Networked Society On The Brink.
With respect to healthcare, the next decade holds four inevitabilities:
- People, on average, wil get unhealthier and we will see increased rates of obesity, diabetes and death through lifestyle-related disease.
- The healthcare system will become less efficient as the boomers start to use up a greater proportion of healthcare resources. In the US, 25% of all Medicare spending is for the 5% of patients who are in their final year of life so as our parents’s generation starts moving into that phase of their lives, there will be an unprecedented drain on healthcare resources.
- Governments will not be able to repair this inefficiency meaning the onus will shift back on to the individual to manage and improve their own health.
- As the onus shifts back on to the individual, digital tools will become the primary means of individual healthcare management.
Within that context, many new business are emerging to provide digital health solutions.
Companies like Redbrick Health, Bloom Health, Limeade and others are engaging employees in health programs. One of my favourite products in the space, Runkeeper is building a Health Graph to aggregate all this new data in one place. Buster and Jen are building Health Month and bud.ge to help people change their behaviour for the better. Before he went and built Facebook’s new timeline, Nicholas Felton was helping people to beautify their data with Daytum. Massive Health just released The Eatery to get people eating healthier. Daily Feats are inspiring healthy behaviour through rewards and community support. Withings, Fitbit and Zeo have been leading the charge for #quantifiedselfers for a couple of years now.
And last week UP was released by the Jawbone team, allowing you to track all your data, all day in style.
The video above is a promo-piece from Ericsson, and it includes comments by Wired UK’s editor David Rowan identifying the power of sensors to change people’s health. With Wired Magazine fully bought in, this is a trend that is likely to take off in the mainstream media.
However, there’s some fundamental things that the hype is going to miss.
In a vacuum, your health data doesn’t change anything.
Data is just knowledge, which is a weak lever for behaviour change. If you have decided to make a change to your health, data will help, but it is just one helpful option among many.
Data doesn’t change your environment. It doesn’t give you a genuine social driver for change. It doesn’t strengthen your willpower. It doesn’t create a meaningful stick to make the change. And it doesn’t give you a clear path to achieve your goal.
My friend, let’s call him Johnny, had his first child recently. Johnny was 15kg overweight at the time but realised immediately he needed to protect his daughter’s future by taking better care of himself. And so, he set himself an end of year goal to lose the weight. Using meticulous data-tracking, he did and as a result, he’s a cheerleader for this new movement. However, a year later, after returning to life-as normal (or as normal as it can be with a baby daughter), he put the weight back on.
Occasionally he steps on to his Withings scale, but he knows he’s overweight, he doesn’t need to be auto-Tweeting it. He wants to start tracking his meals again, but he’s done that already and it doesn’t hold the same novelty it once did.
Data’s value decreases over time.
The same datapoint, whether it’s weight or sleep or stress, sent to you over and over eventually just piles up until it’s as meaningless as an inbox with 497 unread emails or a Google Reader with 1397 unread articles.
I have a friend who is bipolar. He meticulously tracks his mood so as to be aware of signals that he may be entering a high or low swing. This strategy was recommended to him by his doctor. The issue is, at the very point he most needs to input the data, just as his mood is plummeting or sky-rocketing, it’s already too late.
Just as taking photos of your food or counting your steps or measuring your heart rate may have some novelty value at first, at the very point you most need data it will desert you.
Because data is you. It relies on you for its value. And when you’re doing the wrong thing, you know it without needing the data point to back you up. In Mint’s early days, the biggest challenge they faced wasn’t getting people to trust them, it was getting people to log in when they knew their account balances weren’t going to tell a happy story.
This is data’s great challenge. Becoming something more than just an unread email. Becoming useful at the point it’s most needed.
When I walk around my neighbourhood on weekends, there’s often stoop sales happening. Almost without fail, in the pile of unsold items lies a fitness relic of some sort – Tae-bo videos, thighmasters, ab-crunchers. None of the people selling these relics look as though they ever gave them much use.
Health data is one crucial piece of the puzzle. But if we’re pinning all our hopes on it, then we’re likely to be disappointed. Healthy behaviour changes is a mixture of many elements, data being just one. If we miss this point, then health-data tools could end up like the stoop sale relics. Unused, still-new and full of false promise.
{ 11 comments… read them below or add one }
Everyone avoids difficult conversations. Those who are successful (not quite the word I’m looking for) lean into the pain of a difficult conversation to reap the benefits on the other side – negotiating with a colleague or boss, challenging a housemate… easily avoided but to no benefit.
Health data or financial data and other things you’re referring to are another form of that difficult conversation – but this is a conversation with ourselves, so even more easy to avoid.
My difficult conversations on a daily basis are: Sarah when you FIRST wake up, get up (don’t snooze), Sarah don’t eat that sugar, Sarah get off the internet and go to bed.
There’s no silver bullet that’ll replace discipline and persistence.
I also have bipolar and for me, tracking my moods and having that data is part of the holy trinity of MUSTS that I need to do to stay well. (Sleep and medication are the other two).
I use http://www.moodtracker.com for this purpose – mostly because my handwriting is dreadful, but also because it takes the data and graphs it.
I’ve got nearly 18 months of data recorded using that site, and being able to look at a graph and see my mood AND the things that might be affecting it (work problems, period, social life, caffeine/alcohol/prescription meds intake) is incredibly valuable.
For mood diaries to work though, you do have to be brutally honest with yourself and I suppose this is your point.
The signs before an episode of mania and hypomania don’t change and for me, having graphical representations of my mood makes it easier to go, “well, the last time you slept 4 hours in 2 days and realised you knew how to fix your hometown’s racism and you wanted to have sex with everyone… you were about to go manic. I know this is fun, but it’s time to ring your doctor.”
@Sarah – I like the way you put that.
@Sophie – Thank you for sharing. The more I understand of bipolar, the more I realise how little is known of it – your ‘holy trinity’ description is really interesting. Appreciate the honesty.
Insightful post Nick, thanks for sharing. I used a fitbit for a little while and agree that it more tracks what you’re doing anyway, rather than provides a place to change behavior too much.
I’m enjoying the thinking. Keep it up
@Steve – Thanks for the insight. That’s been my experience too.
I wholeheartedly agree with your assessment that “In a vacuum, your health data doesn’t change anything”. The apps you mentioned have tried to make it less of a vacuum by creating social networks around tracking data and they’ve tried to incentivise positive change through rewards, badges, etc. Their efforts have worked to a certain extent but ultimately, it comes back to individual responsibility. Even in this system, we must be our own change agents. Motivational web apps are not the panacea for our health problems. They can’t be, as long as we have the power to turn them off and tune them out.
I think one solution lies in a more holistic approach. I’m talking about a collaboration, not just between me and my friend who is also trying to eat more vegetables or exercise daily and the smartphone app we’re tracking our progress through, but between me, and my doctor who’s concerned about my long term health, and the insurance company who can offer incentives for positive lifestyle changes. As a web developer, I love the technology that’s come out of the quest for better health. Heck, I watched your “Floss the teeth you want to keep” TED talk and my first 2 thoughts were 1. “I’m going to change” and 2.”I’m going to build a web app that tracks my changes”. But I think where many missed the mark is that they’ve created yet another separate channel that my brain has to tune into. Now I’m responsible for exercising AND for logging in somewhere to note that I’ve exercised. They’ve created another context within which to manage health. A more successful (albeit more difficult) approach might be to put in the context of what I’m already doing for my health and to make me accountable to the people and organizations who have a stake in my health. That might create the “social driver for change” that you’re looking for.
@Sima – Thanks for the comment. I like your holistic approach and agree with it. Data is one part of that mix – a really important one – but alone, can’t solve everything.
I guess the thing is there is plenty of information out there about bipolar, but not many useful personal accounts.
There are plenty of high drama blogs and articles and unfortunately, many news stories were people “go bipolar” and kill their loved ones, which is sad.
One of the best things I’ve read on and about bipolar is a memior called “An Unquiet Mind” by Kay Redfield Jamison. Jamison is a psychologist specialising in mood disorders, while also having bipolar herself.
It was first published in 1993 and pretty groundbreaking for public perception of the illness.
I guess the thing is – there is plenty of information out there about bipolar, but not many useful personal accounts.
There are plenty of high drama blogs and articles and unfortunately, many news stories were people “go bipolar” and kill their loved ones, which is sad.
One of the best things I’ve read on and about bipolar is a memior called “An Unquiet Mind” by Kay Redfield Jamison. Jamison is a psychologist specialising in mood disorders, while also having bipolar herself.
It was first published in 1993 and pretty groundbreaking for public perception of the illness.
I agree with a lot of what has been said in this post and in the comments. I’ve found it useful to track what I eat daily (even though I didn’t during the majority of my weight loss phase) and have tried almost all the applications listed by Nick. I still use some (Loseit, Runkeeper/Dailymile) on a regular basis but I think the issue is two fold: lots of people aren’t solving the big data problems still and what happens when you no longer want to play the game.
Runkeeper and Loseit have a TON of my information and I’d love to combine them for example. Runkeeper’s step in the right direction with their HealthGraph is great and I’ve been toying with that a bit. I’d love, for example, my running performance to be immediately correlated to my diet.
But for things like The Eatery and HealthMonth, the problem to be solved is how to keep the novelties of the game from either wearing out or allowing those novelties to transform into useful habits. At some point, badges aren’t that useful to me anymore. So how do we keep these apps that rely on game mechanics to still hold useful value after the first month, second month, first year, and throughout your life? Thats the biggest question to be answered.
This article and some of the comments here match my sentiments towards this field. I think when you have technologists working on a field like healthcare, you get a lot of swings and misses. This is because technologists (I’m one too) love to work with data and presenting it in cool ways. However, it’s all for naught if the principles(science, psychology, culture, etc) behind them don’t work. Innovation happens because of principles, not implementation.
Building a pedometer or a social network around health is easy. But finding the principles behind what can lead to massive change is the hard part. That’s the secret sauce. Not badges, or more accurate self tracking, or beautiful visualization. We need to nail down the principles and then create a framework around them. Not the other way around.. we can’t take something that sounds cool, and intriguing, and force it to solve healthcare problems.
@Kyle
I think a lot of people obsess over game mechanics, but they’re moving towards the wrong direction. Game mechanics wrong because some of the psychology behind them works towards behavioral change. But it has nothing to do with games… Games just use the same psychology. Games are the trees. The psychology is the forest. People need to learn what psychological principles out there can be used in conjunction with technology to spur change. I agree with the comment that a solution needs to be holistic in nature. What we’re fighting against is 100,000 years of evolution. At the core, what is needed is a way to re-wire neural connections, and create new responses to food, and laziness. But in the 2nd level are also tools like NLP (neuro-linguistic programming) and instilling internal/identity change to people. Too much focus on extrinsic influence, not enough on internal.
There’s a lot of possibilities. I recommend entrepreneurs looking to do damage at this field look at the research being done in the area of drug addictions. Stop thinking so narrowly and focus on something specific like quantified self, or gamification. The problem is much more vast, and interesting than that.