A few weeks ago I attended a fascinating event on the future and potential for “people driven digital health and wellbeing“. There were some fascinating conversations (these were more substantive than the presentations which were very short, lightning talks as this was an “unconference“).
Annie Cooper highlighted how in the course of managing their conditions many patients, especially people with diabetes, become data managers but currently health professionals (who may only look at data once a year) have better access to it than patients do.
In a speculative frame Tim Kelsey suggested that “machine learning” could be the most important technological development for tackling challenges and making the most of the opportunities in the context of an ageing population.
In the midst of discussions about the potential of new devices, apps and systems Shirley Ayres emphasised that a social model of health in the digital is crucial. I totally agree with this and it is this statement that really set the tone for my experience of the event.
Some of the work I heard about held real potential to integrate a social model into the digital. A project I found particularly exciting was the “Baby Buddy” app which has been developed by Alison Baum and the Best Beginnings charity. This is a phone app which provides resources on the ante and post natal process as well as systems for monitoring the health of the mother and baby but crucially social networking functions which make it easy for parents to share information with one another and offer support.
Baum framed the app as helping to ameliorate the impacts of social isolation by enabling the development of social capital (which has been found to be central to most health conditions). The potential for this app really struck me as it is one of the few health related apps which immediately seems to be able to tackle health inequalities.
I have been concerned for a while that many of the most popular and widely discussed health apps and devices (such as Fitbits) function to increase inequalities. The focus for many apps is on individual behaviour change rather than tackling the social context or structural factors which might make it more difficult for people to live healthier lives.
A lot of people at the event expressed frustration about the barriers to introducing new apps or devices into the UK health system which can be very restrictive and cautious and not very open with data. There was something of a negative attitude expressed towards the NHS no doubt born of genuine frustrations. But it did make me think about the importance of what the UK health system does well and whether these things are intricately connected with the problems people identified.
Aside from any specific successes or failures of the NHS it serves a quite remarkable function of providing a broad based material and social safety net. However, this is not just a net which catches us when we fall but also connects us to one another. I believe the NHS serves a cultural function of giving a material reality to our sense of community.
As Zygmunt Bauman (2009: 149) has suggested trust in the benefits of human solidarity is the meaning of belonging, but this trust requires a sense of an ‘imagined totality’, a ‘shared network’ which enables collective solidarity. The embodiment of this in modernity was, Bauman suggests, the social state, which was tied to the everyday reality of people’s lives through social rights and the NHS as the embodiment of the universal right to health care is a great example of this.
Any entity which achieves such a thing is likely to be big, cumbersome and slow moving. Of course a health service should not be holding back good care but the sometimes quite individualised benefits of greater data transparency or certification of new apps should not be prioritised over the social safety net.
To me the aspects of digital health which are the most exciting are those which might be able to support and perhaps expand the social safety net rather than increase individual opportunity. It seemed to me that “Baby Buddy” is an example of an innovation which might be able to make that kind of contribution.
Bauman Z (2009) The absence of society. In: Utting D (ed.) Contemporary Social Evils. Bristol: The Policy Press, 147–157.