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.

Theorising mHealth and the quantified self

I have published several posts on this blog now about mHealth and the quantified self (see them here). I have also written two scholarly publications that have been published in academic journals discussing this topic in greater depth. In the first article I looked at how theories of surveillance society and the cyborg body could be applied to understanding the use of digital health technologies as they are used for health promotion, and also discussed privacy, intimacy and ethical issues (see here for details of the first article, the full version of which is open access).

The latest article is entitled ‘Quantifying the body: monitoring, performing and measuring health in the age of mHealth technologies’, published in Critical Public Health (see here for details). It builds upon the previous article by bringing in discussion of the quantified self movement. Here is the abstract:

Mobile and wearable digital devices and related Web 2.0 apps and social media tools offer new ways of monitoring, measuring and representing the human body. They are capable of producing detailed biometric data that may be collected by individuals and then shared with others. Health promoters, like many medical and public health professionals, have been eager to seize the opportunities they perceive for using what have been dubbed ‘mHealth’ (‘mobile health’) technologies to promote the public’s health. These technologies are also increasingly used by lay people outside the professional sphere of health promotion as part of voluntary self-tracking strategies (referred to by some as ‘the quantified self’). In response to the overwhelmingly positive approach evident in the health promotion and self-tracking literature, this article adopts a critical sociological perspective to identify some of the social and cultural meanings of self-tracking practices via digital devices. Following an overview of the technologies currently available for such purposes I move on to discuss how they may contribute to concepts of health, embodiment and identity. The discussion focuses particularly on how these technologies promote techno-utopian, enhancement and healthist discourses and the privileging of the visual and the metric in representing the body via these devices.

My current research is moving from a focus on health promotion to the construction of patienthood in digital health discourses. I’m looking at how patients are being encouraged to engage in self-monitoring and self-care activities to reduce healthcare costs, and the commodification of patients’ accounts of their experiences of illness and healthcare on social media platforms designed to elicit patient opinion.

Moving attachments: our emotional relationship with mobile digital media technologies

I recently read an article by Dave Beer in which he discussed the current lack of academic research and theorising about the emotional attachments users of the new mobile media develop with their devices. I agree that there is rather a dearth of writing about the ways in which we use and relate to new mobile media. I was frustrated, for example, to read a new edited book recently entitled Digital Cultures and the Politics of Emotion that focused on the topic of affect and digital technologies and to find that none of the contributions dealt with the affective dimensions of the technologies themselves. The focus, instead, was on the content produced via the technologies (their texts and images) and how affective states were reproduced and circulated online: for example, racist, violent and misogynistic material shared via social networks. While this book certainly provided interesting material on ‘digital structures of feeling’ there was little discussion of the ways in which digital technologies themselves as material objects and their embodied use are part of these structures.

This is a subject in which I have long had an interest. I have written extensively both on the topic of emotions, selfhood and embodiment (published in my book The Emotional Self ) and on the sociology of computer technologies. In the 1990s, I penned some articles on various aspects of the affective relationship we have with what were then emphatically ‘non-mobile’ digital technologies: the chunky desktop personal computer (PC). My argument was that using these PCs we developed a relationship with them that borders on the anthropomorphic.

One such piece was an essay entitled ‘The embodied computer/user’ (Lupton, 1995), where I explored the emotions that may be evoked by the PC not working or taking over one’s life, including  frustration, hostility and fear, and the tendency for users to describe their PCs as ‘friends’, ‘work companions’ or even ‘lovers’. With Greg Noble (Lupton and Noble, 1997) I then conducted some empirical research using interviews to address the ways in which the users of desktop computers incorporated their technologies in the context of the academic workplace. Our findings showed that PC users tended to evince an ambivalent position between seeing their PCs as humanoid and resisting this. Some people gave their PCs human names, or ascribed a gender or personality to them, describing them as spiteful, sexy, grumpy, intelligent or stupid. One person remarked that she saw her PC as ‘part of me’, ‘an extension of myself’.

I am still very interested in these dimensions of digital technology use (see here for a recent journal article and here, here and here for my blog posts on mHealth technologies and the quantified self). Digital technologies now have far more of a capacity to be intimately involved in our lives. Now, more than ever, as the new digital technologies become ever more mobile and wearable, as we carry them on our bodies throughout the day or even wear them at night (in the case of self-tracking headbands with embedded sensors designed to monitor sleep patterns): indeed as some can now be swallowed or stuck upon the skin as paper-thin patches to measure bodily functions, they are becoming even more a part of us, part of our bodies as prosthetics of the self, part of our identities as they store more data about our experiences, our social relationships and encounters and our bodily functioning.

There are moments when we become aware of our dependence on technologies, or find them annoying or difficult to use, or lose interest in them. As I have remarked in an earlier post on self-tracking technologies for health purposes, some people find wearable self-tracking devices not fashionable enough, or not water-proof enough, or too clunky or heavy, or not comfortable enough to wear, or find that they get destroyed in the washing machine when the user forgets to remove them from their clothing.

A blog post by designer Jennifer Darmour made similar observations, arguing that the aesthetic dimensions of wearable technologies have been little addressed. If these technologies remain too obvious, she argues, ‘bolting’ these devices to our bodies (an unlikely Frankenstein metaphor) and therefore obviously proclaiming ourselves as cyborgs will ‘distract, disrupt, and ultimately disengage us from others, ultimately degrading our human experience’. Darmour asserts that these objects need to be designed more carefully so that they may be ‘seamlessly’ integrated into the ‘fabric of our lives’. Her suggested ways of doing this include making them look more beautiful, like jewellery (broaches, necklaces, bracelets, rings), incorporating them into fashionable garments, making them peripheral and making them meaningful: using colours or vibrations rather than numbers to display data readings from these devices.

Another blogger has remarked upon the emotions that wearing digital self-tracking devices may provoke in people. Putting on a self-tracking device makes some people feel athletic, some fashionable, others fat and self-conscious about their bodies. Others feel safer and develop a greater sense of security about having their health monitored by these devices. Here again it was noted that the design of the device – its ‘look’, its conspicuousness or lack thereof  – may be integral to how people feel when they wear it.

Researching and theorising the affective dimensions of the configuration of user/mobile device potentially brings together the literatures on affect and emotion, embodiment, actor-network theory, media and cultural studies, the anthropology of material culture, digital cultures, digital sociology, digital anthropology and social computing. One way forward is to tap into the literature on the domestication of technologies emerging from media and cultural studies. This perspective is interested in how we ‘domesticate’ or ‘appropriate’ the technologies we use: that is, incorporate them into our everyday lives. I drew upon some of this work in my earlier research described above, and think that it still has much to offer in relation to understanding our affective attachments to our new digital technologies.

The material culture literature is also relevant to understanding how things in our lives are appropriated, incorporated and domesticated, how meaning and significance is invested in objects, and what the affective dimensions of this may be (see, for example, Miller’s The Comfort of Things and Turkle’s Evocative Objects, and my chapter on ‘emotion, things and places’ in The Emotional Self). So too, the work of Bourdieu, particularly his writings on the habitus, or the habitual practices of everyday life as they contribute to embodiment and subjectivity, may usefully be applied to understanding the interaction of bodies/selves with technologies. The actor-network approach to theorising the ways in which material objects join with fleshly bodies, other people’s bodies, other living things, ideas and practices to configure dynamic assemblages can potentially contribute to theorising and researching the affective dimensions of digital object use.

Computer science is well ahead of sociology when it comes to exploring what is termed in that field ‘social computing’ or ‘human-computer interaction’. The focus for computer scientists is in recognising that users interact with computerised technologies in often emotional ways (sometimes described as the subfield of ‘affective computing’), and to incorporate that recognition into designing systems and technologies that are accepted by users as useful, meaningful and a positive rather than frustrating experience.

Much remains to be explored, including the following questions: What does it feel like to carry, wear and use a mobile digital device? How much does their appearance and size matter? How are these devices incorporated into the habits and practices of everyday life (the habitus)? What are the practices of appropriation? How are they resisted? How do these devices configure users’ bodies and sense of selfhood and what are the emotional dimensions of this? What are the enabling and constraining aspects of their use? How do users adjust to giving up one device for another? How do they feel if the technology stops working? What are the interactions between the feelings configured and circulated via the texts and images produced by these devices and the physical material objects themselves?

References

Lupton, D. (1995) The embodied computer/user. Body & Society, 1(3/4), 97—112.

Lupton, D. and Noble, G. (1997) Just a machine? Dehumanizing strategies in personal computer use. Body & Society, 3(2), 83—101.

Living the quantified self: the realities of self-tracking for health

The end of 2012 and the dawning of a new year brought with it a multitude of news reports and blogs on the phenomenon of the quantified self or using self-tracking tools for health promoting purposes. Much hype has been generated around ‘digital health’ or ‘mHealth’ technologies, or mobile digital devices such as smartphones and wearable materials with embedded sensors that are able to connect to device apps or websites and download the data collected. These technologies include thousands of health-related apps for smartphones, tablet computers and iPods that can keep track of the user’s food and alcohol consumption, physical activity, body weight, ovulation cycle, stress levels, mood, sexual activity and many other physical functions and habits. It has been argued that by using such apps the smartphone can become a ‘”soulmate device” that knows your body better than you know it yourself’.

There are also an increasing number of specifically designed devices such as the Fitbit, Jawbone’s Up, Nike Fuelband and Zeo headband and various brands of adhesive patches that are available for self-tracking. All of these are designed to be worn upon the body to automatically collect data on bodily functions such as physical activity, pulse, heart rate, body temperature, calories burned and sleep patterns. Some can be worn 24 hours a day to provide constant readings of biometrics. Digital body weight scales, blood oxygen saturation monitors and blood pressure monitors that link to smartphones are also on the market. To motivate users, some devices include ‘gamification’ strategies. These use built-in reward or docking systems so that points or real money can be collected or paid if various commitments (to regular exercise or weight loss goals, for example) are either met or unmet, as well as websites where one’s metrics can be compared competitively against those uploaded by other users.

Nike+ FuelBand

Nike+ FuelBand (Photo credit: LoKan Sardari)

The combination of New Year resolutions season, predictions for digital innovation in 2013 and the reporting of the new technologies that were showcased at the 2013 Consumer Electronics Show in Las Vegas has contributed to the recent intensified focus on self-tracking for health reasons. Self-tracking mobile devices, apps and gadgets were reported as the new way of ensuring resolutions to lose weight or engage in more exercise would be accomplished (see here and here). They were frequently mentioned in lists of trends to watch in digital health technologies in 2013 (see here and here). Weird and wonderful devices such as self-tracking devices for dogs to wear to monitor their exercise levels, smartphones that could detect bad breath and other odours and a ‘smart fork’ embedded with sensors that could warn people they were eating too fast all received media attention in the early days of 2013.

I have written elsewhere about the ways in which self-tracking for health and the quantified self movement may be theorised sociologically, drawing attention to some of the ethical, moral and political issues (see here and here for previous blog posts on the topic and here for a lengthy academic article). Little academic research has yet been published on how people are taking up this approach to health promotion as part of their everyday lives. But accounts are beginning to appear in news stories and blog posts that have begun to explore the lived experience of self-tracking.

On the positive side, several self-trackers have reported that they feel more in control of their health using digital devices and have argued that there are many benefits to quantifying the self. Many people have discovered that tracking of their food intake and body weight has allowed them to achieve weight-loss goals. One success story is that of Dan Hon, who has type 2 diabetes and uses the Nike Fuelband and the Fitbit to monitor his physical activity levels as well as a digital blood glucose meter and weight scales. He reported that the combination of these technologies had allowed him to reduce his blood sugar levels to normal and that he had ‘healed myself through data’ (see here for his story). Another user experiencing problems with sleep used a Zeo headband to track his sleep patterns and experimented with taking magnesium supplements, giving up caffeine and changing the lighting in his room to see which of these factors affected his sleep. Using the data downloaded from the headband he eventually worked out how to best achieve a good night’s sleep. Other people with a diverse range of health problems have used self-tracking devices to monitor medical treatments for acute diseases or chronic conditions, evaluate the moods created by eating certain foods, track their alcohol consumption  and many more aspects of their bodily functions, health and illness states. Patients have also been able to ‘crowdsource’ the data they have collected on websites such as PatientsLikeMe and CureTogether, allowing the massing of data for a better understanding of what treatments are effective (see here and here for overviews).

Image representing PatientsLikeMe as depicted ...

Image via CrunchBase

Also beginning to emerge are accounts by people who have tried self-tracking for health reasons but have become disenchanted with the practice. As these stories demonstrate, the realities of quantifying the self do not always meet expectations. The devices do not share data with each other, so it is impossible to track different activities using more than one device and then produce statistics that combine the data collected. Some users find them inconvenient or uncomfortable to wear. Some people quickly become bored with the effort involved in self-tracking. It has been reported that the devices are often not compatible with some types of smartphones.

Other users who have tried self-tracking for health have suggested that the intense focus on the body that these devices encourage may place too much pressure on oneself, leading to feelings of failure and self-hatred. It has been argued that intense self-tracking may cause ‘cyberchondria’, leading to people becoming unduly anxious about their health state based on the data they collect. Devices may be used by people such as anorexics to facilitate health-destructive behaviours by engaging in too much obsessive self-tracking. Activities such as walking may become viewed through the lens of the self-tracking device rather than for the other pleasures they may bring, as one commentator wrote of his experiences using a Fitbit while visiting Paris. As he noted, ‘the data mind is hard to shake’, even while immersed in the sights and sounds of one of the most celebrated cities in the world.

Privacy issues are a concern as more and more data are collected by self-trackers. The manufacturers of self-tracking devices are beginning to approach workplaces as a site for encouraging people to use them and compete against each other. There are concerns that people may feel pressured into using them to meet employers’ expectations and that employers may use the data. Other critics have questioned what may happen if health insurance companies begin to expect their clients to use the devices if they wish to avoid higher premiums (see here for an account of these issues). The quality and efficacy of health apps and their potential for harming rather than promoting users’ health have also been questioned, given that they are currently not regulated (see here).

Using digital devices to self-track for health reasons is a very new phenomenon. While stories such as those referred to above are beginning to identify both positive and negative dimensions, it is a practice that still requires much more investigation and analysis in the face of all the hype.

The quantified self movement: some sociological perspectives

Today's Track Workout

Today’s Track Workout (Photo credit: nocklebeast)

The concepts of ‘self-tracking’ and the ‘quantified self’ have recently begun to emerge in discussions of how best to optimise one’s life. These concepts refer to the practice of gathering data about oneself on a regular basis and then recording and analysing the data to produce statistics and graphs relating to one’s bodily functions, diet, illness symptoms, appearance, social encounters, phone calls, work output, computer use, mood and many more aspects of everyday life.

The advent of digital technologies able to assist in the collecting, measuring, computation and display of these data has been vitally important in promoting the cause of the self-tracking movement. While people have been able to monitor and measure aspects of their bodies and selves using non-digital technologies for centuries, mobile digital devices connected to the internet have facilitated the ever more detailed measurement and monitoring of the body and everyday life in real time and the analysis, presentation and sharing of these data.

These technologies include not only digital cameras, smartphones and tablet computers, but also wearable wristbands, headbands or patches with digital technologies embedded in their fabric able to measure bodily functions or movement and upload data wirelessly. Tiny sensors can also be incorporated into everyday items such as toothbrushes, pyjamas or watering cans to measure such activities. Blood pressure cuffs and body weight scales can be purchased that connect wirelessly to apps. Global positioning devices and accelerometers in mobile devices provide spatial location and quantify movement. Apps that regularly ask users to document their mood can monitor affective states. There seems hardly a limit to the ways in which one’s daily activities can be monitored, measured and quantified. Some committed self-trackers even regularly send stool and blood samples for analysis and use commercially available genetic tests as part of their efforts to construct a detailed map of their bodily functions and wellbeing.

While the concept of self-tracking is not particularly new, the term the ‘quantified self’ (QS) to represent a social movement facilitated by digital technologies is novel. The QS movement was first developed by two Wired Magazine editors, who set up a website devoted to the movement in 2008, and thus began as a technologically-informed phenomenon. According to the Wikipedia definition ‘The Quantified Self is a movement to incorporate technology into data acquisition on aspects of a person’s daily life in terms of inputs (e.g. food consumed, quality of surrounding air), states (e.g. mood, arousal, blood oxygen levels), and performance (mental and physical)’ . This definition immediately begins to construct a view of the body/self as a machine-like entity, with ‘inputs’ and ‘outputs’ (glossed as ‘performance’ in the definition) that can readily be measured and quantified.

How might the QS movement be interpreted through a sociological lens? One way of analysing the phenomenon is via the theoretical perspectives offered by the ‘risk society’ thesis developed by Ulrich Beck (1992). In a world in which risks and threats appear to be ever-present, the certainties promised by the intense self-monitoring of the ‘self-tracker’ may be interpreted as a means of attempting to contain risk, to control the vagaries of fate to some extent. Beck describes the concept of self-reflexivity, or seeking information and making choices about one’s life in a context in which traditional patterns and frameworks that once structured the life course have largely dissolved. Self-tracking represents the apotheosis of self-reflexivity in its intense focus on the self and using data about the self to make choices about future behaviours. In relation to health matters, self-tracking offers users of such technologies a strategy by which they feel as if they can gather data upon their health indicators as a means of avoiding illness and disease. The self-knowledge that is viewed as emerging from the minutiae of data recording a myriad of aspects of the body is a psychological salve to the fear of bodily degeneration. As one self-tracker has noted, his tracking efforts have ‘made me believe I had more power over my health than I thought’.

Another perspective that may be adopted is that drawing on the philosophy of Michel Foucault. Foucault’s writings on the practices and technologies of the self in neoliberalism are pertinent to understanding the QS as a particular mode of governing the self. Self-tracking may viewed as one of many heterogeneous strategies and discourses that position the neoliberal self as a responsible citizen, willing and able to take care of her or his self-interest and welfare. As Foucault and others using his work have noted, neoliberalism promotes the concept of the citizen who needs no coercion to behave productively and in the interests of the state. Rather, the citizen voluntarily takes up modes of practice that both achieves self-interest and conforms to state objectives (see Lupton, 1995, for this perspective applied to public health).

The QS movement takes up and interprets a view of the body/self that positions it as amenable to improvement, an object of persona enterprise and work. Here an integral source of knowledge is that offered by metrics. The statistical aspect of the practice of self-tracking – the ability to produce ‘numbers’ measuring aspects of one’s life – is integral to the approach. It is assumed that the production of such hard/objective data is the best way of assessing and representing the value of one’s life and that better ‘self-knowledge’ will result: tellingly, the QS official website has as its motto ‘self knowledge through numbers’. The implication of this motto is that ‘self-knowledge’ as it accomplished via self-tracking and the production of ‘numbers’ is a worthy goal for individuals to aspire to. The more we know about ourselves and our bodies, the more productive, wealthier, wiser, healthier, emotionally stable and so on we can be.

The lure of ‘numbers’ is that they appear scientifically neutral and exact. The body/self as it is produced through QS, therefore, is both subject and product of scientific measurement and interpretation. Using self-tracking facilitated by digital technologies encourages people to think about their bodies and their selves in different ways; through numbers and as the product of computerised technologies. Such a transformation extends further the move from the haptic (touch sensations) to the optic or visual understanding of the body/self within medicine, as well as the increasing focus on the metric as a valued source of knowledge in many other aspects of social life. As one’s bodily states and functions become ever more recordable and visualised via data displays, it becomes easier to trust the ‘numbers’ over physical sensations.

As recent sociological analyses into questions of measure and value have argued, there has been a huge increase generally into the use of metrics in many aspects of social life, which has been greatly impelled by the development of technologies for achieving quantification (Adkins and Lury 2012). Yet there is a politics of measurement: numbers are not neutral, despite the accepted concept of them as devoid of value judgements, assumptions and meanings. The ways in which phenomena are quantified and interpreted and the purposes to which these measurements are put are always implicated in social relationships, power dynamics and ways of seeing.

The surveillance society literature (for example, Lyon, 2007) might interpret the QS movement somewhat differently. According to this literature, in the surveillance society, digital technologies are increasingly monitoring and measuring individuals, whether this is achieved via the closed circuit television cameras that have become ubiquitous in public spaces, the loyalty cards offered by businesses or the mobile digital technologies one can now carry or wear upon one’s body. Much of the surveillance society literature has focused on the ways in which others use the data they collect on individuals using digital technologies for security or business reasons. What remains to be fully explored is how the data that are collected voluntarily by an individual using such approaches as self-tracking (in other words, self-surveillance or participatory surveillance) are used by that person for her or his own purposes (Lupton, 2012).

The latest self-tracking technologies allow people to broadcast their ‘numbers’ to many others via social media tools such as Facebook and Twitter. Self-surveillance here moves from an inner-directed preoccupation with the body/self to a performative mode, inviting further scrutiny from one’s friends and followers. Social media tools and other digital platforms also allow people to collate their self-gathered data with others interested in the same phenomenon, or compare their data against others’ data. Indeed at least one multinational workplace has already instituted a competition requiring participating employees to upload and display to all other workmates data they have collected on their bodily movements and weight loss using self-tracking devices as part of efforts to motivate them to achieve higher fitness levels.

Approaches from postphenomenology developed in science and technology studies and philosophy offer a theoretical approach to think about the ways in which humans interact with their technologies (see, for example, Ihde, 2009). These perspectives address such issues as the ontological nature of the human/technology interaction, the ways in which technologies are incorporated into concepts of embodiment and selfhood and how they extend or enhance these and how social relations are configured through, with and by technologies. For this theoretical position it is difficult, if not impossible, to separate technology from its user, as both are viewed as mutually constituted. Research questions focus on how the user/technology assemblage is configured, and how this assemblage views itself and interacts with other human and non-human actors or assemblages. There are complex ontological issues here in relation to the ways in which the human/technology assemblage is constructed and reconstructed.

Little specific academic research has been published that has specifically addressed the QS movement thus far, as it is such a new phenomenon (although for some interesting blog posts that have begun to explore some of these issues see my Scoop.it collection The Sociology of the Quantified Self). Yet from a sociological perspective a number of interesting questions about the quest to achieve ‘self-knowledge through numbers’ arise, including the following: What types of people are attracted to self-tracking? How do they use the data they produce? How are concepts of the body, self, social relationships, health and happiness both configured and negotiated via these data? How do members of their social networks respond to the sharing of data produced through this self-surveillance? How do self-trackers’ doctors or therapists make use of the data they produce? What the implications of shared data derived from self-tracking for patient empowerment? How does the digital device construct reality for its user, how it is incorporated into the routines of everyday life, how does it shape social encounters, how does it present users to others and to themselves? There is much more here to investigate in relation to the attempt to achieve ‘self-knowledge through numbers’.

References

Adkins, L. and Lury, C. (2012) Introduction: special measures. The Sociological Review, 59(s2), 5—23.

Beck, U. (1992) Risk Society: Towards a New Modernity. London: Sage.

Ihde, D. (2009) Postphenomenology and Technoscience. New York: State University of New York.

Lupton, D. (1995) The Imperative of Health: Public Health and the Regulated Body. London: Sage.

Lupton, D. (2012) M-health and health promotion: the digital cyborg and surveillance society. Social Theory & Health, 10, 229–44.

Lyon, D. (2007) Surveillance Studies: An Overview. Cambridge: Polity Press.

The new mobile digital technologies, health and the body

I’ve just had an article accepted in the journal Social Theory & Health (see link below). It looks at the phenomenon of ‘m-health’, or the use of mobile digital devices such as smartphones and tablet computers to promote health. There are now a plethora of apps available for downloading onto these devices that measure and monitor aspects of the user’s health: blood pressure and heart rate, ovulation, hearing function, body mass index (BMI), adherence to a medication regime, alcohol and cigarette intake, diet, sleep quality and length, exercise frequency and level and other bodily functions and activities can all be monitored using such apps. Apple has produced technologies and apps that allow users to hook up a blood pressure monitor or a set of scales to their mobile devices to record blood pressure and weight, produce tables and readouts of these and compare daily (or hourly) fluctuations. These data can then be shared with other people via social media, so that friends or followers may keep a close eye on how many kilometres a user has run that week, what her or his heart rate was for each run, how the user’s weight has changed (or not), what kind of diet they have consumed, whether they have stuck to their medication and so on.

Many of these apps are produced by commercial developers. However health promoters are beginning to see their potential and to consider and adopt the capabilities of mobile digital devices to individualise and target health promotion messages so as to change people’s behaviour. As one writer argued in a recent blog post on the use of messaging for public health objectives, such apps can be used to ‘become a “personal health coach”‘ to remind people to takeup health-related behaviours.

The use of mobile digital devices in health promotion endeavours represents a significant shift in the methods of health promotion. Health promotion has traditionally been a low tech area of public health in comparison with the vast array of medical technologies used in the clinical setting. The primary use of technology in health promotion has tended to be in employing communication media to disseminate illness-prevention messages to a wide audience. Health promotion has borrowed extensively from commercially-oriented social marketing, advertising and public relations approaches and methods to do so. These industries are now embracing social media and mobile devices as part of their publicising efforts. Here again, therefore, health promotion can be seen to be taking the lead from commercial enterprises which are directed at marking and selling commodities.

Writers from medical and health promotion backgrounds about the new social media and mobile devices tend to confine themselves in their discussions to describing how these technologies could be most effectively used as tools in their efforts to help people deal with medical conditions or improve their general health and wellbeing. From a sociological perspective, a more critical analysis may be undertaken of how these technologies may operate to construct various forms of identities and ways of experiencing and viewing one’s body. This analysis includes identifying the kinds of assumptions that are made about the target of these technologies and what the moral and ethical ramifications of using them may be. Moral implications include the kinds of meanings and the representation of the ideal subject that are related to the use of these technologies in the interests of promoting health. Ethical issues include questioning the extent to which health promotion practice should intrude into their targeted populations’ private lives and what kinds of messages and practices they employ when using digital surveillance devices. The article addresses these and other issues, drawing upon a range of social and cultural theory to do so.

I argue that m-health technologies produce a digital cyborg body. They are able to act not only as prostheses but also as interpreters of the body. The subject produced through the use of m-health technologies is constructed as both an object of surveillance and persuasion and as a responsible citizen who is willing and able to act on the health imperatives issuing forth from the technologies and to present their body/self as open to continual measurement and assessment. The implications of this new way of monitoring and regulating health have yet to be fully explored. These include privacy issues, questions about the intrusion of health promotion even more insistently into everyday lives and the possible ways in which concepts of ‘health’ might be reconfigured via the use of these new technologies.

References

Lupton, D. (in press) M-health and health promotion: the digital cyborg and surveillance society. Social Theory & Health. Advance online pre-publication details are here.

See my pinterest board on ‘M-health and the Digital Cyborg‘ for images related to this topic.