digital media and health
Since the 1990s, many digital technologies have been invented that allow people to learn about health, illness, and health care; seek medical advice; share information and support; and monitor and care for their bodies or those of people for whom they care. These media include search engines, information websites, blogs, wikis, online discussion forums, content curation and sharing platforms, video games, apps, wearable devices, and digital self-care technologies. This entry provides an overview of the major digital health technologies that are available, discusses the social structuring of the use of these technologies, and explores personal health data privacy and security issues.
Overview of Digital Health Technologies
In the days before personal computing and the Internet, lay people had few opportunities to use media to find and share health and medical information and experiences. News reports and self-help books were the major sources available to them. With the advent of personal computing in the 1980s, followed by the Internet and the World Wide Web as a way of linking online materials in the mid-1990s, digital technologies were taken up for health care and health information uses. Search engines offered lay people a way of readily finding health and medical information online. Websites offering information about health and medical topics were established by health-care providers and organizations as well as commercial entities such as pharmaceutical companies.
At first, health websites simply provided static digitized content. They were supplemented by blogs and online discussion forums and message boards where lay people could interact with each other. The emergence of the social web (also referred to as Web 2.0) and mobile computing (e.g., smartphones, tablet, Wi-Fi) brought with them vastly expanded opportunities for people to not only access but also create and share their own health information and to provide support to others. Key social media sites such as Facebook and Twitter were introduced, followed by Instagram, Tumblr, and Snapchat. The video content curation and sharing site YouTube was also established, while Pinterest offered a way to curate and share visual images. Many patient-specific platforms such as PatientsLikeMe have been set up, allowing people to engage with others experiencing the same health condition. Digital games such as Wii Fit offer people the opportunity to engage in health-promoting activities.
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Mobile apps for smartphones and tablet computers have been available since 2008, introduced first by Apple and then by Google. Health and medical apps constitute one of the most popular categories in the app stores, with hundreds of thousands of these apps available for download. Fitness and weight loss apps are among the most highly used health and medical apps. Other apps are offered for a diverse range of health-related topics including self-diagnosis and symptom-tracking, self-monitoring and promoting mental health and well-being, information about alternative therapies, reproductive health information and tracking, and for making medical appointments and ranking and rating health-care providers. Wearable devices such as smartwatches and fitness bands also provide health and fitness self-tracking technologies. People with chronic illnesses and disabilities are able to use digital devices for self-care. A range of digital technologies is available to support older peopleās health in their homes, including wearable devices to monitor falls and blood pressure, heart rate, blood glucose, and joint function trackers.
Social Structuring of Digital Health Use
There are many potential benefits to lay people of using digital health technologies. People can find emotional support in connecting online with others experiencing similar health conditions, share important insights based on their experiences, and engage in activism to promote the rights of patients or people with disabilities. Tools such as the Google Search engine provide ready access to online health and medical information that people can use instead of or in addition to traditional face-to-face medical advice.
However, not everyone benefits equally from digital health. Social research has demonstrated that there are often major differences in the ways that social groups use digital technologies, which has implications for how they use health-related technologies. Devices and software are often designed for relatively privileged users. People living in developing countries or in rural and remote regions or of lower socioeconomic status in wealthy countries have less access to Wi-Fi and lack the financial resources to purchase smart devices. There is a strong relationship between how familiar and skilled people are with using digital technologies as part of their everyday lives and the extent to which they may engage with health-related technologies.
The design of digital technologies is also a key contributor to how they are taken up. People with disabilities, injuries, or chronic health conditions often find that digital technologies are difficult to use because they have not been designed with their needs in mind. For example, fitness-tracking apps and wearable devices often set a target of a certain number of steps to be achieved each day or send notifications that people must stand up and move every hour. These targets are arbitrary and assume an able-bodied person who has the opportunity to readily respond to these nudges and goals. The needs of people who may be recovering from an injury, pregnant, are living with a sight or mobility disability, are caring for others, or in demanding occupations in which it is not possible to regularly stand up and move around are generally not recognized or catered to by the developers of these technologies.
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The designers and developers of digital health technologies also tend to adopt an individualistic approach that ignores the social determinants of health and digital technology use. Encouragements in apps or wearable devices for people to move more, lose weight, consume a healthy diet, reduce their alcohol consumption, and engage in other self-care practices focus on the importance of people engaging as ideal-type responsible citizens or empowered patients who are willing and able to use these technologies. Social structural factors contributing to poor health such as low education and low income, social marginalization, and poor housing conditions are often ignored in many digital health initiatives. Simply designing and promoting a new app to encourage people to be more engaged with health-supporting practices does little to address socioeconomic disadvantages.
Personal Health Data Privacy and Security
Personal health data privacy and security issues have also received attention from social researchers. The interactions that people have online as well as their use of health and fitness-tracking apps generate vast reams of often very personal and sensitive digital data about their bodies and health and illness states. The people who generate this information about themselves do not profit from their data and their work in commenting on, sharing, or curating health-related material online. However, as with other forms of human bodily materials (e.g., cells, blood products, organs, body tissues), health and medical data have become valuable commodities, generating profit for many different actors and agencies. Health data can be exploited for commercial benefit by technology developers, who may sell this information to third parties such as advertisers and pharmaceutical and medical device companies. The dominant Internet companiesāGoogle, Amazon, Apple, Facebook, and Microsoftāhave major control over the collection and use of personal health data, with little opportunity for users themselves, researchers, or patient communities to access these details.
Personal health and medical information can also be used in ways that disadvantage people, as part of an array of data harms that can affect them. A vast industry of data mining and profiling companies has sprung up; they use this information to generate detailed profiles on people for use in decisions about whether they should be offered credit, employment, or health and life insurance. While the big data generated from peopleās online engagements and use of apps can provide important insights into the distribution of and effective treatments for illness and disease, algorithmic decision-making using peopleās health data can limit their life opportunities and further entrench socioeconomic disadvantage and marginalization.
Many data breaches and leaks of health and medical data have occurred, resulting in the leak of personal medical records, including of sensitive information such as peopleās sexual activities and preferences and mental health conditions. Health and medical data are considered highly profitable because they can readily be used for insurance fraud and other forms of identity theft. They are, therefore, key targets of hackers and other cybercriminals.
Once personal health data are sent to the computing cloud and archived there, people lose control over these details and have little opportunity to challenge the ways in which their data are exploited by others or used to limit their life opportunities. The publicās understanding of the black boxes of algorithmic decision-making, data profiling, and third-party use of personal health and medical data is low, and they tend not to realize the multitude of ways in which their details are used by other actors and agencies. These are important issues that require awareness not only on the part of lay people but also health-care providers, medical data analysts, and health promotion professionals who may seek to collect and use personal health data and encourage lay people to use digital health technologies.
The original version of this article was published by SAGE Publications in The SAGE International Encyclopedia of Mass Media and Society.