From a Culture of Apps to a Culture of Health

Friday, March 25, 2016

Health trackers and apps are all the rage. Or so it seems, especially if you are in certain parts of the United States. A certain segment of the population does want to have its own private health and behavior trackers. They put their personal lives (biometrics, activity, behavior, etc.) into these trackers and out comes data. Hopefully, they will also have optimal access to their own data though they don't for now. (Also, for now, we will set aside the discussion on what is “optimal.”) Some will want the data as is, others might want to convert that data into information products, do that themselves or get help from others, and still others might even want to sell access to their personal data to those who would aggregate data from many users and do something else with it.

Rachel Kalmar describes¹ the current state of self-quantification like so

I like to compare all of these devices to mills, creating flour. Just as some people have questions they want to ask with data, or like experimenting with different recipes, most people don’t bake. Instead of flour, most people want cookies.

That we don’t yet know how to turn flour into cookies is less a criticism of the field, and more a reflection that we’re still in the early days here. We’re all prototyping, and eventually we’ll have not just cookies and breads and baked goods, but also bakeries, restaurants, catering companies, national chains, boutique eateries, delivery services, and all the infrastructure to go along with it.

So, I agree with you. Activity tracking is not ubiquitous, and never will be, in the same way that most people won’t cook their food from scratch. But some will, and that’s how we’ll figure out what everyone else wants to eat.

Rachel’s description is vivid and makes a lot of sense. There is just one limitation with the above scenario, and that is that outside of the pockets of high-tech adoption, not many people actually want personal health and behavior trackers. More than anything, for most people quantifying themselves is just not interesting. Most people are simply not interested in their own personal data. I contend there are three kinds of people who do use the personal trackers that excel in ingesting signals from us and our behavior and churning out data:

Alpha users of tech: these are the ones who are prototyping devices, behavior and institutions
Those trying to achieve a milestone: they are training for a challenge
Those worried enough about their health: they are worried enough to want to do something about it

There are two kinds of people in this world. Those who are ill and those who will be. Of the three categories of users of personal health trackers listed above, the last one is interesting because not only are they most like the rest of us, they have reached a point in their lives where they want to do something about their health. The desire to get well can motivate them to put up with the hassle of wearing a device and assiduously collecting and reporting the data.

So, if not the trackers then what? Most likely it is going to be the phone. I have maintained this view for a while, and my last year wandering around the world observing people has confirmed it for me that the telephone is the only product that almost everyone around the world wants to carry with them.² Any other product is going to continue to have a niche appeal. So, unless the telephone itself becomes the personal tracker, and some of them are becoming just so, the personal trackers themselves will continue to have a limited appeal.

This is not a criticism of the trackers or the field of quantified self (QS) but it is just the way we humans are. The phone appeals to us because it is a communication device and we love to communicate. The phone enables us to communicate in numerous ways, so we use it to remain in touch with our friends and loved ones in spite of it being used less and less as a phone. Everything else about the phone is secondary.

If people are willing to carry a phone, why won’t they carry an additional device? Because it is simply too much work for too little return. Most devices are single-purpose, and they have to be so to optimize battery life. But that also reduces their attractiveness. One would have to carry many special purpose devices to get a more complete picture of one’s health. Most devices are too tiny, so they get lost easily. Most depend on a smartphone to be useful, but why carry them when the smartphone itself does what the devices claim to do.

We are indeed in the early days of prototyping, and eventually we will hopefully have an entire ecosystem of trackers, the secondary-level data analysts, self-analysis tools, aggregators, etc., ready to convert our data into bespoke information products for our consumption. Or will they? Well, they will only if there is enough data. But I think there simply won’t be enough data from these trackers, not at a scale comparable to that generated by cellphones. And the trend with phone-generated data well might be toward individual ownership of data.

The individual health tracking devices will continue to remain disconnected either in the silos of their device manufacturers. The phones, on the other hand, will offer a slightly different model. As popularized by Apple, the data will be owned by individuals who may then choose to donate or sell them to specialized collections. Specialized data collection for specific studies will continue, but may be governed by IRB protocols, and be subject to health-data guidelines. Personal ownership of data might empower individuals to accrue some benefit from sharing their data thereby giving them incentive to do so.

Public collection of private data is not likely to happen unless we change the technical, social and legal infrastructure so individuals become partners in a collective exercise. We already have such an infrastructure, and that is the cities we lead our lives, where we make collective decisions about our environment. We will need to build city and neighborhood services that can respond to individual needs with the data from the individuals being the signal. This would need both infrastructure and policy change.

One of the most effective localized feedback that doesn’t even require any data collection is making restaurants publish the calorie count next to each menu item. It is a simple policy enforcement that allows diners to reconnect back with their food in a simple way, a way that has long disappeared under mysterious layers of cooking methods and ingredients. Not many people can tell that their breakfast provided them with more calories than a normal person’s recommended daily allowance (RDA) or that one serving of granola gives them more calories than they can burn in two hours of walking. But, labeling could make that apparent, and this doesn’t even require any access to private data.

Similarly, a city designed for walking and biking rather than for cars could doubly benefit from smart labeling that would give walkers/joggers an idea about the effectiveness of their routine workout. Small, neighborhood food stores would encourage frequent shopping for small amounts of groceries rather than infrequent shopping of large amounts thereby shifting the balance toward more fresh produce. I am thinking here of the example of Paris where there are almost no large grocery stores. Instead, almost all neighborhoods have their markets, produce stalls, bakeries, butcher shop, etc. so that no matter where you live you are never a short walk away from fresh food. The city would be designed at a more human scale. The city itself would be an app for developing a culture of health wherein the very act of daily living will be net positive toward good health.

The one thing going for us, those who believe that there may be public good from private data, is that illness is almost inevitable. The problem with us humans is that we usually don’t worry about falling ill until we fall ill. We are interested in being healthy but are not interested in health. Focusing on developing a culture of health can change that.

Activity tracking is already mainstream in that people know about it, and those who have any motivation to do so are already tracking themselves (see the three sets of people above). It will never be ubiquitous, certainly not at the scale of the cellphone, the only personal technology adoption. However, there is scope for us to innovate in a way that creates a system that is more inclusive than it is right now. That would be a neat challenge to work on, and the way forward may be by shifting the focus from a culture of apps to a culture of health through the following three ways:

QS: Shift the focus from quantified self to quality of self.
Data: From “Big Data” to localized databases organized around common standards that enable a diversity of tools and creative solutions.
Network: From an “internet of things” to a network of people and communities.