Digitising female fertility and reproduction

Over the past few months, I have been working on writing about the findings of several research projects addressing the topic of digital technologies directed at female fertility and reproduction. These projects involve:

1) a critical content analysis of fertility and reproduction-related software and devices (especially apps);

2) an online survey of 410 Australian women’s use of pregnancy and parenting apps; and

3) focus groups and interviews with Australian and British women about their use of these technologies (these are still in progress).

Several outcomes have now been published drawing on these findings. They include a report (with Sarah Pedersen from Robert Gordon University, Aberdeen) outlining the findings of the online survey (this can be accessed here), an article on the gamification and ludification of pregnancy in apps (with Gareth Thomas from Cardiff University, available here) and a book chapter on the concept of the reproductive citizen and the range of digital technologies that are directed at helping women to monitor and regulate their fertility and reproduction (available here).

Some of the key findings are:

  • The survey showed that pregnancy and parenting apps were very popular among the survey respondents – three-quarters of the respondents (who were either pregnant or who had a baby in the past three years at the time of the survey) said that they had used at least one pregnancy app, while almost half had used at least one parenting app.
  • Googling information about pregnancy is very common among pregnant women, for whom too much information about pregnancy appears never to be enough (this finding emerged in the focus groups). They tend to invest their trust in the first few search findings that come up on their search engine, reasoning that because this is evidence of popularity, then these websites must be credible.
  • Despite the popularity of pregnancy and parenting apps, few women are contemplating the validity of the information presented in them, or demonstrated concern about the data security and privacy of the personal information that the apps may collect (this was evident in both the survey and the focus groups).
  • This genre of software is intensifying an already fervid atmosphere of self-surveillance, attempts at management and control and self-responsibility in which female fertility and reproduction are experienced and performed.
  • Stereotypical concepts of idealised female fertile and pregnant bodies are reproduced in apps and other software. They use highly aestheticised images and the promise of rational calculation and monitoring to seek to contain and control women’s fertility and reproduction.
  • Women in their fertile years – and particularly those contemplating pregnancy or already pregnant – are part of a highly commodified demographic. The information that they generate from their online practices possess a new form of value, biovalue, as part of the bioeconomy of personal health and medical data.

Self-tracking, social fitness and biovalue

I have just completed a chapter for the forthcoming volume The Sage Handbook of Social Media. The chapter addresses the intersections of self-tracking for health and medical purposes with social media platforms and rationales. As I argue in the chapter, the expanded array of digitised devices that are available for self-tracking and the capacity of many of these technologies to interact with social media platforms have encouraged self-trackers to share the details that they collect about themselves with others. I begin with a description of self-tracking and the sociomaterial theoretical foundations on which the chapter rests. This is followed with an overview of the technologies that are available for health and medical self-tracking and for self-trackers to share their data. The discussion section of the chapter presents an analysis of the new forms of value that personal health and medical data have attracted in the digital data economy, and the moral and political repercussions of encouraging people to participate as socially fit citizens. The chapter ends with outlining key questions for further research.

The full pre-print of the chapter is available here.

Who owns your personal health and medical data?

09/01/15 -- A moment during day 1 of the 2-day international Healthcare and Social Media Summit in Brisbane, Australia on September 1, 2015. Mayo Clinic partnered with the Australian Private Hospitals Association (APHA), a Mayo Clinic Social Media Health Network member to bring this first of it's kind summit to Queensland's Brisbane Convention & Exhibition Centre. (Photo by Jason Pratt / Mayo Clinic)

Presenting my talk at the Mayo Clinic Social Media and Healthcare Summit (Photo by Jason Pratt / Mayo Clinic)

Tomorrow I am speaking on a panel at the Mayo Clinic Healthcare and Social Media Summit on the topic of ‘Who owns your big data?’. I am the only academic among the panel members, who comprise of a former president of the Australian Medical Association, the CEO of the Consumers Health Forum, the Executive Director of a private hospital organisation and the Chief Executive of the Medical Technology Association of Australia. The Summit itself is directed at healthcare providers, seeking to demonstrate how they may use social media to publicise their organisations and promote health among their clients.

As a sociologist, my perspective on the use of social media in healthcare is inevitably directed at troubling the taken-for-granted assumptions that underpin the jargon of ‘disruption’, ‘catalysing’, ‘leveraging’ and ‘acceleration’ that tend to recur in digital health discourses and practices. When I discuss the big data phenomenon, I evoke the ‘13 Ps of big data‘ which recognise their social and cultural assumptions and uses.

When I speak at the Summit, I will note that the first issue to consider is for whom and by whom personal health and medical data are collected. Who decides whether personal digital data should be generated and collected? Who has control over these decisions? What are the power relations and differentials that are involved? This often very intimate information is generated in many different ways – via routine online transactions (e.g. Googling medical symptoms, purchasing products on websites) or more deliberately as part of people’s contributions to social media platforms (such as PatientsLikeMe or Facebook patient support pages) or as part of self-tracking or patient self-care endeavours or workplace wellness programs. The extent to which the generation of such information is voluntary, pushed, coerced or exploited, or indeed, even covert, conducted without the individual’s knowledge or consent, varies in each case. Many self-trackers collect biometric data on themselves for their private purposes. In contrast, patients who are sent home with self-care regimes may do so reluctantly. In some situations, very little choice is offered people: such as school students who are told to wearing self-tracking devices during physical education lessons or employees who work in a culture in which monitoring their health and fitness is expected of them or who may be confronted with financial penalties if they refuse.

Then we need to think about what happens to personal digital data once they are generated. Jotting down details of one’s health in a paper journal or sharing information with a doctor that is maintained in a folder in a filing cabinet in the doctor’s surgery can be kept private and secure. In this era of using digital tools to generate and archive such information, this privacy and security can no longer be guaranteed. Once any kind of personal data are collected and transmitted to the computing cloud, the person who generated the data loses control of it. These details become big data, part of the digital data economy and available to any number of second or third parties for repurposing: data mining companies, marketers, health insurance, healthcare and medical device companies, hackers, researchers, the internet empires themselves and even national security agencies, as Edward Snowden’s revelations demonstrated.

Even the large institutions that are trusted by patients for offering reliable and credible health and medical information online (such as the Mayo Clinic itself, which ranks among the top most popular health websites with 30 million unique estimated monthly visitors) may inadvertently supply personal details of those who use their websites to third parties. One recent study found that nine out of ten visits to health or medical websites result in data being leaked to third parties, including companies such as Google and Facebook, online advertisers and data brokers because the websites use third party analytic tools that automatically send information to the developers about what pages people are visiting. This information can then be used to construct risk profiles on users that may shut them out of insurance, credit or job opportunities. Data security breaches are common in healthcare organisations, and cyber criminals are very interested in stealing personal medical details from such organisations’ archives. This information is valuable as it can be sold for profit or used to create fake IDs to purchase medical equipment or drugs or fraudulent health insurance claims.

In short, the answer to the question ‘Who owns your personal health and medical data?’ is generally no longer individuals themselves.

My research and that of others who are investigating people’s responses to big data and the scandals that have erupted around data security and privacy are finding that concepts of privacy and notions of data ownership are beginning to change in response. People are becoming aware of how their personal data may be accessed, legally or illegally, by a plethora of actors and agencies and exploited for commercial profit. Major digital entrepreneurs, such as Apple CEO Tim Cook, are in turn responding to the public’s concern about the privacy and security of their personal information. Healthcare organisations and medical providers need to recognise these concerns and manage their data collection initiatives ethically, openly and responsibly.

Edited book ‘Beyond Techno-Utopia: Critical Approaches to Digital Health Technologies’ now out

Last year I guest-edited a special issue of the open-access sociology journal Societies that focused on critical perspectives on digital health technologies. The collection includes my editorial and another article I contributed (on the topic of apps as sociocultural artefacts), as well as eight other articles from scholars based in the UK, Australia, Finland, the USA and Sweden. Individual contributions may be accessed on the journal’s website here, and now the whole collection is available as an open access book PDF (or can be purchased as a hard copy), both available here.

The following outline of the special issue/book’s contents, an edited excerpt taken from my editorial, provides an overview of its contents.

The articles in this special issue build on a well-established literature in sociology, science and technology studies and media and cultural studies that has addressed the use of digital technologies in health and medicine… Several of these topics are taken up in the articles published in this special issue. All the authors use social and cultural theory to provide insights into the tacit assumptions, cultural meanings and experiences of digital health technologies. The articles cover a range of digital health technologies: devices used for the self-tracking of body metrics (Ruckenstein; Till; Rich and Miah; Lupton); social media platforms for discussing patients’ experiences of chronic disease (Sosnowy) and experiences of pregnancy and early motherhood (Johnson); health and medical apps (Till; Johnson; Christie and Verran; Lupton); telehealthcare systems (Hendy, Chrysanthaki and Barlow); and a digital public health surveillance system (Cakici and Sanches). While some articles focus on globalised digital media (Cakici and Sanches; Rich and Miah; Till; Lupton), others engage more specifically with a range of sociocultural groups, contexts and locations. These include Aboriginal people living in a remote region of Australia (Christie and Verran) and Australian mothers in urban Sydney (Johnson) as well as research participants in Helsinki, Finland (Ruckenstein), the United States (Sosnowy) and England (Hendy, Chrysanthaki and Barlow).

Understandings and experiences of selfhood and embodiment as they are generated and experienced via digital health devices are central preoccupations in the articles by Ruckenstein, Rich and Miah, Till, Lupton, Sosnowy and Johnson. Ruckenstein’s study of self-trackers found that they often conceptualised their bodies and their physical activities in different ways when these were being monitored and rendered into digital data. The data that were generated by these devices proved to be motivational and to give value to some activities (like housework) that otherwise lacked value or new meaning to functions such as sleep (which when digitised and quantified became viewed as a competence). Ruckenstein found that the digital data tended to be invested with greater validity than were other indicators of bodily wellbeing or activity, such as the individual’s physical sensations.

All of the above authors comment on the ways in which digital health devices such as wearable self-tracking devices, social media platforms, apps and patient support websites work as disciplinary tools. They invite users to conform to the ideals of healthism (privileging good health above other priorities) and the responsible self-management and self-monitoring of one’s health and body, including avoiding exposure to risk. Rich and Miah use the concept of “public pedagogy” to describe the socio-political dimensions of digital health technologies as they are employed to educate people about their bodies and promote self-management. As Johnson notes, for women who are pregnant or have the care of young children, this sphere of responsibility is extended to the bodies of others: the foetus or child. And as Till’s article emphasises, when employees are “encouraged” to engage in self-tracking, the ethos of responsibility extends from personal objectives to those of employers.

Ruckenstein, Till and Sosnowy also highlight the digital labour involved for people who engage with social media or self-tracking apps as part of their personal health or fitness practices. Sosnowy’s interviews with women with multiple sclerosis who blog about their condition emphasise the work involved in such engagement as an “active patient”. Till’s analysis of digital exercise self-tracking points to the appropriations of people’s labour by other actors for commercial reasons.

The article by Hendy, Chrysanthaki and Barlow moves in a somewhat different direction. Using ethnographic cases studies, they look at the managerial issues involved with implementing telehealthcare in English social and health care organisations. Their focus, therefore, is not on the recipients or targets of digital health technologies but rather those who are attempting to institute programs as part of their work as managers. These authors’ contribution highlights the messiness of introducing new systems and practices into large organisations, and the resistances that may emerge on the part of both workers and the targets of telehealthcare programs. Cakici and Sanches’ article also takes an organisational perspective in addressing a European Commission co-funded project directed at syndromic surveillance, or the use of secondary sources to detect outbreaks and patterns in diseases and medical conditions. Digital data are increasingly being use as part of syndromic surveillance: Google Flu Trends is one such example. Cakici and Sanches’ analysis highlights the role played by human decision-making and the affordances of digital technologies in structuring what kinds of data are retrieved for syndromic surveillance and how they are interpreted.

While there are as yet few detailed ethnographic accounts of how people are implementing, adopting or resisting contemporary digital health technologies, there are even fewer that investigate the use of these technologies by members of cultural groups outside the global North. The article by Christie and Verran takes a much-needed diversion from perspectives on white, privileged groups to Aboriginal people living in a remote part of Australia. As they argue, the concepts on health, illness and the body that are held by this cultural group differ radically from the tacit assumptions that are invested in mainstream health and medical apps. Any app that is developed to assist in health literacy that is targeted at this group must incorporate culturally-appropriate modes of communication: positioning people within their cultural and kinship networks of sociality, for example, rather than representing them as atomised actors.

The articles collected here in this special issue have gone some way in offering a critical response to digital health technologies, but they represent only a beginning. Many more compelling topics remain to be investigated. These include research into the ways in which lay people and healthcare professionals are using (or resisting the use) of social media, apps and self-monitoring devices for medicine and health-related purposes; the implications for medical power and the doctor-patient relationship; how citizen science and citizen sensing are operating in the public health domain; the development of new digital health technologies; the implications of big data and data harvesting in medicine and healthcare; the spreading out of health-related self-tracking practices into many social domains; the unintended consequences and ethical aspects of digital technology use and their implications for social justice; and data security and privacy issues.

Digitised children’s bodies

This is an excerpt from the pre-print version of a chapter I have written on the topic of ‘digital bodies’. The full pre-print can be accessed here.

The sociomaterialist perspective has been taken up by several scholars writing about children’s bodies, particularly within cultural geography, but also by some sociologists and anthropologists (Prout, 1996; Horton and Kraftl, 2006a, 2006b; Lee, 2008; Woodyer, 2008). Researchers using a sociomaterialist approach have conducted studies on, for example, children’s use of asthma medication (Prout, 1996), the surveillant technologies that have developed around controlling children’s body weight in schools (Rich et al., 2011), children’s sleep and the objects with which they interact (Lee, 2008), the interrelationship of objects with pedagogy and classroom management of students’ bodies (Mulcahy, 2012) and sociomaterial practices in classrooms that lead to the inclusion or exclusion of children with disabilities (Söderström, 2014). Outside sociomaterialist studies, young children’s interactions with digital technologies have attracted extensive attention from social researchers, particularly in relation to topics such as the potential for cyber-bullying, online paedophilia and for children to become unfit and overweight due to spending too much time in front of screens (Holloway et al., 2013). However few researchers thus far have directed their attention to the types of digital technologies that visually represent children’s bodies or render their body functions, activities and behaviours into digital data; or, in other words, how children’s bodies become digital data assemblages.

From the embryonic stage of development onwards, children’s bodies are now routinely monitored and portrayed using digital technologies. A plethora of websites provide images of every stage of embryonic and foetal development, from fertilisation to birth, using a combination of digital images taken from embryo and foetus specimens and digital imaging software  (Lupton, 2013). 3/4D ultrasounds have become commodified, used for ‘social’ or ‘bonding’ purposes. Many companies offering 3/D ultrasounds now come to people’s homes, allowing expectant parents to invite family and friends and turn a viewing of the foetus into a party event. This sometimes involves a ‘gender reveal’ moment, in which the sonographer demonstrates to all participants, including the parents, the sex of the foetus . Some companies offer the service of using 3D ultrasound scan files to create life-sized printed foetus replica models for parents.

The posting to social media sites such as Facebook, Twitter, Instagram and YouTube of the foetus ultrasound image has become a rite of passage for many new parents and often a way of announcing the pregnancy. Using widgets such as ‘Baby Gaga’, expectant parents can upload regular status updates to their social media feeds automatically that provide news on the foetus’s development. While a woman is pregnant, she can use a range of digital devices to monitor her foetus. Hundreds of pregnancy apps are currently on the market, including not only those that provide information but others that invite users to upload personal information about their bodies and the development of their foetus. Some apps offer a personalised foetal development overview or provide the opportunity for the woman to record the size of her pregnant abdomen week by week, eventually creating a time-lapse video. Other apps involve women tracking foetal movements or heart beat. Bella Beat, for example, is a smartphone attachment and app that allows the pregnant women to hear and record the foetal heart beat whenever she likes and to upload the audio file to her social media accounts.

YouTube has become a predominant medium for the representation of the unborn entity in the form of ultrasound images and of the moment of birth. Almost 100,000 videos showing live childbirth, including both vaginal and Caesarean births, are available for viewing on that site, allowing the entry into the world of these infants to be viewed by thousands and, in the case of some popular videos, even millions of viewers. Some women even choose to live-stream the birth so that audiences can watch the delivery in real time. Following the birth, there are similar opportunities for proud parents to share images of their infant online on social media platforms. In addition to these are the growing number of devices on the market for parents to monitor the health, development and wellbeing of their infants and young children. Apps are available to monitor such aspects as infants’ feeding and sleeping patterns, their weight and height and their development and achievements towards milestones. Sensor-embedded baby clothing, wrist or ankle bands and toys can be purchased that monitor infants’ heart rate, body temperature and breathing, producing data that are transmitted to the parents’ devices. Smartphones can be turned into baby monitors with the use of apps that record the sound levels of the infant.

As children grow, their geolocation, educational progress and physical fitness can be tracked by their parents using apps, other software and wearable devices. As children themselves begin to use digital technologies for their own purposes, they start to configure their own digital assemblages that represent and track their bodies. With the advent of touchscreen mobile devices such as smartphones and tablet computers, even very young children are now able to use social media sites and the thousands of apps that have been designed especially for their use (Holloway et al., 2013). Some such technologies encourage young children to learn about the anatomy of human bodies or about nutrition, exercise and physical fitness, calculate their body mass index, collect information about their bodies or represent their bodies in certain ways (such as manipulating photographic images of themselves). These technologies typically employ gamification strategies to provide interest and motivation for use. Some involve combining competition or games with self-tracking using wearable devices. One example is the Leapfrog Leapband, a digital wristband connected to an app which encourages children to be physically active in return for providing them with the opportunity to care for virtual pets. Another is the Sqord interactive online platform with associated digital wristband and app. Children who sign up can make an avatar of themselves and use the wristband to track their physical activity. Users compete with other users by gaining points for moving their bodies as often and as fast as possible.

In the formal educational system there are still more opportunities for children’s bodies to be monitored measured and evaluated and rendered into digitised assemblages. Programmable ‘smart schools’ are becoming viewed as part of the ‘smart city’, an urban environment in which sensors that can watch and collect digital data on citizens are ubiquitous (Williamson, 2014). The monitoring of children’s educational progress and outcomes using software is now routinely undertaken in many schools, as are their movements around the school. In countries such as the USA and the UK, the majority of schools have CCTV cameras that track students, and many use biometric tracking technologies such as RFID chips in badges or school uniforms and fingerprints to identify children and monitor their movements and their purchases at school canteens (Taylor, 2013; Selwyn, 2014). A growing number of schools are beginning to use wearable devices, apps and other software for health and physical education lessons, such as coaching apps that record children’s sporting performances and digital heart rate monitors that track their physical exertions (Lupton, 2015).

We can see in the use of digital technologies to monitor and represent the bodies of children a range of forms of embodiment. Digitised data assemblages of children’s bodies are generated from before birth via a combination of devices that seek to achieve medical- or health-related or social and affective objectives. These assemblages may move between different domains: when, for example, a digitised ultrasound image that was generated for medical purposes becomes repurposed by expectant parents as a social media artefact, a way of announcing the pregnancy, establishing their foetus as new person and establishing its social relationships. Parents’ digital devices, and later those of educational institutions and those of children themselves when they begin to use digital devices, potentially become personalised repositories for a vast amount of unique digital assemblages on the individual child, from images of them to descriptions of their growth, development, mental and physical health and wellbeing, movements in space, achievements and learning outcomes. These data assemblages, containing as they do granular details about children, offer unprecedented potential to configure knowledges about individual children and also large groups of children (as represented in aggregated big data sets).


Holloway D, Green L and Livingstone S. (2013) Zero to Eight: Young Children and Their Internet Use. London: LSE London, EU Kids Online.

Horton J and Kraftl P. (2006a) Not just growing up, but going on: Materials, spacings, bodies, situations. Children’s Geographies 4(3): 259-276.

Horton J and Kraftl P. (2006b) What else? some more ways of thinking and doing ‘Children’s Geographies’. Children’s Geographies 4(1): 69-95.

Lee N. (2008) Awake, asleep, adult, child: An a-humanist account of persons. Body & Society 14(4): 57-74.

Lupton D. (2013) The Social Worlds of the Unborn, Houndmills: Palgrave Macmillan.

Lupton D. (2015) Data assemblages, sentient schools and digitised health and physical education (response to Gard). Sport, Education and Society 20(1): 122-132.

Mulcahy D. (2012) Affective assemblages: body matters in the pedagogic practices of contemporary school classrooms. Pedagogy, culture and society 20(1): 9-27.

Prout A. (1996) Actor-network theory, technology and medical sociology: an illustrative analysis of the metered dose inhaler. Sociology of Health and Illness 18(2): 198-219.

Rich E, Evans J and De Pian L. (2011) Children’s bodies, surveillance and the obesity crisis. In: Rich E, Monaghan LF and Aphramor L (eds) Debating Obesity: Critical Perspectives. Houndsmills: Palgrave Macmillan, 139-163.

Selwyn N. (2014) Data entry: towards the critical study of digital data and education. Learning, Media and Technology: 1-19.

Söderström S. (2014) Socio-material practices in classrooms that lead to the social participation or social isolation of disabled pupils. Scandinavian Journal of Disability Research online first.

Taylor E. (2013) Surveillance Schools: Security, Discipline and Control in Contemporary Education, Houndmills: Palgrave Macmillan.

Williamson B. (2014) Smart schools in sentient cities. dmlcentral.

Woodyer T. (2008) The body as research tool: embodied practice and children’s geographies. Children’s Geographies 6(4): 349-362.

Medical diagnosis apps – study findings

Over 100,000 medical and health apps for mobile digital devices have now been listed in the Apple App Store and Google Play. They represent diverse opportunities for lay people to access medical information and track their body functions and medical conditions. As yet, however, few critical social researchers have sought to analyse these apps.

In a study I did with Annemarie Jutel we undertook a sociological analysis of medical diagnosis apps, and two articles have now been published from the study. Annemarie is a sociology of diagnosis expert and we were interested in investigating how these apps represented the process of diagnosis. We drew on the perspective that apps are sociocultural artefacts that draw on and reproduce tacit norms and assumptions. We argue that from a sociological perspective, digital devices such as health and medical apps have significant implications for the ways in which the human body is understood, visualised and treated by medical practitioners and lay people alike, for the doctor-patient relationship and the practice of medicine.

In one article, published in Social Science & Medicine, we focused on self-diagnosis apps directed at lay people. We undertook a search using the terms ‘medical diagnosis’ and ‘symptom checker’ for apps that were available for download to smartphones in mid-April 2014 in the Apple App Store and Google Play. We found 35 self-diagnosis apps that claimed to diagnose across a range of conditions (we didn’t include apps directed at diagnosis of single conditions). Some have been downloaded by tens or hundreds of thousands, and the case of WebMD and iTriage Health, millions of smartphone owners.

Our analysis suggests that these apps inhabit a contested and ambiguous site of meaning and practice. The very existence of self-diagnosis apps speaks to several important dimensions of contemporary patienthood and healthcare in the context of a rapidly developing ecosystem of digital health technologies. They also participate in the quest for patient ‘engagement’ and ‘empowerment’ that is a hallmark of digital health rhetoric (or what I call ‘digital patient engagement’).

Self-diagnosis apps, like other technologies designed to give lay people the opportunity to monitor their bodies and their health states and engage with the discourses of healthism and control that pervade contemporary medicine We found that app developers combined claims to medical expertise in conjunction with appeals to algorithmic authority to promote their apps to potential users. While the developers also used appeals to patient engagement as part of their promotional efforts, these were undermined by routine disclaimers that users should seek medical advice to effect a diagnosis. While the cautions that are offered on the apps that they are for ‘entertainment purposes only’ and not designed to ‘replace a diagnosis from a medical professional’ may be added for legal reasons, they detract from the authority that the app may offer and indeed call into question why anyone should use it.

In our other article, published in the new journal Diagnosis, we directed attention at diagnosis apps that are designed for the use of medical practitioners as well as lay people. We analysed 176 such apps that we found in Google Play and the Apple App Store in December 2013. While 36 of these were directed at lay people, the remainder were for medical practitioners. The Diagnosis article mainly concentrates on the latter, given that our other article was about the self-diagnosis apps for lay people.

Our research suggests that these apps should be used with great caution by both lay people and practitioners. The lack of verifiable information provided about the evidence or expertise used to develop these apps is of major concern. The apps are of very variable quality, ranging from those that appear to have the support and input of distinguished medical experts, specialty groups or medical societies to those that offer little or nothing to support their knowledge claims. While at one end of the spectrum we can see apps as a delivery system for information which has been subject to the conventional forms of academic review, at the other extreme, we see apps developed by entrepreneurs with interests in many topics outside medicine, with little input from medical sources, or with inadequate information to ascertain what the sources might be. The lack of information provided by many app developers also raises questions about how users can determine the presence of conflicts of interest and commercial interests that might determine content.

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.


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.


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.