I am organising an event called Digital Health/Digital Capitalism on 4th July 2016 at Leeds Beckett University the call for papers for which closes on 15th February. In the CfP I have tried to outline some of the issues which might be addressed on the day but of course what is actually on the agenda will be determined by the speakers and delegates. In this post I will try to outline how I understand the central concepts of digital health and digital capitalism and what it is that I find interesting about the ways in which they are coming together.
What is digital health?
Digital data and technologies are having a significant impact on how health is experienced, treated and managed on an individual, group and population level. For many people who experience a potential symptom of ill health or decide that they want to prevent a future illness the first thing they do is go to Google. In their search for a strategy to deal with their insomnia or tightening jeans they don’t ask their mum or their best friend but the algorithmic oracles of Google. How alarmed people interpret their own bodies and the strategies they take to manage them are therefore significantly influenced by whatever results Google decided to put at the top of the results, or at least on the first page (only 8% of people ever look beyond the first page).
Others might need more specialist help and consult sites such as patientslikeme on which people upload data on their conditions in the hope of aiding research. Other sites such as CrowdMed allow people post their symptoms and a price they will pay for advice and clinicians offer up their prognosis in the hope of claiming the fee. Some people seem to get diagnoses with miraculous results when they had struggled to get any recognition of their symptoms through traditional means although there seems to also be the possibility of serious misdiagnosis.
The informal interactions of medics, as with any profession, help to shape the culture in which they make decisions and how they think about their responsibilities and patients. These interactions are now often taking place through digital means such as the app Figure1 which serves as a kind of Instagram for doctors. It enables them to share images of symptoms or scans and get advice from their community as well as just laugh and make jokes about disgusting things they have seen; like they probably do in their staff rooms or at the pub after work.
Digital technologies are helping to reshape the structures of support in broad terms. For instance, systems of support (sometimes referred to as telecare and telehealth) have been implemented for a long time which are designed to enable vulnerable people to live on their own but be monitored in case they need help. For instance, some older people will be provided with sensors to detect if they have fallen over in which case they will be contacted or a paramedic notified. But these it can be questioned to what extent care can be delivered through such dispersed networks.
Self-tracking devices and smart phone apps have made it easier than ever to monitor and analyse our bodies, health and exercise and I am particularly interested in the ways in which digital self-tracking is enabling (and possibly encouraging) new ways of accumulating, aggregating and disaggregating individuals and populations and in the process making connections between the intimacies of peoples’ everyday lives and the machinations of capitalism. I have previously written about how self-tracking may be transforming the meaning of exercise and exercising bodies.
What is digital capitalism?
The journalist John Naughton wrote:
Need a crash course in digital capitalism? Easy: you just need to understand four concepts – margins, volume, inequality and employment. And if you need more detail, just add the following adjectives: thin, vast, huge and poor.
The more cynical (such as Naughton) believe that digital technologies and economic structures create inequalities through narrow profit margins and precarious labour practices. Alternatively, Paul Mason proposes that these structural imbalances are caused by neo-liberal capitalism and that the sharing and labour saving possibilities of digital technologies provide a radical challenge to the existing economic structures.
Regardless of whether you think that digital technologies encourage or discourse inequalities it is probably uncontroversial to propose that they are changing our experience of everyday life. Judy Wacjman has suggested that email, smartphones and other digital innovations have contributed to a perception of life as accelerated (and increasingly so). Such technologies rather than saving us work and time increase the expectations we have of ourselves and others and what we should be able to achieve in a day. Wacjman stresses, however, that this is the result of how we design the technologies and what aspects of their functioning we prioritise rather than an inevitable outcome.
The debt-ridden economies and related inequalities that have developed over the last three decades (and the resulting health problems) in many countries have often been linked with the financial deregulation which was implemented around 1980 and enabled the growth of London and other cities as financial centres. However, scholars such as Saskia Sassen have discussed how digitized and decentralized networks have been crucial in enabling the widespread use of financial instruments that have helped to speed up markets and create economic uncertainty. The sale of derivatives on the current scale has only been made possible through the computer programmes and digital networks.
José Van Dijk has suggested that the current iteration of the internet is not structured around open networks but heavily controlled platforms such as Facebook or Twitter. The version of the internet which most people experience is one which is heavily mediated and controlled. One of the core functions of this platform society is not just to enable people to connect but to package types of people to advertisers. I have previously written about how this intersects with the medical world through the increasingly popular social networking sites for medical doctors such as Sermo and doctors.net.uk who sell their credibility as trusted spaces for doctors discuss issues to pharmaceutical companies who wish to target medical professionals.
Some scholars have tried to capture the impact of recent technological developments through the concept of “digital labour” which I have previously summarised as the ways in which:
“we have been successfully convinced that the productive activities in which we engage online are not work but a form of leisure or self-realisation despite the fact that they collectively produce vast amounts of wealth for some people (for more on this notion which has been called ‘playbour’ see Beer and Burrows (2013) [paywalled] or here). This can be seen as being the ultimate triumph of capitalism; an ideological framework which has the workers so successfully indoctrinated that even they do not think that they deserve to be paid anything at all. Furthermore, this has occurred in times of increasing austerity, job insecurity and suppression of wages”
The blurring of the separation between work and leisure and the extraction of profit from non-work activities without pay is perhaps present in the self-tracking of exercise through devices such as Fitbit as I have previously claimed. It was my suggestion that companies are making money out of the data people generate through walking, running or cycling and that this is given away free. A potential outcome of this is that these kinds of activities (if considered to be generators of values) might come to be rethought as “labour”. My assertion is perhaps supported by the recent emergence of apps such as bitwalking which actually pay people in bitcoins or the amount of steps they take.
These are just some of the issues which I find interesting related to these topics and I am sure that they speakers at the event in July will bring insights, empirical observations and analytical approaches which have never occurred to me.
If you are interested in presenting a paper at the Digital Health/Digital Capitalism event then please get in touch c.till@leedsbeckett.ac.uk
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