Politics of wearable, intimate, health technologies

Posted by Anna Jackman

“This is the future of technology. I feel wearable technology should integrate into a user’s life without the hassle of it being a device. And you can only do that when technology and fashion merge” (Co-founder of Ducere Technologies in BBC 2015)

Wearable technology today* refers to “computing and communication systems that are body-worn” (Farina et al 2012: 1117). Wearable technology comes in a number of forms, boasting a range of sensing activities and applications. From ‘smart watches’ that integrate a number of apps, email, and media notifications into a wristwatch (such as the Apple Watch and Samsung Gear), to sophisticated fitness trackers that monitor and relay metrics and data regarding your activity levels, sleep patterns, calorie consumption, heart rate, and blood pressure (such as the Nike Fuel Band, FitBit, and Jawbone), ‘wearables’ are an increasingly popular and commercially lucrative consumer technology.

The emergence and proliferation of wearable technology is perhaps best demonstrated by its increased presence at notable global consumer technology fairs such as the Consumer Electronic Show® (CES). Held most recently in January 2015 in Las Vegas, CES showcased a range of wearable technologies, with one particular product category enjoying the CES spotlight: that of ‘health wearables’. This hype and limelighting of health wearables looks set to continue when perusing the exhibitor line-up at the Wearable Technology Show to be held in London in March.

The category of ‘health wearables’ is a wide-ranging one, including two broad types of devices: those (marketed as) (reactive) activity and fitness self-awareness or ‘improvement’ devices, and those that are (marketed as) proactive and preventative. The first category of health wearables includes those that monitor and track various fitness metrics and bodily activities (like those previously mentioned), offering a number of reporting functions (often via a smartphone or laptop) that allow users to self-monitor and thus determine their fitness metrics and assess their ‘progress’. These fitness or activity health wearables include ‘smart earphones’ that track your heart-rate while you run, ‘smart socks’ that monitor your running cadence, and ‘smart belts’ that monitor your sedentary/ activity levels and calorific intakes. Several of such wearables marketed as self-knowing and ‘self-improvement’ devices also seek to integrate warning capabilities. Microsoft’s ‘Smart Bra’, for example, is a concept involving a bra that “can measure your emotional state [via “heart rate and respiration, skin conductance and movement”], cross reference this with your diet patterns and send alerts to your smartphone when you are at high risk of over-eating” (Telegraph 2013). In essence, these wearable devices are utilised by users in a reactive capacity; they are marketed as tools for self-knowledge and improvement (via fitness), promoting the mantra: listen to your body, it tells you what you need to do: we “aspire to influence human behaviour in ways that improve quality of life through fitness intelligence and smarter living” (Atlas 2015).

Rather than (being marketed as) monitoring and tracking activity levels for the purpose of health and fitness, a second set of health wearables focus instead upon proactive preventative health monitoring. Consider, for example, recent advances in the area of ‘ingestible wearables’, such as Google’s cancer cell detection wearable currently under development. This system functions via the ingestion of a pill which contains nano-particles with specific markings that latch on to cancerous cells. The user then wears an accompanying bracelet that can detect the presence of such cancerous cells via the emission of light pulses (The Atlantic 2015). Similarly, California-based Proteus Digital Health are developing an ingestible ‘smart pill’ that is able to gather and relay data about suspected digestion issues straight to your smartphone (CNN Money 2014, Forbes 2014a). Such intra-body wearables arguably raise a series of socio-political questions about technological intimacy and the sub-skin and body.

Another form of emergent proactive and preventative health wearables is that of ‘stick-on wearables’, such as ‘wearable tattoos’ and ‘smart contact lenses’. These have (thus far) been developed to persistently monitor a diagnosed diabetic’s blood sugar levels without the need for needles. In conjunction with the ‘ingestibles’, these ‘body worn’ health wearables are marketed to users that are diagnosed, predisposed or susceptible to particular health issues. This distinguishes them from are the aforementioned fitness health wearables in both their proactive detection or diagnosis role, and their distinct conception of health (as that beyond fitness).

But what’s so interesting about these increasingly complex and body-integrated wearable technologies? In what follows, I put forward several areas for reflection that the rise of health wearables might prompt for social, cultural and political geographers.

Technological integration and ‘naturalism’

“Very powerful, yet very small and increasingly cheap, computing devices are becoming available, making their portability and their integration into everyday objects and spaces more feasible” (Jones et al. 2003: 166)

Accompanying the aforementioned developments in the area of health wearables is the common mantra and trope denoting wearables as “extensions of your body” (Itea3 2015; NDTV 2013; The Atlantic 2015; Wear it at work 2015). In corporate and media coverage of these technologies, wearables are presented as increasingly developmentally “unobtrusive”, “a natural extension of your body”, and as “not get[ting] in the way” (Smailagic in NDTV 2013).

Such assertions have prompted the design and development of some health wearables with a ‘natural’ (bodily) fit. Consider, for example, the ongoing development of a wearable “powered by naturally occurring chemical processes in the blood” (Wall St Daily 2014). Both the nature and design of wearable ‘biofeedback data’ (FPF 2015) collection is thus changing, with companies increasingly seeking to produce technologies with “a better and more unobtrusive fit with habitation” (Thrift and French 2002: 309). Further reflection around the increasing desire to develop what has been dubbed “intimate computing”, that is wearables that are “sensual and tactile, personal and discreet” (The New Yorker 2014), may thus interrogate the performativity of techno-bodily extension discourse, and the resultant material changes in wearable architectures and product design.

The power politics of persistent health monitoring: sousveillance and surveillance

Wearable technology can be understood as a self-surveillance or ‘sousveillance’ tool, facilitating “the personal monitoring and management of one’s own life” (Kitchin and Dodge 2011: 216). Health wearables act as “life logging” technologies that record and “intelligently index” “interior capta” and data (Dodge and Kitchin 2007: 434), allowing us to build a metric and sensory health picture and overview, a “quantified self” (FPF 2015; The Guardian 2015). In engaging in such practices of self-monitoring, tracking, and evaluating, the use of health wearables raises a series of emergent opportunities and risks.

Beyond their potential health indications and benefits, such devices are increasingly presented as a wider area of opportunity. Consider, for example, the foray of wearables into the so-called “corporate-wellness programs” (Forbes 2014b). I refer here to instances in which corporations are offering employees opportunities to use wearable devices, and subsequently monitoring the data generated, in “exchange for discounts on health insurance” (Forbes 2014b; New Scientist 2014). A number of well-known companies, “including BP, ebay and Buffer”, are already running such incentive programs (New Scientist 2014). In addition, health wearables have recently entered the previously unchartered territory of the court room, being accepted as a permissible form of evidence. As The Guardian (2014) reported, “a Canadian law firm will use data from a Fitbit fitness tracker for the first time in court…in a personal injury lawsuit in an effort to show life-affecting reduced activity post injury”.

Whilst these applications and encounters with health wearables can be seen as opportunities, there is also an underbelly to this promise-rich technology, particularly around the issue of privacy. For example, in a comprehensive report and consumer survey on wearable technology, PriceWaterhouse Coopers (2014) propose that “privacy and security are consumers’ main concerns regarding the impact of wearable technology”, noting that “82% (of those surveyed) said they were concerned that wearable tech will invade their privacy” (PWHC 2014: 6).

But why the concern?

Discussions around data privacy and health wearables specifically have arisen in recent media reportage, centring predominantly around concerns regarding the accessibility of such (increasingly intimate) data to third parties, and of two such actors in particular: health insurers and marketers. For example, a number of news media outlets have expressed concern about health insurance industries purchasing and gaining access to health wearable generated data. For example, Forbes (2014b) recently published a discussion about the potential of wearable-generated data “in the setting of health insurance costs and premiums”, suggesting that this approach may follow on from the “tracking gadgets” used by some car insurance firms in the US, which monitor users driving for 30 days in order to assess whether they’re “eligible for a discount” (Forbes 2014b). This speculation highlights a complex issue in the area of health wearables in particular given current uncertainly around the extent of applicability of the (US) ‘Health Insurance Portability and Accountability Act’ (HIPAA), that which protects patient data and medical records, to health wearable generated data (Varonis 2014). As CNET (2014) report, this (the HIPAA),“doesn’t yet apply to [all] user-generated wearable data”, and the “market for collecting and selling that information is a booming business” (see also The Washington Post 2014). Similarly, concerns have been raised around the potential of marketing agencies to access such data, providing them a novel means in which to “use the data collected to tailor ads to users” (USA Today 2015). The emergence of a more intimate form of ‘contextual targeting’ could thus be explored. Of course there are also many additional contentious third-party users and uses of such data which should be reflected upon. At the very least, further investigation of the emergence and potential of such wearable data ‘business’ (USA Today 2015) should begin with the assertion that this data is certainly “an asset” (Tech Republic 2014), and as such has been labelled “the most valuable information in the digital age, bar none” (The Washington Post 2014).

“Collect it all, process it all, exploit it all, sniff it all, know it all” (NSA Collection Posture revealed in Snowden documents, in Crampton 2014:1)

In addition to privacy concerns surrounding corporate access to such data, concerns have been raised around ‘intelligence community’ access to wearable-generated data in a “post-Snowden era” (Big Think 2014). As Crampton (2014: 5) valuably outlines, following Snowden’s initial leaking of “a Top Secret warrant from the Foreign Intelligence Surveillance Court (FISC)”, and the numerous other documents and leaks that followed, the intelligence community has received sustained (critical) attention around the mechanisms, extent, and legality of surveillance and monitoring operations conducted by numerous intelligence community actors (see Crampton 2014 and Crampton et al. 2014 for incredibly valuable and comprehensive overviews). Part of the initial revelations and news coverage following Snowden’s release of documents demonstrating the far-reaching nature of the (US) National Security Agency’s (NSA) mass surveillance program focussed upon the agency’s storage of the “online metadata of millions of internet users for up to a year, regardless of whether or not they are persons of interest to the agency” (The Guardian 2013a; Crampton 2014). This “metadata provides a record of almost anything a user does online” and can be “used to build a detailed picture of an individual’s life” (The Guardian 2013a). The gathering of such metadata allows the NSA to “build what it calls a ‘pattern of life’, a detailed profile of a target and anyone associated with them” (Soghoian in The Guardian 2013b).

Whilst it is important to distinguish the difference between the capture and monitoring of metadata (data about data) and “full take” (“the content of every single phone call”, that which the NSA captures and analyzes for at least two countries, see Crampton 2014), privacy advocates have expressed huge concerns over the revealing and personal nature of such metadata (Guardian 2013a). This concern is unsurprising when you consider the involvement of various actors (including social media) in the intelligence community’s interest in “human dynamics”: namely “how humans move, interact, behave”, and the emergent understandings, “often known as activity based intelligence” (Crampton 2014: 2). In the wake of the rapid emergence and uptake of wearables, technology dealing precisely in metrics associated with these activity and movement variables, it seems apt that the concerns of privacy advocates, especially those around the construction of ‘pattern of life profiles’, are revisited. Questions are beginning to emerge, for example, around whether the Fair Information Privacy Practices (FIPPs), the guiding principles “frequently [used as] the foundation of many privacy laws as well as organizational privacy practices” (FERPA 2014), adequately address these emergent technologies and the resultant privacy and security concerns (FPF 2015). Further reflection in this area might also consider the range and variety of wearables out there, each requiring and recording very different (amounts of) user data (The Atlantic 2015). Together, this range of ‘third-parties’ (corporate and intelligence community) and the implications of their access to wearables data thus raise questions around the resultant “potential for invasive profiling, social sorting and pernicious disciplining effects” (Dodge and Kitchin 2007: 439). Such concerns culminate in the wider question of who really benefits from such health inventions and interventions (Delabre 2015).

“People are so willing to give up privacy for functionality because functionality is a tangible benefit and privacy is an immaterial one” (Dooley, security analyst, in Tech Republic 2014)

In this ‘rambling post’ I have sought to offer some brief reflections on the emergence and proliferation of health wearables; increasingly integrated technologies gathering increasingly intimate data. I have sought to highlight some potential questions and possible areas of interest for social, cultural and political geographers, ranging from (the politics of) technological integration to (self)surveillant practices. In so doing I hope to have highlighted (health) wearables as an emergent site of various material and immaterial complexities, worthy of further geographic investigation.

* Caveat: wearable technology is not a new phenomenon, and I am not trying to valorise it as such. As it refers to technology you carry with you, it also includes technologies such as wristwatches, heart monitors, and hearing aids (Gough 2003). This piece engages specifically with the technology its latest popular resurgence.

Anna Jackman is a PhD Candidate in Human Geography at the University of Exeter. This blog post is a departure from her PhD research interests, which are around unmanned technologies (drones). You can find out more on her University profile page, or find her on Twitter (@ahjackman).

Reference list

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