In a post-modernist and post-structuralist world, the conceptual understanding of the term "Health" has taken on new forms and directions, and it is now understood to refer to more than just one's survival or well-being. It is now a commodity with a significant economic, political, and social value in the market economy. One effect of this commodification is that there is a growing awareness among individuals that the maintenance of good health directly correlates with the quality of life. In order for such to occur, there is a constant effort to know more about what is happening inside the body, so that any potential health risks can be managed before the onset of illness.
In his essay, The Politics of Life Itself, Nikolas Rose talks about the idea of “risk politics” whereby risk includes many computations and ways of acting in the present, so as to limit the possibilities of risk in the potential future (Rose, 2001). This risk politics plays a very integral role in the smooth functioning of biopolitical power structures. The State, its various healthcare systems, and discourses of science and technology are some of the key characteristics that ensure that an individual’s biological existence gets inextricably linked with the very politics of the existence of life itself (Rose, 2001).
In his essay, The Crisis of Medicine or the Crisis of Antimedicine? Foucault discusses the shift where the State undertook the charge of ensuring and enforcing not just the “right of life” to its individuals but the right to a healthy life. This shift becomes relevant in understanding that in the twentieth century, the “panoptic gaze” of power is not just concerned with ensuring the life but the quality of life of an individual, thus, making the human body and its existence a part of deeper mechanisms of surveillance and control. This paper attempts to look at such means of surveillance through the increased usage of Fitbit bands and smartwatches in today’s times.
Fitbit bands, smartwatches, and Surveillance
The American company Fitbit manufactures "wireless-enabled and wearable fitness devices" including smart watches, pedometers, and other devices that fundamentally monitor people's physical activity, including their step count, heart rate, menstrual cycle, calories burned per second, and other metrics. Joseph I. Sirven, who is a professor of neurology at the Mayo Clinic in Phoenix, says, that with the more precise information provided through such wearable bands, one “can often spot problems even before a patient is aware of them”. This brings to one’s attention how these devices are used to keep track of the slightest movements in the bodies of individuals, monitoring their everyday activities in the minutest details possible. This data is further used in order to regulate the individuals in altering their behaviors, habits, and practices so as to deliver the promise of ‘better health and a quality life’.
In his book, Discipline, and Punish, Foucault talks about the idea that the “panopticon” operates in a way that it is like a laboratory of power that aims to “alter behavior, to train and correct individuals”. The panoptic eye supervises the body of the individual in a way that “he is seen but he does not see; he is the object of information, never a subject in communication” (Foucault, 1991). In the case of smartwatches and Fitbit bands, the panoptic eye becomes flexible, whose sole function is to enable and facilitate the information provided by the user. This information is further used and sold to pharmaceutical companies so as to identify individuals with illnesses or with the potential of having an illness. Pharmaceutical firms in turn capitalize on and leverage the fears and anxieties of people with or without potential medical issues through the use of marketing and social media platforms.
Shoshana Zuboff, in her book The Age of Surveillance Capitalism, talks about how companies like Google, Facebook, etc. transform individuals into “objects from which raw materials are extracted and expropriated for Google’s prediction factories. Predictions about our behavior are Google’s products, and they are sold to its actual customers but not to us. We are the means to others’ ends” (Zuboff, 2019). Thus, the users are turned into objects who are only facilitating the capitalistic gains of companies and health insurance businesses, as they navigate their way through personal techniques that guarantee the care of the self.
The constant surveillance ensured by such wearable gadgets further leads to a certain automatism where the user continues to alter their bodily motions and activities even after discontinuing the usage of such devices. As a result, the panoptic eye metamorphoses into the ‘eye’ (and ‘I’) of an individual where even in the absence of such devices, the individual’s eye moulds, regulates, and adjusts one’s behavior and conduct.
Usage of Smartwatches in Healthcare Systems
The usage and dependence on science and technology in the field of healthcare have increased over time. It is possible to comprehend the concept and promise of technological developments in healthcare systems in their dual capacity, as described by Bernard Stiegler. Stiegler defines technology as a "pharmakon," which is both an inescapable poison and something that also has curative potential (Steigler, 2013).
One of the major technological advances in the medical industry is the use of wearable biosensors, which are increasingly utilized to assess and monitor illnesses and medical diagnostics. These devices employ a number of biochemical indicators that assist monitor physiological fluids like perspiration, tears, saliva, etc. Wendy Nilsen discusses the use of Echowear, a smartwatch-based technology that is used to gather information on the various characteristics of speech exercises carried out by Parkinson's disease patients outside of the clinic. These smartwatches measure the loudness, speech signals, and fundamental frequency, which helps speech-language pathologists (SLPs) design treatments that are relevant and effective (Nilsen, 2015). As a result, it is anticipated that the use of wearable biosensors in the medical industry will significantly enhance the health of the people being monitored.
Similar to this, dementia patients, particularly the elderly, whose condition is characterized by a loss of memory and cognitive functions, appear to benefit from such biosensors because, in the absence of caretakers, these sensors assist in recording the physical status of the health, which in turn improves the structures of care for the respective person. Jia Zhou explained in his paper how the Basis B1 band was useful in documenting a variety of health-related problems, such as daytime napping, challenges with nighttime sleep, poor sleep quality, and early morning awakenings. By using these bands to verify these problems, it was possible to take the necessary precautions to "guarantee the patient's good health, safety, and quality of life" (Zhou, 2015).
With the use of biosensors, it is now possible to automatically maintain physiological data and collect it in a timely manner. However, the concept of health itself has undergone a transformation because it no longer solely refers to the absence of disease but also to the visibility of a corporeal body that aspires to embrace the concept of "quality living" and total well-being. The constant surveillance by biosensors also highlights the additional contributions made by "ethnopolitics," which is concerned with "the self-procedures by which human beings should judge themselves and act upon themselves to make themselves better than they are" (Rose, 2001). Although these sensors are employed for their productive potential, as molecular-level medical interventions expand, the distinction between illness and health is becoming blurrier.
The conceptualization of "Health" has changed in the post-enlightenment world, where it is no longer just a thing to be consumed but rather an entity in itself. "Health" has evolved to have a social character of its own and is no longer merely a category that is limited to one's survival or well-being. The best way to understand its operation and many processes is to critically examine the direction it is moving in relation to the rest of the world.
The healthcare system all across the globe is undergoing a significant change from hospital-based to individual-based systems. With more than 20 billion spent on wearable biosensors each year, the healthcare system has taken a personalized form as individuals continue to monitor and regulate their behavior by just looking at the data produced by such gadgets. The usage of technology in the medical field can be understood in its dual capacities where it can be productive but also sterile.
- Foucault, Michel. Discipline and Punish (Penguin Social Sciences). Translated by Alan Sheridan, Penguin Books, 1991.
- Foucault, Michel. “The Crisis of Medicine or the Crisis of Antimedicine?” Foucault Studies, No 1, pp. 5-19, December 2004. Nilsen, Wendy. Proceedings of the Conference on Wireless Health. Edited by Wendy Nilsen, Association for Computing Machinery, 2015.
- Ramasubramanian, Sowmya. “Smartwatch data can be used to predict underlying illness.” The Hindu, https://www.thehindu.com/sci-tech/technology/smartwatch-data-can-be-used-to-predict-underlying-illness/article34728647.ece
- Rose, Nikolas. “The Politics of Life Itself.” Theory, Culture, and Society, vol. 18(6), 2001, pp. 1-30.
- Stiegler, Bernard. What Makes Life Worth Living: On Pharmacology. Translated by Daniel Ross, Wiley, 2013.
- Zhou, Jia, and Gavriel Salvendy, editors. Human Aspects of IT for the Aged Population. Design for Everyday Life: First International Conference, ITAP 2015, Held as Part of HCI International 2015, Los Angeles, CA, USA, August 2-7, 2015. Proceedings, Part II. Springer International Publishing, 2015.
- Zuboff, Shoshana. The Age of Surveillance Capitalism: The Fight for the Future at the New Frontier of Power. Profile Books, 2019.
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