Advertisement

AI & SOCIETY

pp 1–11 | Cite as

Promoting inequality? Self-monitoring applications and the problem of social justice

  • Katrin Paldan
  • Hanno Sauer
  • Nils-Frederic Wagner
Open Forum

Abstract

When it comes to improving the health of the general population, mHealth technologies with self-monitoring and intervention components hold a lot of promise. We argue, however, that due to various factors such as access, targeting, personal resources or incentives, self-monitoring applications run the risk of increasing health inequalities, thereby creating a problem of social justice. We review empirical evidence for “intervention-generated” inequalities, present arguments that self-monitoring applications are still morally acceptable, and develop approaches to avoid the promotion of health inequalities through self-monitoring applications.

Keywords

Health inequality Social inequality Social justice Health-monitoring Self-monitoring mHealth Persuasive technology Nudging Health literacy Health interventions Intervention-generated inequalities 

Notes

Acknowledgements

The authors would like to thank the reviewers and the editor for their helpful comments and suggestions.

Funding

This research is part of the PAnalytics Project, and was funded by the Bundesministerium für Bildung und Forschung.

References

  1. Abu-Omar K, Rütten A (2006) Sport oder körperliche Aktivität im Alltag? Zur Evidenzbasierung von Bewegung in der Gesundheitsförderung [Physical activity and health. Evidence for the health benefits of different physical activity promotion concepts]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 49(11):1162–1168.  https://doi.org/10.1007/s00103-006-0078-5 CrossRefGoogle Scholar
  2. Albrecht U-V, Höhn M, von Jan U (2016) Kapitel 2—Gesundheits-Apps und Markt. Chancen und Risiken von Gesundheits-Apps CHARISMHA, pp 62–82. http://www.digibib.tu-bs.de/?docid=00060007
  3. Armitage CJ, Conner M (2000) Social cognition models and health behaviour: a structured review. Psychology Health 15(2):173–189.  https://doi.org/10.1080/08870440008400299 CrossRefGoogle Scholar
  4. Becker S, Mitchell A, Albrecht U-V (2014) Medical Apps: Hilfreich für chronisch kranke. Dtsch Artzbl, 111(15)Google Scholar
  5. Bernard P, Charafeddine R, Frohlich KL, Daniel M, Kestens Y, Potvin L (2007) Health inequalities and place:: a theoretical conception of neighbourhood. Soc Sci Med (1982) 65(9):1839–1852.  https://doi.org/10.1016/j.socscimed.2007.05.037
  6. Bodie GD, Dutta MJ (2008) Understanding health literacy for strategic health marketing: eHealth literacy, health disparities, and the digital divide. Health Market Q 25(1–2):175–203.  https://doi.org/10.1080/07359680802126301 CrossRefGoogle Scholar
  7. Boulos MNK, Wheeler S, Tavares C, Jones R (2011) How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX. Biomed Eng Online 10:24.  https://doi.org/10.1186/1475-925X-10-24 CrossRefGoogle Scholar
  8. Bundesministerium der Justiz und für Verbraucherschutz (2016) Positionspapier Wearables und Gesundheits-Apps aus verbraucherpolitischer Sicht. https://www.bmjv.de/DE/Ministerium/Veranstaltungen/SaferInternetDay/Positionspapier.pdf?__blob=publicationFile&v=2
  9. Burke LE, Ma J, Azar KMJ, Bennett GG, Peterson ED, Zheng Y, Quinn CC (2015) Current science on consumer use of mobile health for cardiovascular disease prevention: a scientific statement from the American Heart Association. Circulation 132(12):1157–1213.  https://doi.org/10.1161/CIR.0000000000000232 CrossRefGoogle Scholar
  10. Carter MC, Burley VJ, Nykjaer C, Cade JE (2013) Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial. J Med Internet Res 15(4):e32.  https://doi.org/10.2196/jmir.2283 CrossRefGoogle Scholar
  11. Cecchini M, Sassi F, Lauer JA, Lee YY, Guajardo-Barron V, Chisholm D (2010) Tackling of unhealthy diets, physical inactivity, and obesity: health effects and cost-effectiveness. Lancet 376(9754):1775–1784.  https://doi.org/10.1016/S0140-6736(10)61514-0 CrossRefGoogle Scholar
  12. Chatterjee S, Price A (2009) Healthy living with persuasive technologies: framework, issues, and challenges. J Am Med Inform Assoc JAMIA 16(2):171–178.  https://doi.org/10.1197/jamia.M2859 CrossRefGoogle Scholar
  13. Cleland CL, Tully MA, Kee F, Cupples ME (2012) The effectiveness of physical activity interventions in socio-economically disadvantaged communities: a systematic review. Prevent Med 54(6):371–380.  https://doi.org/10.1016/j.ypmed.2012.04.004 CrossRefGoogle Scholar
  14. Cohen J (1989) The economic basis of deliberative democracy. Soc Philos Policy 6(02):25.  https://doi.org/10.1017/S0265052500000625 CrossRefGoogle Scholar
  15. Deaton A (2013) The great escape: health, wealth, and the origins of inequality. Princeton University Press, Princeton. http://site.ebrary.com/lib/alltitles/docDetail.action?docID=10745365
  16. Department of Health (2010) Healthy lives, healthy people: our strategy for public health in England. Crown, NorwichGoogle Scholar
  17. DiMaggio P, Hargittai E, Coral C, Shafer S (2004) Digital inequality: from unequalaccess to differentiated use: Literature Review and Agenda for Research on Digital Inequality. In: Neckerman KM (ed) Social inequality. Russell Sage, New York, NY, pp 355–400Google Scholar
  18. European Commission (2013). Health inequalities in the EU: Final report of a consortium—Consortium lead: Sir Michael MarmotGoogle Scholar
  19. Fogg BJ (2003) Persuasive technology. Using computers to change what we think and do. Morgan Kaufmann Publishers (The Morgan Kaufmann series in interactive technologies), AmsterdamGoogle Scholar
  20. Fogg BJ (2009) A behavior model for persuasive design. In: Samir Chatterjee und Parvati Dev (Hg.): Proceedings of the 4th International Conference on Persuasive Technology. Persuasive ‘09. Claremont, California, April 26–29, 2009. ACM Press, New York, S. 1Google Scholar
  21. Fors S, Thorslund M (2015) Enduring inequality:: educational disparities in health among the oldest old in Sweden 1992–2011. Int J Public Health 60(1):91–98.  https://doi.org/10.1007/s00038-014-0621-3 CrossRefGoogle Scholar
  22. Frankfurt HG (2015) On inequality. Princeton University Press, PrincetonCrossRefGoogle Scholar
  23. Frohlich KL, Potvin L (2008). The inequality paradox: the population approach and vulnerable populations. Government, Politics Law 98(2)Google Scholar
  24. Gigerenzer G (2014) Risk savvy: how to make good decisions. Viking, New YorkGoogle Scholar
  25. Glied S, Lleras-Muney A (2008) Technological innovation and inequality in health. Demography 45:741–761CrossRefGoogle Scholar
  26. Glynn LG, Hayes PS, Casey M, Glynn F, Alvarez-Iglesias A, Newell J, Murphy AW (2014) Effectiveness of a smartphone application to promote physical activity in primary care: the SMART MOVE randomised controlled trial. Br J Gen Pract J R Coll Gen Pract 64(624):e384–e391.  https://doi.org/10.3399/bjgp14X680461 CrossRefGoogle Scholar
  27. Gostin LO, Powers M (2006) What does social justice require for the public’s health? Public health ethics and policy imperatives. Health affairs (Project Hope) 25(4):1053–1060.  https://doi.org/10.1377/hlthaff.25.4.1053 CrossRefGoogle Scholar
  28. Grundy E, Sloggett A (2003). Health inequalities in the older population: the role of personal capital, social resources and socio-economic circumstances. Soc Sci Med.  https://doi.org/10.1016/S0277-9536(02)00093-X Google Scholar
  29. Hamilton HA, Noh S, Adlaf EM (2009) Perceived financial status, health, and maladjustment in adolescence. Soc Sci Med 68(8):1527–1534.  https://doi.org/10.1016/j.socscimed.2009.01.037 CrossRefGoogle Scholar
  30. Huisman M, Read S, Towriss CA, Deeg DJH, Grundy E (2013) Socioeconomic inequalities in mortality rates in old age in the World Health Organization Europe region. Epidemiol Rev 35:84–97.  https://doi.org/10.1093/epirev/mxs010 CrossRefGoogle Scholar
  31. Koch-Weser S, Bradshaw YS, Gualtieri L, Gallagher SS (2010) The internet as a health information source: findings from the 2007 health information national trends survey and implications for health communication. J Health Commun 15(Suppl 3):279–293.  https://doi.org/10.1080/10810730.2010.522700 CrossRefGoogle Scholar
  32. Kostkova P (2015) Grand challenges in digital healthGoogle Scholar
  33. Landry K (2015) Using eHealth to improve health literacy among the patient population. Creat Nurs 21(1):53–57.  https://doi.org/10.1891/1078-4535.21.1.53 CrossRefGoogle Scholar
  34. Lee YJ, Boden-Albala B, Larson E, Wilcox A, Bakken S (2014) Online health information seeking behaviors of Hispanics in New York City: a community-based cross-sectional study. J Med Internet Res 16(7):e176.  https://doi.org/10.2196/jmir.3499 CrossRefGoogle Scholar
  35. Lee YJ, Boden-Albala B, Jia H, Wilcox A, Bakken S (2015) The association between online health information-seeking behaviors and health behaviors among hispanics in New York City: a community-based cross-sectional study. J Med Internet Res 17(11):e261.  https://doi.org/10.2196/jmir.4368 CrossRefGoogle Scholar
  36. Lehne G, Bolte G (2016) Equity impact of interventions to promote physical activity in older adults: protocol for a systematic review. Syst Rev 5:17.  https://doi.org/10.1186/s13643-016-0194-8 CrossRefGoogle Scholar
  37. Liberati N (2016) Augmented reality and ubiquitous computing: the hidden potentialities of augmented reality. AI Soc 31(1):17–28.  https://doi.org/10.1007/s00146-014-0543-x CrossRefGoogle Scholar
  38. Link BG (2008) Epidemiological sociology and the social shaping of population health. J Health Soc Behav 49:367–384CrossRefGoogle Scholar
  39. Lorenc T, Petticrew M, Welch V, Tugwell P (2013) What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Commun Health 67(2):190–193.  https://doi.org/10.1136/jech-2012-201257 CrossRefGoogle Scholar
  40. Lorence DP, Park H, Fox S (2006) Racial disparities in health information access: resilience of the digital divide. J Med Syst 30(4):241–249.  https://doi.org/10.1007/s10916-005-9003-y CrossRefGoogle Scholar
  41. Lubans DR, Smith JJ, Skinner G, Morgan PJ (2014) Development and implementation of a smartphone application to promote physical activity and reduce screen-time in adolescent boys. Front Public Health 2:42.  https://doi.org/10.3389/fpubh.2014.00042 CrossRefGoogle Scholar
  42. Lupton D (2015) Health promotion in the digital era: a critical commentary. Health Promot Int 30(1):174–183.  https://doi.org/10.1093/heapro/dau091 CrossRefGoogle Scholar
  43. Lustria MLA, Smith SA, Hinnant CC (2011) Exploring digital divides: an examination of eHealth technology use in health information seeking, communication and personal health information management in the USA. Health Inform J 17(3):224–243.  https://doi.org/10.1177/1460458211414843 CrossRefGoogle Scholar
  44. Luszczynska A, Mazurkiewicz M, Ziegelmann JP, Schwarzer R (2007) Recovery self-efficacy and intention as predictors of running or jogging behavior: a cross-lagged panel analysis over a two-year period. Psychol Sport Exerc 8(2):247–260.  https://doi.org/10.1016/j.psychsport.2006.03.010 CrossRefGoogle Scholar
  45. Macintyre S (2007) Inequalities in health in Scotland: what are they and what can we do about them? Occasional Paper No 17Google Scholar
  46. Mackenbach JP, Kunst AE (1997) Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 44(6):757–771.  https://doi.org/10.1016/S0277-9536(96)00073-1 CrossRefGoogle Scholar
  47. Marteau TM, Ogilvie D, Roland M, Suhrcke M, Kelly MP (2011) Judging nudging:: can nudging improve population health. BMJ 342:263–265.  https://doi.org/10.1016/j.jcps.2010.08.002 CrossRefGoogle Scholar
  48. Marteau TM, Hollands GJ, Fletcher PC (2012). Changing human behavior to prevent disease: the importance of targeting automatic processes. Science (New York, NY), 337(6101):1492–1495.  https://doi.org/10.1126/science.1226918
  49. McLaren L, McIntyre L, Kirkpatrick S (2010) Rose’s population strategy of prevention need not increase social inequalities in health. Int J Epidemiol 39(2):372–377.  https://doi.org/10.1093/ije/dyp315 CrossRefGoogle Scholar
  50. McMahan J (2016). Philosophical critiques of effective altruism. Philos Mag 73:92–99.  https://doi.org/10.5840/tpm20167379
  51. McManus RJ, Mant J, Franssen M, Nickless A, Schwartz C, Hodgkinson J et al (2018) Efficacy of self-monitored blood pressure, with or without telemonitoring, for titration of antihypertensive medication (TASMINH4). An unmasked randomised controlled trial. Lancet 391(10124):949–959.  https://doi.org/10.1016/S0140-6736(18)30309-X CrossRefGoogle Scholar
  52. Mielck A (2002) Gesundheitliche Ungleichheit: Empfehlungen für Prävention und Gesundheitsförderung. In: Homfeldt HG (ed) Studienbuch Gesundheit: Soziale Differenz—Strategien—wissenschaftliche Disziplinen. Luchterhand, Neuwied, pp 45–63Google Scholar
  53. Nguyen E, Modak T, Dias E, Yu Y, Huang L (2014) Fitnamo: using bodydata to encourage exercise through google glass. https://dl.acm.org/citation.cfm?id=2580933
  54. Nozick R (1974) Anarchy, state, and utopia. Basic Books, New YorkGoogle Scholar
  55. O’Neill J, Tabish H, Welch V, Petticrew M, Pottie K, Clarke M, Tugwell P (2014) Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health. J Clin Epidemiol 67(1):56–64.  https://doi.org/10.1016/j.jclinepi.2013.08.005 CrossRefGoogle Scholar
  56. Oliver A, Brown LD (2012) A consideration of user financial incentives to address health inequalities. J Health Polit Policy Law 37(2):201–226. ISSN: 0361–6878CrossRefGoogle Scholar
  57. Orrell M, Brayne C (2015) Dementia prevention: call to action. Lancet 386(10004):1625.  https://doi.org/10.1016/S0140-6736(15)00528-0 CrossRefGoogle Scholar
  58. Pearce KE, Rice RE (2013) Digital divides from access to activities: comparing mobile and personal computer internet users. J Commun 63(4):721–744.  https://doi.org/10.1111/jcom.12045 CrossRefGoogle Scholar
  59. Pogge T (2014) Are we violating the human rights of the world’s poor? Yale Human Rights Dev J 2011(2):1–33Google Scholar
  60. Powers M, Faden RR (2006) Social justice: the moral foundations of public health and health policy. Issues in biomedical ethics. Oxford: Oxford Univ. Press. http://www.loc.gov/catdir/enhancements/fy0637/2005050856-d.html
  61. Quenzel G, Schaeffer D (2016) Health literacy—Gesundheitskompetenz vulnerabler Bevölkerungsgruppen: Ergebnisbericht. https://www.uni-bielefeld.de/gesundhw/ag6/publikationen/QuenzelSchaeffer_GesundheitskompetenzVulnerablerGruppen_Ergebnisbericht_2016.pdf
  62. Rainie L (2013) Cell phone ownership hits 91% of adults. http://www.pewresearch.org/fact-tank/2013/06/06/cell-phone-ownership-hits-91-of-adults/
  63. Rawls J (1971) A theory of justice. Universal Law Publishing Co Ltd, New DelhiGoogle Scholar
  64. Raz J (1986) The morality of freedom. Clarendon Press, OxfordGoogle Scholar
  65. Read S, Grundy E, Foverskov E (2016) Socio-economic position and subjective health and well-being among older people in Europe:: a systematic narrative review. Aging Mental Health 20(5):529–542.  https://doi.org/10.1080/13607863.2015.1023766 CrossRefGoogle Scholar
  66. Reisch LA, Sunstein CR (2016) Do Europeans like nudges? Judgment Decis Making 11(4):310–325.  https://doi.org/10.2139/ssrn.2739118
  67. Richter M, Hurrelmann K (2009) Gesundheitliche Ungleichheit: Ausgangsfragen und Herausforderungen. In: Richter M, Hurrelmann K (eds) Gesundheitliche Ungleichheit: Grundlagen, Probleme, Perspektiven, 2nd edn. VS Verlag für Sozialwissenschaften/GWV Fachverlage, Wiesbaden, Wiesbaden, pp 13–33CrossRefGoogle Scholar
  68. Robert Koch-Institut (2015) Gesundheit in Deutschland (1. Aufl.). Gesundheitsberichterstattung für Deutschland. Robert Koch-Institut, BerlinGoogle Scholar
  69. Robert Koch-Institut (2016) Gesundheitliche Ungleichheit im höheren Lebensalter. GBE kompakt 7(1):1–14Google Scholar
  70. Sallis JF, Owen N, Fisher EB (2008) Ecological models of health behavior. In: Glanz K, Rimer BK, Viswanath K (eds) Health behavior and health education: theory, research, and practice, 4th edn. Wiley, San Francisco, pp 465–486Google Scholar
  71. Schaeffer D, Vogt D, Berens E-M, Hurrelmann K (2016): Gesundheitskompetenz der Bevölkerung in Deutschland. Ergebnisbericht. Universität Bielefeld, Bielefeld. Fakultät für Gesundheitswissenschaften. http://www.uni-bielefeld.de/gesundhw/ag6/downloads/Ergebnisbericht_HLS-GER.pdf
  72. Schmidtz D (2011) The right to distribute. In: Bader RM, Meadowcroft J (eds) Cambridge companions to philosophy. The Cambridge companion to Nozick’s Anarchy, state, and utopia. Cambridge University Press, Cambridge, pp 197–229Google Scholar
  73. Schröder P (2007) Public-Health-Ethik in Abgrenzung zur Medizinethik [A separation of public health ethics from medical ethics]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 50(1):103–111.  https://doi.org/10.1007/s00103-007-0115-z CrossRefGoogle Scholar
  74. Segall S (2009) Health, luck, and justice. Princeton University Press, PrincetonCrossRefGoogle Scholar
  75. Shaw M, Gordon D, Dorling D, Mitchell R, Smith D, G (2000) Increasing mortality differentials by residential area level of poverty: Britain 1981–1997. Soc Sci Med 51:151–153CrossRefGoogle Scholar
  76. Smith A (2013). Smartphone ownership 2013. http://www.pewinternet.org/2013/06/05/smartphone-ownership-2013/
  77. Smith A (2015) ChapterOne: a portrait of smartphone ownership. http://www.pewinternet.org/2015/04/01/chapter-one-a-portrait-ofsmartphone-ownership/
  78. Statista (2015) Nutzung von Digital Health-Applikationen und -Services im Bereich Fitness Training/Tracking/Monitoring in Deutschland nach Alter und Geschlecht 2015. https://de.statista.com/statistik/daten/studie/454386/umfrage/nutzung-digitaler-apps-und-services-im-bereich-fitness-training-tracking-monitoring/
  79. Stieglitz S, Potthoff T, Kißmer T (2017) Digital Nudging am Arbeitsplatz: Ein Ansatz zur Steigerung der Technologieakzeptanz. HMD Praxis der Wirtschaftsinformatik 54(6):965–976.  https://doi.org/10.1365/s40702-017-0367-5 CrossRefGoogle Scholar
  80. Tanaka A, Fiebrink R, Parkinson A (2015) D2.1 user-centerd design methodology. RAPIDMIX-WD-WP2-UPF18May15-D2.1.docx. http://rapidmix.goldsmithsdigital.com/wp-content/uploads/2016/02/D2.1UCD.pdf
  81. Temkin L (1993) Inequality. Oxford University Press, OxfordGoogle Scholar
  82. Thaler RH, Sunstein CR (2008) Nudge: improving decisions about health, wealth, and happiness. Yale University PressGoogle Scholar
  83. The Lancet (2017) Does mobile health matter? Lancet 390(10109):2216.  https://doi.org/10.1016/S0140-6736(17)32899-4 Google Scholar
  84. Thomas A (2012) Cohen’s critique of rawls: a double counting objection. Mind 120(480):1099–1141.  https://doi.org/10.1093/mind/fzs005 CrossRefGoogle Scholar
  85. Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A, Worthy G (2008) Population tobacco control interventions and their effects on social inequalities in smoking: systematic review: systematic review. Tobacco Control 17(4):230–237.  https://doi.org/10.1136/tc.2007.023911 CrossRefGoogle Scholar
  86. Turrell G, Patterson C, Oldenburg B, Gould T, Roy M-A (2003) The socio-economic patterning of survey participation and non-response error in a multilevel study of food purchasing behaviour: area- and individual-level characteristics. Public Health Nutr 6(2):181–189.  https://doi.org/10.1079/PHN2002415 Google Scholar
  87. Weicksel J, Pentsi A (2015) 44 Millionen Deutsche nutzen ein Smartphone. https://www.bitkom.org/Presse/Presseinformation/44-Millionen-Deutsche-nutzen-ein-Smartphone.html
  88. White M, Adams J, Heywood P (2009) How and why do interventions that increase health overall widen inequalities within populations? In: Babones SJ (ed) Social inequality and public health. Policy Pr, Bristol, pp 65–83Google Scholar
  89. Wolff J, De-Shalit A (2007) Disadvantage. Oxford political theory. Oxford University Press, Oxford.  https://doi.org/10.1093/acprof:oso/9780199278268.001.0001
  90. World Health Organization, Regional Office for Europe (1986) Ottawa Charter for Health Promotion. http://www.euro.who.int/__data/assets/pdf_file/0004/129532/Ottawa_Charter.pdf

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Katrin Paldan
    • 1
  • Hanno Sauer
    • 2
  • Nils-Frederic Wagner
    • 3
  1. 1.Abteilung für Informatik und Kognitionswissenschaft AG Interaktive Systeme, Fakultät für IngenieurswissenschaftenKompetenzzentrum Personal Analytics, Universität Duisburg-EssenDuisburgGermany
  2. 2.Department of PhilosophyUtrecht UniversityUtrechtThe Netherlands
  3. 3.Department of PhilosophyUniversity of Duisburg-EssenDuisburgGermany

Personalised recommendations