How did the connected health movement begin and what are the roadblocks to access and adoption? We talked to a Health Economist about the history and future of the technology that is revolutionizing healthcare.
Inventing, producing, and marketing connected health devices requires attention to consumer trends, regulatory developments, international markets, and a variety of other fields. However, devoting resources and centering product philosophy to uplifting people who might otherwise be left out of the connected health world is paramount as there is no complete ecosystem without their participation. But when we mention people being left out of the connected health ecosystem, who are we referencing? Some might typically point to older members of the population, but this would not accurately describe everyone who stands to lose by not being part of the connected health revolution.
Health economist and author Jane Sarasohn-Kahn has spent decades researching the healthcare industry and its associated technology and limits to wider adoption. Sarasohn-Kahn touches upon various events that have led to connected health and the limits that have prevented more participation in the ecosystem, and Withings Co-founder and current President Éric Carreel responds with how he is working to address roadblocks and inviting more stakeholders into the connected health fold.
The curious case of recessions driving innovation
Addressing the limits on connected health requires a bird’s-eye view of the landscape, and Sarasohn-Kahn does so by saying COVID19 has accelerated “do-it-yourself” (DIY) care, partly evidenced by spending on out-of-pocket costs increasing by a third during the pandemic. However, according to Sarasohn-Kahn, this DIY health trend didn’t start in 2020, but far earlier. She cites the Great Recession of 2007 as a turning point towards wider adoption of connected health.
“In recessions, people are broke. We end up depending on ourselves to make life, rather than going to restaurants, doctors, etc. So, how do we avoid spending money outside of the house? We take it inside the house,” says Sarasohn-Kahn.
And a lack of money is key in the story of the Great Recession. Inflation may have contracted and recovered within 18 months, but The Great Recession’s financial effects extended well beyond as one in five U.S. workers were laid off and never received a full-time job again. In addition, from 2006 to 2016, middle income earners’ wages grew at a slower rate than low and high earners. Digital gigwork began to fill in the employment holes with Airbnb and TaskRabbit in 2008 and Uber in 2010, and all of these events together made for either no healthcare coverage or increasingly expensive plans and doctor visits.
The decrease in the number of jobs that provided healthcare meant more self-reliance with regard to personal health. Again, Sarasohn-Kahn explains the wider psychological effect on this wider national decrease in income-disparities for American workers. “We go through these recessions, feel broke or limited, and we make up for it with more self-care, with the home emerging as a health hub.” This idea of health at home was especially pronounced three years after the Great Recession as the Health Care and Education Reconciliation Act (the ACA) was not signed until the end of March of 2010 before states were mandated to expand American citizens’ access to healthcare.
The rise of the quantified self
However, the DIY home-health phenomenon wasn’t just due to financial insecurity and job loss. The increase in connected health intersected with Apple’s iPhone release the same year of the recession’s beginning, 2007, and this convergence led to wider adoption of connected health beyond the original enthusiasts known as the Quantified-Self (QS) community who would previously go to Radio Shack to buy components and “make” their own contraptions to capture health metrics. 2008 was also the year Withings was founded by engineers, including Carreel, who were looking to revolutionize the world’s relationship with health. Then in 2009, Withings engineers developed and brought to market the world’s first connected scale.
In terms of access, America was headed towards the beginnings of connected health, but the journey towards wider adoption had not been one of linear progress but a mix of deep and painful economic realities and technological advancements.
Connected health roadblocks: high-speed internet, health literacy, and data privacy and control
This most recent economic downturn is not only different with respect to its origin in the pandemic, but also the force by which it has pushed people towards the home as a health hub. Fear of visiting the doctor or actual pauses in annual physicals and other routine care have been a feature of the pandemic as well as the explosion in telemedicine. Therefore, data collection has been pushed even further to digital; but have the limits to greater access been lowered?
Ideally connected health can enable better outcomes by decreasing barriers to meaningful data for both patients and providers, but what are the limits on connected health from expanding into the future or even being accessible to people now? Sarasohn-Kahn states that one of the biggest blocks is access to broadband or high-speed internet, something the Federal Communications Commission says is not being rolled out at the rate needed for America. With almost 15% of American households without an internet subscription (or double that rate for low-income earners), access to connected health is not tenable in the absence of reliable broadband.
Sarasohn-Kahn continues by saying that health “literacy” is another major challenge, and this can be divided into four categories:
- General reading literacy
- Digital literacy
- Health plan literacy
- Medical literacy, as in understanding how to use a prescription drug regimen, etc
Regarding general literacy, the U.S. Department of Education reported in 2019 that 43 million adults (16–65) in America lack basic literacy, or more specifically, are unable to complete simple forms, consume relatively short texts, or find the meaning of sentences. Two-thirds of those adults were born in the U.S..
General illiteracy leads to additional illiteracy in the other three categories without explicit and external help from community and healthcare sources. The added weight of poverty being closely associated with illiteracy is another strike in terms of families and individuals being able to allocate personal funds for connected devices, and this can leave a large segment of the population out of the connected health ecosystem even in the presence of Wi-Fi access.
This realization led Sarasohn-Kahn to assert that access to broadband is a social determinant of health; without it, and especially learned in the COVID-19 public health crisis and #StayHome era, people could not work from home, attend school or college at a distance, seek jobs, or communicate with loved ones living elsewhere.
Data privacy and control is another limit to connected health that Sarasohn-Kahn lists. Though many of us may be vacillating back and forth between the acceptance that most of our data has been compromised at one point and the idea that we still retain some morsel of anonymity regarding our personal health information, scientists have polled segments of the population across the world and find that a majority of people would be fine sharing their health data for scientific research and even disclosing analytics for financial reward.
Forward-thinking health companies are responding to these limits on connected health by developing devices that operate with cellular service. Take Withings Health Solutions, the new B2B arm of Withings to provide digital health programs, providers, and patients the tools they need to address the limits of connected health as outlined above:
- Broadband access — Health Solutions provides digital health programs with smart devices including scales and blood pressure monitors that require no Wi-Fi or internet connection. Instead, devices connect through cell service thereby making a more inclusive environment for people living in rural areas, low-income households, and others who might lack access to broadband services. In addition, devices can be mailed directly to patients thereby overcoming potential issues in transportation.
- Literacy — The Withings devices from Health Solutions require minimal installation usually entailing one step to complete setup. However, healthcare professionals can opt to be part of the program so patients receive external help that any literacy might otherwise be impeded by. Technology is scary for a lot of people, and making it as easy to use as possible reduces barriers in literacy.
- Data privacy and control —Devices sold in the Withings Health Solutions range can be set up in a HIPAA compliant environment. In addition, Withings is a European company that follows GDPR rules which ensures users’ data is not abused. Finally, because patient data is oriented towards improving care, the sharing of analytics between patient and doctor follows positive inclinations based on polling conducted across segments of the population.
- Cost — Health Solutions promotes preventative care, which by itself is a cost-saving measure, and investments in daily measurements that Health Solutions devices provide ultimately save money by reducing instances of more serious events.
When asked about the work Withings has done to create a more robust connected health ecosystem, Carreel sums up the above by saying, “Our mission has always been to provide empowering tools for patient-centered care. To achieve better long-term health outcomes, Health Solutions is laser-focused on helping save time and money by bridging the gap with accurate data and a system that improves patient management. Reducing barriers, increasing literacy, and respecting others’ data are all key to delivering on the promise of connected health.”
Jane Sarasohn-Kahn is a health economist, advisor, and consultant that has spent three decades advising healthcare stakeholders including public sector entities, NGOs, and life science and tech companies. Jane is also the author of Health Citizenship: How a virus opened up hearts and minds, a book that explores the four pillars of ‘health citizenship’: access to healthcare, data rights, institutional trust, and love for fellow health citizens. You can keep up with Jane and her work at HealthPopuli or follow her on LinkedIn. Please note that Sarasohn-Kahn’s participation in this conversation is not an endorsement of Withings or its associated programs and/or technology.
Health Solutions is the new B2B arm of Withings which provides HIPAA-certified and GDPR-compliant devices for programs and providers to view patient analytics and implement informed care. Data points including weight, heart rate, ECG readings, blood pressure, body temperature, and more can be collected through Withings medical-grade device ecosystem.* Drop shipment of connected devices and dedicated support channels for care managers are available, and cellular capability combined with long battery life ensure that patients remain engaged in programs.
*Certain measurements are country-specific regarding availability.
Learn more about data security at Withings.