Normalizing Health-Positive Technology

(Photo by iStock/yulkapopkova)

Even before the COVID-19 outbreak, it had become hard to be healthy in the United States. Healthier choices are often more expensive, less accessible, and less convenient: Not only are opportunities for health not evenly distributed, but almost every major health indicator shows big differences based on income. We’re all swimming upstream, but those with resources can more easily overcome these currents: They can afford healthier foods, live in walkable communities, purchase gym memberships, or can afford the time to pursue healthier choices instead of work.

When we leave the task of staying healthy to individuals, and when individual efforts fail, the medical system must intervene, late, and at great expense. As a society, therefore, we have a shared interest in making health less of a struggle. All sectors need to be deeply engaged in promoting health to improve health outcomes, but the technology sector’s ubiquity makes it a perfect place to direct individuals toward more healthy choices and behaviors. Innovation focused on health-positive technologies could have an outsized impact: What if health-positive were the default option rather than a suggestion?

To achieve this vision, the technology sector’s goals and execution must align with societal goals for health and well-being, an alignment which requires clear vision and understanding, a supportive regulatory approach, and pressure from multiple sectors—investors, employees, consumers, communities—to be better corporate citizens. Yet, even when willing, technology companies need help in identifying ways to create healthy incentives.

Technology companies have entered the health space on multiple fronts, from supporting fitness and wellness regimens and working to improve the health-care experience to medical and life sciences research. Alphabet, Amazon, Apple, Facebook, and Microsoft all have health divisions or significant health initiatives. Yet technology companies also have an extensive impact on health and well-being outside of the health divisions they are creating: They provide the screens, the content, and the gaming platforms we use to entertain ourselves; the communications platforms that mediate how we socialize; the smart home technology that increasingly controls lighting, temperature, and other ambient characteristics; the appliances we use to store and prepare our food (even a grocery chain in Amazon’s case); the maps, the directions, and even some of the vehicles and vehicle networks we use to transport ourselves; and the workplace technology that shapes many of our jobs.

This pervasiveness creates opportunities to address health at a societal scale by consciously embedding health and well-being as explicit goals for the design of the products and services that touch our everyday lives in these many ways.

From Health and Technology to Health-Positive Technology

Aligning the technology sector with a societal goal of greater health and well-being entails a number of shifts in thinking. The most fundamental is understanding health not as a vertical market segment, but as a horizontal value: In addition to developing a line of health products or services, health should be expressed across a company’s full portfolio of products and services. Rather than pushing behaviors on people through information and feedback, technology companies should also pull behaviors from people by changing the environment and products they are offered; in addition to developing technology to help people overcome the challenge of being healthy, we need to envision technology that helps to reduce the challenges to being healthy. And in addition to holding individuals responsible for choices that they make, we also need to recognize the collective responsibility that society bears for the choices it makes available.

 

How to catalyze these shifts?

To find out, we convened a “tech-enabled health,” in which 50 entrepreneurs, leaders from large technology companies, investors, policymakers, clinicians, and public health experts designed a hands-on, interactive, and substantively focused agenda. Participants brainstormed ways that consumer-facing technologies could help people move more, eat better, sleep well, stay socially connected, and reduce stress. In groups and collectively, participants also considered ways in which ideas related and might be synergistic, potential barriers and contextual conditions that might impede or support transformation, and strategies for catalyzing the desired shift. Participants were mixed in terms of sector, discipline, and gender (though the attendees were not as diverse in terms of race/ethnicity or economic strata as the users we potentially wanted to impact—a limitation noted by participants). We intentionally maintained a positive tone, emphasizing potential benefits of shifting toward a health-positive approach, rather than bemoaning the negative role that technology can play.

The goals of this workshop were:

(1) to apply a process that would enable participants to see the potential for and understand what it would take to develop health positive products and the barriers that would need to be overcome to facilitate their development and adoption; and

(2) to build a core community interested in making this change happen and moving in this direction.

We did not intend, nor did we, derive specific strategies for tech-enabled health. Rather, through experiencing the process of brainstorming and considering ideas, we wanted participants to explore the viability of health-positive technology solutions and to understand the obstacles to developing them.

Several key ideas captivated the group’s imagination:

1. To get people to move more, participants envisioned an internet application that would integrate data from multiple sources and would triangulate among users’ aspirations, medical history, and activity levels to provide customized coaching. The application would enable people to opt into data collection and analytics and to input their preferences and motivations, values, and goals.
2. To encourage people to eat better, participants conceived of a campaign to “make dinner great again!” The product, also likely an internet application, would facilitate dinner planning and execution for the masses, prompt a cultural movement to highlight the value of dinner, and provide decision support around planning meals for the week (e.g., ingredients, shopping, and an Uber-like function for chefs to cook for your home).
3. To promote social connection, participants considered two ideas, one focused on online behavior and the other with a goal of encouraging social interaction offline. First, they recommended requiring badges, like internet driver’s licenses, to promote healthy online interactions; tweens and teens would acquire a license, which would allow them to join online social applications. Artificial intelligence or simply older teenagers with experience using the application would be enlisted as mentors to monitor the platform. Second, they suggested “talk to me” tables, where like-minded people cold meet in safe places. An online directory would provide real-time information about offline locations where people were gathering to discuss particular topics.

Over the course of the day, a series of themes emerged:  

1. More than internet applications | Most of the approaches focused on developing new internet applications, the technology sector’s dominant paradigm. But technology companies also need to envision ways to change the default options embedded in their consumer-facing products and services, which will require more robust and creative thinking. Participants therefore highlighted the need for, and strongly encouraged, continued effort to develop use-cases for health-positive technologies—including their business models—to generate deeper engagement and more creative thinking. 

2. Ongoing need for infrastructure | Applications don’t address the need for infrastructure that encourages consumer-facing technologies that get us to move more, eat better, sleep well, make meaningful connections, and relax when we use them. New ways of thinking about our relationship to things—such as the movement to view mobility as a service (MaaS)—could increase opportunities for health-positive technology applications, but promoting MaaS requires, for example, installation of bike lanes and more buses as well as a set of innovative policies and regulations for encouraging their use. Technology companies encourage the infrastructure needed to make these technologies viable. Currently, most health-promoting technology resides vertically within the health delivery sector, rather than horizontally across sectors. Identifying mechanisms that enable diverse companies to receive payment for producing health where it is a positive externality of their health positive products will be a key element of health-positive infrastructure.

3. Personalization versus privacy | Technology affords opportunities for greater personalization, but whether this is welcome by consumers depends on the source and on the value of the technology. On the one hand, technology companies have so much information that they can deliver customized service; on the other, knowing that your technology knows so much about you can be off-putting. Efforts to personalize technologies would need to be paired with privacy regulations that increase people’s willingness to share personal information by respecting individual preferences regarding personalization and privacy. 

Participants felt that technologies would be more successful by personalizing outreach; products designed to reflect the preference of a majority, will tend to reinforce the status quo. Yet helping people do what they want to do, rather than what the technology leads them to do, represents a design challenge. How can technologies know what people intend to do based on their actions? Technology needs to get better at honoring people’s intentions (e.g., Google ought to know that I don’t like to drive in Manhattan, even if most people do), not saddling them with community norms.

4. Equity matters | Participants emphasized the need for technology developers to be intentional in their design and distribution model to reduce the potential for inequitable impacts of new products, such that “health-positive” technologies don’t add to disparities in health between those who can afford them and those who cannot. Suggestions included ensuring that training of technology employees included information on this topic and that product development and distribution included diversity of experiences.

5. Safety concerns | Finally, participants raised concerns about product safety and the “move fast and break things” ethos that drives innovation in Silicon Valley’s technology sector. In contrast to health care settings governed by the physicians’ oath to “first, do no harm,” technology companies offer products with potential to enhance health governed by no such restraints. While there is much to be gained by involving the technology sector in the quest for health, participants encouraged monitoring for added risk.

Health as Foundational

Creating a culture among technology companies that embeds healthy choices in the operating systems of consumer-facing products and services will require health considerations to be foundational to design choices. Navigating the themes above will promote alignment of the technology sector’s goals with societal goals and create conditions more conducive to the development of health-positive technologies. Socializing the idea of health-positive technology—and of health as a horizontal value that should be expressed across all products and all companies—will require a multi-pronged approach that builds a coalition of leaders and champions, provides a few highly successful examples, engages stakeholders including investors, employees, consumers, and students to advocate for and develop solutions. All of this will take time but needs to start now. 

Acknowledgement

The authors would like to gratefully acknowledge the contribution of the entrepreneurs, technology executives, investors, policymakers, clinicians, and public health experts who participated in the Tech-Enabled Health Workshop and the Robert Wood Johnson Foundation for its financial support of this work.

Read more stories by Christopher Gardner, Nina Hersher, Kelsey P. Mellard, Norma Padrón, Sara J. Singer, Yennie Solheim, Stephen Downs, Grace Ann Joseph & Neha Chaudhary.