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Self-tracking has been talked up a lot over the last few years as a potential component of e-health or m-health. It has been proposed as a tool of public health and particularly health promotion because of the ways in which it can blend in with the daily life of users. For instance, self-tracking can easily generate data on behaviour change for researchers without bothering users too much, provide automated “nudges” to users (“you’re near the park why not go for a run?”) and potentially form a feedback system to users who will respond to the “gamification” of their daily activities (by trying to beat their previous week’s step count perhaps).

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The ability of self-tracking devices to blend into everyday life and make exercise easier and more fun has been one of the big drivers for optimism in their potential. While I can see that this could be a strength I have been wondering if it might be something of an Achilles heel.

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A recent post by Catherine Will on the excellent Cost of Living Blog warned of the ways in which health promotion is in danger of turning almost all activities into health activities (this is perhaps healthicization rather than medicalization). One of the big health promotion drives of the moment is to encourage the incorporation of healthy practices into our everyday lives. The authors cited examples of older people being advised to walk while making phone calls or listening to the radio and to research family history or do crosswords to keep their brain active. While this in itself may be good advice it also means that it may become harder to associate these activities purely with enjoyment.

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In the Cost of Living Blog post another really interesting idea is highlighted. The rationale behind this approach to health promotion is effectively to trick people, or for people to trick themselves, into healthier lifestyles. The idea is that if we build exercise into our daily lives then we don’t realise we are doing it. The authors suggest this is potentially problematic as it constructs exercise and healthy activities as something undesirable that we do not want to do; a bitter pill which needs some sugar to help it go down. Furthermore, they suggest that this “make healthy easy” approach is analogous to a “liberal” model of political participation which is based on the notion that low effort will increase participation. Whereas an approach, which they align with pragmatist political philosophy, suggests that effort generates more active engagement.

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Perhaps the liberal approach to health promotion is partly the reason for what public health professionals call “low compliance” with interventions. If people are not truly invested in an activity they will probably be less likely to continue with it after the initial novelty wears off. The same might be true of self-tracking for health.

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Self-tracking apps and devices do both of the things highlighted in the cost of living blog post. They turn everyday activities into health activities (for instance by tracking steps taken or sleep patterns) and analysing them in relation to norms and standards of health and they purport to make healthy behaviour easy and less like exercise (for instance apps which “gamify” running by encouraging the user to run away from virtual zombies). While there has been a big growth in sales of self-tracking devices frequent engagement with them seems to drop off pretty steeply after a couple of months.

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It has often been suggested that the Quantified Self is somehow aligned with a kind of libertarian, “California ideology” with an emphasis on knowing oneself better through data and the valorisation of an entrepreneurial lifestyle of self-improvement. If this liberal approach to participation is indeed baked into self-tracking technology it is likely to be present in health promotion strategies as well.

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