

  • 10.00 am—4.00 pm: ‘Biosensors in Everyday Life’ workshop at Lancaster University. Speaking on ‘Self-tracking cultures: thinking sociologically about the quantified self’. Further details here.

Friday 16 January

  • 12.00 pm—4.00 pm: Yorkshire BSA Medsoc group event, University of York. Speaking on ‘Digital data, big and small: some critical sociological reflections‘. Further details here.

 

 

The digital tracking of school students in physical education classes: a critique

I have had a new article published in the journal of Sport, Education and Society on the topic of how school  health and physical education (HPE) is becoming digitised and technologies of self-tracking are being introduced into classes. As its title suggests – ‘Data assemblages, sentient schools and digitised HPE (response to Gard)’ – the article outlines some thoughts in response to a piece published in the same journal by another Australian sociologist, Michael Gard. Gard contends that a new era of HPE seems to be emerging in the wake of the digitising of society in general and the commercialising of education, which is incorporating the use of digital technologies.

Few commentators in education, health promotion or sports studies have begun to realise the extent to which digital data surveillance (‘dataveillance’) and analytics are now encroaching into many social institutions and settings and the ways in which actors and agencies in the digital knowledge economy are appropriating these data. In my article I give some examples of the types of surveillance technologies that are being introduced into school HPE. Apps such as Coach’s Eye and Ubersense are beginning to be advocated in HPE circles, as are other health and fitness apps. Some self-tracking apps have been designed specifically for HPE teachers for use with their students. For example the Polar GoFit app with a set of heart rate sensors is expressly designed for HPE teachers as a monitoring tool for students’ physical activities during lessons. It allows teachers to distribute the heart rate sensors to students, set a target zone for heart rate levels and then monitor these online while the lesson takes place, either for individuals or the class as a group.

I argue that there are significant political and ethical implications of the move towards mobilising digital devices to collect personal data on school students. I have elsewhere identified a typology of five modes of self-tracking that involve different levels of voluntary engagement and ways in which personal data are employed. ‘Private’ self-tracking is undertaken voluntarily and initiated by the participant for personal reasons, ‘communal’ self-tracking involves the voluntary sharing of one’s personal data with others, ‘pushed’ self-tracking involves ‘nudging’ or persuasion, ‘imposed’ self-tracking is forced upon people and ‘exploited’ self-tracking involves the use of personal data for the express purposes of others.

Digitised HPE potentially involves all five of these modes. In the context of the institution of the school and the more specific site of HPE, the previous tendencies of HPE to represent paternalistic disciplinary control over the unruly bodies of children and young people and to exercise authority over what the concepts of ‘health’, ‘the ideal body’ and ‘fitness’ should mean can only be exacerbated. More enthusiastic students who enjoy sport and fitness activities may willingly and voluntarily adopt or consent to dataveillance of their bodies as part of achieving personal fitness or sporting performance goals. However when students are forced to wear heart rate monitors to demonstrate that they are conforming to the exertions demanded of them by the HPE teacher, there is little room for resistance. When certain very specific targets of appropriate number of steps, heart-rate levels, body fat or BMI measurements and the like are set and students’ digitised data compared against them, the capacity for the apparatus of HPE to constitute a normalising, surveilling and disciplinary gaze on children and young people and the capacity for using these data for public shaming are enhanced.

The abstract of the article is below. If you would like a copy, please email me on deborah.lupton@canberra.edu.au.

Michael Gard (2014) raises some important issues in his opinion piece on digitised health and physical education (HPE) in the school setting. His piece represents the beginning of a more critical approach to the instrumental and solutionist perspectives that are currently offered on digitised HPE. Few commentators in education, health promotion or sports studies have begun to realise the extent to which digital data surveillance and analytics are now encroaching into many social institutions and settings and the ways in which actors and agencies in the digital knowledge economy are appropriating these data. Identifying what is happening and the implications for concepts of selfhood, the body and social relations, not to mention the more specific issues of privacy and the commercialisation and exploitation of personal data, requires much greater attention than these issues have previously received in the critical social literature. While Gard has begun to do this in his article, there is much more to discuss. In this response, I present some discussion that seeks to provide a complementary commentary on the broader context in which digitised HPE is developing and manifesting. Whether or not one takes a position that is techno-utopian, dystopian or somewhere in between, I would argue that to fully understand the social, cultural and political resonances of digitised HPE, such contextualising is vital.

New project on fitness self-tracking apps and websites

My colleague Glen Fuller and I have started a new project on people’s use of fitness self-tracking apps and platforms (such as Strava and RunKeeper). We are interviewing people who are active users of these devices, seeking to identify why they have chosen to take up these practices, what apps and platforms they use, how they use them and what they do with the personal data that are generated from these technologies. We are interested in exploring issues around identity and self-representation, concepts of health, fitness and the body, privacy, surveillance and data practices and cultures.

The city in which we live and work, Canberra, is an ideal place to conduct this project, as there are many ardent cyclists and runners living here.

See here for our project’s website and further details of the study.

Thinking about the ethics and politics of public health campaigns

Over the past few years one of my research foci has been that of fat embodiment and obesity politics. This interest builds on my longstanding research on the sociocultural dimensions of health, medicine and public health, as well as the sociology of food and eating and the sociology of the body.

In July 2012 I wrote a piece for The Conversation critiquing a new Australian anti-obesity campaign, LiveLighter. The campaign included visual material and text that sought to evoke disgust (the ‘yuck factor’) about body fat in audiences. I argued in my piece that such strategies need to be examined for the ethical and moral issues they raise. Should health promotion campaigners be attempting to make people feel hatred and revulsion about their own bodies? To what extent are certain individuals and social groups identified by others as disgusting via such campaigns, and as a result subjected to social discrimination and stigma? How do such campaigns reproduce and exacerbate existing social disadvantage?

These questions have been addressed in several other publications of mine since then. In 2013 my book Fat appeared, in which I investigated the historical, social and cultural underpinnings of the disgust and revulsion that fat bodies tend to evoke in contemporary western culture. And I followed up my interest in public health campaigns and their use of strategies that attempt to arouse negative emotions such as disgust, shame and fear in two journal articles that were published recently.

One of these articles, published last week in Critical Public Health, builds on the piece I wrote for The Conversation by exploring the reasons why disgust is used in public health campaigns directed not only at obesity but also other issues, such as tobacco, excessive drinking and illicit drugs. It is entitled ‘The pedagogy of disgust: the ethical, moral and political implications of using disgust in public health campaigns’. Here is the abstract:

The developers of public health campaigns have often attempted to elicit disgust to persuade members of their target audiences to change their behaviour in the interests of their health. In this critical essay, I seek to problematise this taken-for-granted and unquestioned tactic. I assert that the pedagogy of disgust in public health campaigns has significant ethical, moral and political implications. In outlining my argument, the literature on the social, cultural and political elements of disgust is drawn upon. I also draw more specifically on scholarship demonstrating the ways in which disgust has operated in relation to health and medical issues to reinforce stigmatisation and discrimination against individuals and groups who are positioned as disgusting. It is concluded that advocates of using such tactics should be aware of the challenge they pose to human dignity and their perpetuation of the Self and Other binary opposition that reinforces negative attitudes towards already disadvantaged and marginalised individuals and social groups.

The other article was published last month in Fat Studies and is entitled ‘How do you measure up?’ Assumptions about ‘obesity’ and health-related behaviors and beliefs in two Australian ‘obesity’ prevention campaigns’. This article was based on research I undertook using documents reporting on the formative and evaluation research by market research companies that was undertaken for two other Australian anti-obesity campaigns: the ‘Measure Up’ and the ‘Swap It, Don’t Stop It’ campaigns. Analysing these types of documents provides an interesting insight into the mentalities and rationales that underpin their development on the part of public health authorities and the people they employ to develop the content and strategies of their social marketing efforts. This is the abstract:

This article presents an analysis of two related Australian government-sponsored ‘obesity’ prevention campaigns, including documents produced by commercial social research companies reporting the formative research and evaluation of these campaigns. This material is critically analyzed for its underlying assumptions about weight, ‘obesity’ and the public’s health-related behaviors and beliefs. These include the following: the concept of ‘good health’ has meaning and value that is universally shared; to be ‘overweight’ or ‘obese’ is to be physically unfit and at risk of higher levels of disease and early death; individuals are responsible for their own health status; individuals lack appropriate information about health risks and providing this information leads to behavior change; and information should be provided in a way that arouses concern and a belief that individuals should make a change. These assumptions are challenged from a critical sociological perspective.

Anyone who would like a copy of these articles can contact me on deborah.lupton@gmail.com.

The body-being-born: how women conceptualise and experience the moment of birth

Newborn child, seconds after birth. The umbili...

Newborn child, seconds after birth. The umbilical cord has not yet been cut. (Photo credit: Wikipedia)

Although there is a large body of literature about labour and childbirth in the social sciences, surprising few researchers have sought to investigate women’s experiences of the moment of birth.

Virginia Schmied and I recently published an article in the Sociology of Health & Illness that drew on interview data with Australian women who had recently given birth. We asked women to recount their birth stories to us, and the data that eventuated gave interesting insights into women’s perceptions and experiences of what we call ‘the body-being-born’. We use this term to refer to the foetus/infant, an ambiguous body at the moment of birth because it is not quite inside but not quite outside the maternal body. When inside the maternal body, this body is technically a foetus; once expelled from the maternal body, it is called an infant. But in the process of vaginal labour and birth itself, when the body-being-born is passing through the cervix, parts of this body (most commonly its head) slip inside and outside the maternal body, moving back and forth as the woman works to deliver the body.

This stage of labour, therefore, is a highly liminal one, involving the two-in-one foetal/maternal body in the process of individuating to become two separate bodies over a period of time.  Women who gave birth vaginally without anaesthetic often described this process as a ‘splitting’ of their bodies, a sensation of their bodies ‘opening to the world’ over which they had no control.

We found that most of the women we interviewed struggled to conceptualise this process, as it was so foreign to their embodied experiences. They also needed to take some time following the birth to come to terms with the idea that the foetus was now ‘my baby’: a body/self that was physically separate from their own, now foreign and strange as it was outside their bodies. As one of our interviewees put it:

The midwife handed her straight to me and I held her, but I had held her for a while, I just was — it was like looking at her and wondering ‘Where did this baby came from?’ You know, despite what I’d gone through, it was hard to associate that she was actually mine and she was out of my stomach … Even holding her for the first few minutes — just, it wasn’t like she was mine, my kid, which is weird …when you think of what you went through, it was really quite strange.

This is a time in which women have to deal physically and emotionally with the disrupted boundaries of their bodies, the significant distortion and opening that has occurred with the birth and the splitting of body/self. There is a sense of disbelief, of wonder that this amazing, unique and strange process has happened to them.

An important finding from our study was that women who had undergone a caesarean section had even greater difficulties coming to terms emotionally and conceptually with the notion that their infant was now separate from them; that they had, indeed, ‘had a baby’. Because they did not undergo the physical rigours and often intense pain of prolonged labour and the experience of actually expelling the body-being-born from their own bodies, and because their bodies were numbed to surgically deliver, women who had had a caesarean took longer to accept the fact that the infant was now out of their bodies. They talked about feeling alienated from their infants and struggling to come to terms that it was actually ‘my baby’. In the words of another of our interviewees:

It was very hard to think that she was my daughter after she was born, because I had a caesarean under general anaesthetic and all of a sudden I’m not pregnant any more. And I wake up a few hours later and you’re presented with a baby. You think, ‘Oh, why isn’t this, why aren’t I feeling any kicks in my abdomen anymore?’ — you know. And there’s the baby and it’s very hard to relate to it.

Virginia and I conclude our article by arguing that the circumstances in which women give birth are pivotal to how they experience the process of coming to terms with the body that was once inside them emerging to the outside. Our findings suggest that health professionals and attendants working with women in labour and childbirth need to allow not only for the physical and the emotional but also the ontological dimensions of how a woman experiences both her own body and that of the body-being-born, and the significant difference that undergoing a caesarean section can make to the woman being able to achieve the transition from two bodies in one to two separate bodies successfully.

The rise of the quantified self as a cultural phenomenon

The Quantified Self movement was first developed in 2007 by two Wired Magazine editors, Gary Wolf and Kevin Kelly, who set up a website devoted to the movement in 2008. Interest in the concept and the associated movement has developed rapidly from there. According to The Quantified Self website, there are now over 130 quantified self groups in 34 countries around the world, many of which have regular meetings involving ‘show-and-tell’ discussions of how members have been engaging in self-tracking activities.

As part of investigating the ways in which the quantified self as a new term and practice has developed, I conducted a search for the term as it has appeared in English-language news media articles in the Factiva database, which archives newspaper and magazine articles (including digital and print articles) from over 8,000 sources from the world’s press.

Not surprisingly, given that the Quantified Self website was only established in 2008, the first news article to appear using this term was not until September of that year, just prior to the group’s first-ever meetup. The Washington Post (9 September 2008) noted the establishment of the group and interviewed Gary Wolf and several other people who were engaging in self-tracking.

In 2009 only two news articles appeared mentioning the quantified self: one in the American Life Science Weekly that reported a study on the relevance to healthcare of self-tracking, and the other in the Canadian Globe and Mail that discussed The Quantified Self movement and people involved in it. But the number of articles rose to 21 in 2010 and 33 in 2011 and by 2012 148 articles had been published that used the term. 2013 has witnessed even greater interest: by the end of July 2013, 188 news articles discussing the quantified self had already been published.

While these are not particularly high numbers relative to the thousands of topics that were reported in the news outlets included in Factiva, they do demonstrate evidence of growing and continuing interest in the quantified self which has gathered momentum each year since 2010.

The tenor of news reporting on the quantified self has changed over time. Early reports focused on its innovative aspects and debated whether such close attention to the details of one’s life and bodily functions would extend beyond ‘uber geeks’ or those ‘weirdly narcissistic’ few who are interested in ‘extreme naval gazing’ to the general population (Forbes magazine [USA], 25 April 2011). By 2012, news articles represented the quantified self as growing in popularity and becoming not only an important feature of health promotion but part of everyday life, as a way of maximising productivity and happiness as well as health. The term ‘quantified self’ was now frequently used not only in relation to members of the Quantified Self movement itself, but more generally to refer to the practices of self-tracking or life-logging.

Bearing headlines such as ‘Apps that will help you keep your resolve’ (Sydney Morning Herald, 30 December 2012), these news reports normalised the practice as applicable to everyone interested in improving their bodies or the selves. As the British Sunday Telegraph Magazine (2 December 2012) put it: ‘It began with a small group of digital obsessives recording their every heartbeat. Today the “quantified self” movement is a gadget-filled fitness craze.’ By June 2013, The Guardian (UK) was contending that ‘the “Quantified Self” movement (is) all the rage for people tracking their physical activity, food intake, vital signs and even their personal genome through digital services’.

News articles also increasingly referred to the plethora of new devices that were being released onto the market to support self-tracking efforts, involving major corporations such as Nike, Apple and Qualcomm, demonstrating a growing interest in the business world in taking advantage of the phenomenon. As 2012 drew to a close, several news reports noted how self-tracking devices could help people achieve their New Year’s resolutions. These technologies were also frequently mentioned in lists of innovations that would attract significant attention in the new year to come from those seeking to develop and sell products for quantified selfers.

News articles in 2013 appearing thus far demonstrate the growing dimensions of this potential market for wearable digital self-tracking devices, with many articles reporting new devices that are in development or that have been released, including ‘digital diapers’, wearable devices as fashion accessories, the use of self-tracking by elite athletes to improve their performances and devices for the ‘quantified pet’. There has been a focus on big data as well, with articles noting the power not only of individualised data in contributing valuable knowledge to self-trackers, but also that of the aggregated big data accumulated across many users uploading their data to websites.

However there is also evidence in recent news reports of the growing realisation of privacy concerns in relation to these data collected with these devices. Questions were raised about who should own these very personal data and how self-trackers can protect their rights to access their own data, as in The Guardian’s (26 June 2013) article headlined: ‘Wearable tech: why Intel thinks we should own our data.’

To establish further how general interest in the quantified self is developing, I used the Google Trends1 tool to see how often the ‘quantified self’ was used as search term for the same time period. The resultant graph showed that searches for the term ‘quantified self’ have risen steadily since early 2009, reaching its peak in April 2013. The regional interest figure, which highlights which areas of the world have used the search term comparatively the most, demonstrates that the USA has by far the greatest interest (top of the scale on 100), followed by Germany (60) and the UK (52). No other countries register on this scale, demonstrating far lower interest2.

I am using these analyses in a current article* that I am preparing on the critical sociology of the quantified self. For previous blog posts on the quantified self in relation to digital health, see here and here.

* Update: This article has now been published as ‘Understanding the human machine’ in IEEE Technology and Society, and can be accessed here.

Footnotes

  1. Google Trends analyses a portion of worldwide Google searches to compute how many searches have been conducted for the terms entered relative to all Google searches over that time period. This indicates the likelihood of a random user to search for the search term from a certain location at a certain time. The tool draws a graph showing interest over time plotted on a scale from 0 to 100 (100 representing the relative peak of interest, not the absolute numbers of searches).
  2. This does not mean that no searches for quantified self were initiated from these countries, but rather that the numbers did not reach the threshold set by Google for registering on the scale.

My two new books on unborn humans

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Last month both my new books on the topic of the unborn (human embryos and foetuses) were published. One is an authored book, part of the Palgrave Pivot series, entitled The Social Worlds of the Unborn. The other, The Unborn Human, is an open access book that I edited as part of the Living Books about Life series published by the Open Humanities Press.

Both books deal with very similar issues and theoretical perspectives, and therefore complement each other nicely. The Social Worlds of the Unborn has five substantive chapters. The first chapter examines what I call ‘contingencies of the unborn’, drawing on sociological, anthropological, bioethical, philosophical and historical perspectives to highlight the dynamic nature of the ways we think about foetuses and embryos and the debates over the extent of their humanness and personhood. I then go on in the next chapter to discuss technologies for visualising the unborn, such as foetal photography and computer imaging and obstetric ultrasound. These have been particularly important technologies in opening up the uterus to the gaze so that we can see the previously mysterious entities that inhabit this space. I argue that visualising technologies have worked to represent unborn entities as already persons in their own right, autonomous from the maternal body, and indeed as already infants. These images also represent the unborn as beautiful, fragile and vulnerable entities requiring our utmost love and protection, and thus are powerful agents in anti-abortion politics.

In the third chapter of this book I focus on pregnant women’s perspectives on the unborn entities growing within their own bodies. I highlight the ambivalence that pregnant women often feel about this Other body inhabiting their own, as well as their difficulty in coming to terms with their ‘two-in-one’ bodies that depart so radically from the contained, unitary bodily norm. The concept of the ‘good mother’ often precludes acknowledgement that pregnant women may sometimes feel as if their unborn is antagonistic and even parasitic. Yet these feelings are not uncommon in pregnant women, in addition to the more culturally accepted notions of the unborn as precious proto-infants.

The next chapter goes on to examine the dead unborn, including discussion of abortion practices, policies and politics, decisions about the disposal of surplus IVF embryos and the mourning and memorialisation of unborn entities lost in miscarriage or stillbirth. It also looks at bioscientific definitions of the unborn and how working practices in the medical clinic or stem cell laboratory operate to deal with using matter from dead unborn entities. Here again issues concerning judgements about the humanness and status of personhood of various unborn entities are to the fore. I demonstrated that the context in which these entities are created and grow (or fail to develop) is vital to concepts of their value and vitality.

The final substantive chapter examines the concept of the endangered unborn, particularly in relation to how pregnant women are represented as posing a threat to their unborn through ignorance or deliberate negligence. I argue that the increasing humanisation and personalising of the unborn and their representation as precious, vulnerable and as already infants with full human privileges work to position them as more important than the women who bear them, who increasingly as positioned as vessels rather than as individuals with their own rights and needs that may differ from those of their unborn.

The edited book, The Unborn Human, takes up many of these issues. I review the contents of the book in my Introduction (‘Conceptualising and configuring the unborn human‘), showing how each item in the collection contributes to various ways of thinking about, treating, representing, creating or destroying unborn entities. Like the other books in the Living Books about Life series, The Unborn Human is a curated collection of material that is available as open access publications. Some of this material can be viewed via links to the website embedded in the book, while others can be directly accessed under the Creative Commons Attribution licence. This means that all of the articles and other materials included in the book, which range from historical documents to scientific, medical, bioethical, policy, sociological, anthropological and cultural studies articles as well as social and other digital media material such as websites, blog posts and YouTube videos, can be accessed for free (including my introduction using the link supplied above).

Towards a critical sociology of digital health technologies

A recent research interest of mine is the emergence of ‘digital health’ (otherwise known as Health 2.0, Medicine 2.0, eHealth or mHealth) as central to healthcare and public health policies in developed countries. Digital health technologies include using mobile wireless devices and social media to gather data on health-related behaviours or to encourage people to take up health promoting behaviours, using Web 2.0 devices to seek out information on health-related matters and to contribute to this information, telemedicine, digital medical records and disease-monitoring systems.

There are now many articles in the news media and medical and public health literature that enthusiastically promote digital health as ‘revolutionary’ and ‘disruptive’ to traditional approaches to healthcare and public health. As a sociologist, I have sought to interrogate the assumptions underlying discourses on digital health technologies and to identify the social, cultural and political dimensions of the digital health phenomenon. I have recently written several academic pieces about digital health technologies, as well as a number of blog posts.

Two articles have focused on their use as part of health promotion, quantifying the body and self-tracking (see here and here). Another article looks at the concept of what I have termed ‘the digitally engaged patient’ in relation to the employment of digital technologies in recent telemedicine initiatives . I have also written about the commodification of patient experience data uploaded to patient support websites and the use of Donna Haraway’s cyborg theory to theorise digital health. The most recent piece returns to the subject of what I call ‘digitised health promotion’.

One of my central arguments is that despite the representation of technologies as inert, neutral objects participating in the collection of data in the interests of health promotion and medical self-care, from a critical perspective such objects may be viewed as actively shaping the subjects/bodies of those who use them. Technologies discipline and order bodies in certain ways, just as bodies discipline and order technologies. They are not politically neutral, but rather are implicated in a dense web of power relations. Using medical and other technologies to peer inside the body is part of a mentality that assumes that more information about the body is always better.

There are a number of central themes that come together in the critical sociology of digital health phenomenon. These include examination of the technologies themselves that are part of Web 2.0 and the Internet of Things, including ubiquitous computing (devices that are mobile and wireless), wearable devices and embedded sensors in devices, as well as the ‘big data’ that are produced from digital technologies. Other themes are the emphasis on personal responsibility for self-care and self-monitoring in telemedical and health promotion programs, the withdrawal of the state from alleviating socioeconomic disadvantage and the promise of control over the body, disease and expenditure that is regularly articulated in discourses on digital technologies. Also important are the contributions of the discourse of ‘healthism’, or the assumption that good health should be privileged over other priorities in people’s lives, and the lure of techno-utopian and data-utopian discourses generally that promote digital technologies as the means by which good health and financial savings may be achieved. Surveillance, whether voluntary, imposed or coercive, is another central dimension of using the new digital health technologies.

Now that computers are wearable upon and can even be inserted into the body or ingested as pills, and are used as part of medical care and preventive health strategies, a new set of possibilities and limitations have been generated in relation to the ways that we think about and use these technologies. I argue that digital health discourses work to draw attention from the social determinants of health and support victim-blaming of those who are ill or viewed as not successfully managing health risks. They promote the myth that ‘clean’, ‘controlled’ technologies allow containment of the ‘messiness’ of human disease and bodily disorder.

Furthermore, digital health technologies discipline bodies in certain ways and configure a set of obligations concerning acting upon the data that they generate. Privacy and discrimination issues also need to be identified and acknowledged, given that digital monitoring devices potentially allow healthcare providers, health promoters, employers and health insurance companies to gain access to data on users’ bodily functions and activities in fine-grained detail. Greater attention needs to be paid to the moral, political and ethical dimensions of the digital health phenomenon.