The material micropolitics of digital health technologies

1. The material micropolitics of digital health technologies Nick J Fox University of Sheffield @socnewmat

2. Introduction • A materialist approach to digital health. • What can a digital technology do? • The micropolitics of digital capitalism. • Re-engineering digital technologies. • The digital generation, activism and citizen health. @socnewmat

3. The transparency of technology? • Sociological perspectives on technology: • Technological determinism • Social shaping of technology • Technology as affordance • I explore technology instead from a materialist perspective.

4. Beyond sociological dualism • Avoid both social essentialism and technological essentialism. • Look at the material capacities of digital technologies in specific contexts. • Do we really know what digital technologies can actually do? • What might digital technologies do? @socnewmat

5. A (new) materialist ontology • Not pre-existing entities but relations that assemble. • Not attributes, but entirely contextual capacities. • Not agency but a capacity to affect or be affected. • Not systems of structures but fluctuating assemblages. • Not a politics of social forces but a micropolitics of affecting. • Not texts or discourses but materialities. @socnewmat

6. Applying materialist ontology • Look at digital technologies in their assemblages. • What capacities do they produce? • What is the micropolitical impact of a technology in terms of power, resistance, social order, continuity, change etc? • How might these micropolitics be changed by altering the contexts or other forces? @socnewmat

7. Digital health technologies (DHTs) • For use by an individual outside formal healthcare. • Self-tracking or monitoring of body functions or performance. • May have capacities for therapeutic intervention. • May use communication or networked functionality. Fox, N.J. (2017) Personal health technologies, micropolitics and resistance: a new materialist analysis. Health. 21(2): 136-153.

8. What can a digital health technology do? • I will reverse engineer DHTs, to ask: • What relations does each comprise? • What affect economies make each work? • What is the defining micropolitics of each? • What capacities does the assemblage produce, including bodies’ capacities to do, feel and think? @socnewmat

9. Tracking devices (Fitbit, Apple Watch etc.) • What do they do? - use sensors to provide quantified data; encourage action. • The Fitbit/Watch assemblage: body performance and movement – terrain – device – wearer – manufacturer – other users • Micropolitics - quantifies body performance; encourages behaviours; responsibilises user; creates routines; commercialises fitness. @socnewmat

10. FetalBeatshttps://www.fetalbeats.com/ • What does it do? – links a foetal heart rate monitor to a smartphone/watch, revealing effects of environment on foetus, and enabling sharing of foetal data. • The FetalBeats assemblage: foetal environment - foetal heart – doppler sensor – smartphone – parent – parent’s environment – friends/doctor • Micropolitics: foetus can be monitored by parents in real-time; mother responsible for sustaining positive and healthy foetal environment (e.g. reducing stress levels, eating healthily); data can be shared with doctor, friends etc. @socnewmat

11. Vida: virtual coachingwww.vida.com • What does it do? –coaching app that shares self-tracking data with online health and fitness coaches. • Coaching styles : cheerleader; drill sergeant; innovator; listener; challenger; analyser. • The Vida-assemblage: body – app – device – coach – health programme – company – shareholders – profit • Micropolitics - turns health and fitness into ways to make money; outsources traditional tasks of healthcare to sustain health and fitness.

12. The micropolitics of digital health technologies • Unit of sociological analysis needs to be the assemblage, not the technology. • The micropolitics of these digital assemblages are emergent. • These micropolitics produce the features of ‘digital capitalism’. @socnewmat

13. Digital capitalism (DC) and health • Efficiencies. • Health knowledge as commercial resource. • Monetising services. • Marketisation of health. • Consumerisation. • Opportunities for privatising/out-sourcing. @socnewmat

14. Vida as exemplar of DC • Reduces costs of providing coaching. • Brings coaches and consumers/clients together online. • Establishes a global market that still feels local. • Creates virtual versions of existing businesses and business models. • Reduces margins and increases volume of sales. @socnewmat

15. What else can the digital do? • If we can reverse engineer technology, we can also forward engineer it to produce different micropolitical outcomes. • Less pessimistic analysis of digital health. • Possibilities for action and resistance, including digital activism and ‘citizen health’. @socnewmat

16. An activist perspective • Digital technologies can be engineered to: • Reject biomedical model. • Enable collective responses • Challenge health policy. • Organise against health corporations, fast food outlets, environmental polluters etc. • Encourage environmental sustainability. @socnewmat

17. Citizen Health • Subvert biomedical or corporate interests. • Reject individualised approach to health. • Reject monetisation of health and fitness. • Connect people and social formations to each other. @socnewmat

18. Conclusions • A materialist and micropolitical approach allows us to ask: • What can a digital health technology do? • How do DHTs contribute to digital capitalism? • How can we re-engineer DHTs?

19. The material micropolitics of digital health technologies Nick J Fox University of Sheffield @socnewmat