I can’t say the precious seconds lost trying to get my Fuelband to tell me the time is what made me late for the meeting but it didn’t help. The question I had to ask myself, then, is what help is it giving me?
I guess when I first got the Fuelband it was interesting to see how many steps I was taking each day and how on some days I was more sedentary than I realised. That made me change how I structured my days so that I had time to walk from meeting to meeting across London. It was a good example of how the data collected (steps) was translated into information (active versus sedentary days) and then into actionable knowledge (change more sedentary days into active ones).
But now what? I want it to help me do something else. But it doesn’t. That’s pretty much all it does. I was hoping to map my activity to my weight to see how that changed over time, but Nike doesn’t offer that. I think FitBit does, but I lost my “One” a few weeks back and I have to admit that I wasn’t remotely bothered (I got it for free at TEDMED so there wasn’t even a financial loss). In truth, I also felt a little nerdy walking about with something clipped to my belt so it was sort-of a relief.
To my mind, the quantified-self movement has plateaued. I suspect enthusiasts will tell me that with new sensors we’ll be able to collect more data (see here, for example), which can equally turn into information. Fine, but the real magic is the leap from information to actionable knowledge. In my example that leap was fuelled by what I wanted to do – spend less time on my bum and more time walking. Why? Because it helps to stretch my hip flexors, which, in turn, helps to overcome my almost-absent lumbar lordosis, which, in turn, helps to open up the space around the root of my sciatic nerve, which, in turn, helps to reduce my ongoing sciatic pain. How can any sensor know all that, and hence make the leap for me?
Sensors can’t, at least not yet. If you really listen carefully for the signal in the health innovation noise you’ll hear cogent voices talking about the need for “a high-level approach for creating emergent multi-device user experience”. Great, but it still won’t convert information into actionable knowledge. To do that we need to understand what people are trying to do.
Now I have to be honest and say that I am borrowing my thinking from one of the smartest people I have ever met – Kingshuk Das. He’s now one of the Wellthcare Explorers but after we first met he said something on Twitter that it’s taken me five months to understand: ‘We need to change the focus from “health & wellness” to what folks are actually trying to do in their lives.’
What I’m trying to do is lengthen my hip flexors. The impact of achieving this is to reduce my likelihood of pain and hence, quite frankly, lengthen my days given that when pain-free I’m not as tired as I am when my pain is my constant companion. With longer, pain-free days I can “do” more.
Kingshuk mentioned “wellness” in his tweet and this week I listened in on what I can only describe as a tempestuous webinar about the over-promising, anti-scientific, and perhaps even fraudulent behaviour of the wellness industry. In it, Al Lewis and Vik Khanna continued to do what they have been doing so well to date, which is to examine the evidence underpinning wellness programmes and point at the inconsistencies between the data and the marketing claims.
They made their usual convincing case but my more fundamental problem with “wellness” is that it’s defined by what health providers think we should be doing. I can’t think of anything less motivating than being told what to do, especially when what I want to do is not being considered. I’m sure that when I asked why I want to spend less time on my bum you thought of the cardiovascular benefits of being more active but I couldn’t give two hoots about that in comparison to reducing my sciatic pain.
Therein lies the unspoken tension that inhibits imagination in health and health care. It’s not what you think I should want that matters, it’s what I want that matters. Wellness and health care are what I increasingly see as “supply-side thinking”. Health care, as the all seeing and all knowing Big Brother, is telling us what we should want – and we have to trust it because we don’t know any better. We probably don’t, but you, health care, can’t make me want what you want me to want.
In my ongoing quest to carve open new thinking in health and health care, I call this the “wantified self”. It’s only, as Kingshuk said five months ago, by knowing what people want can we really figure out what health-related services to offer them – in other words, “demand-side thinking”.
Interestingly, my physiotherapist doesn’t buy my flexor-lordosis-sciatic theory. She thinks I have a “chemical neuritis” post-surgery. I don’t really know what that is, but the treatment seems to be the same – to work on my hip flexors. I’m “adhering” to my treatment because it’s aligned with how I justify my “want”, a happy coincidence rather than a validation of the role of health care in my life.
At the end of the first debate between the Wellthcare Explorers they asked: “How do the things that people care about relate to health?” For me, this is about understanding “demand”. How is it that we have a US$7tr global industry that has no mechanism to truly understand demand? It’s time to ease off on the quantifying and think more about wantifying.
This post was first published on MedCrunch and is part of an ongoing series.
Excellent line of thought here. What is really interesting is that a very similar line of thought has begun amongst the front-runners in marketing as well — that we have to stop selling what people need, and rather give them exactly what they WANT, because it’s infinitely more effective … and more genuine. There’s a whole lot less ego involved of course, so will it be difficult for the influencers and providers in health (and business) to seemingly “ignore” what they “know” people need in favour of presenting what people actually want?
Dear Matt,
I think you ask an excellent question.
My view – or perhaps hope – is that providers of care will move to a more blended understanding of the care they provide – part what people “want” and part what they think people “need”. With some luck there will be a significant overlap but that’s yet to be seen.
I also think that with greater transparency people should be able to critique whether what they’re told they “need” is real. All too often in health care we have been guilty of using one-size-fits-all research conclusions to apply to all and sundry. This seems increasingly unjustified as we not only better understand people’s differences, but also spend a little more time understanding what they want.
It’s interesting that marketing is going through the same realisation. I think the media saturation many of us experiencing is making it harder for brands to push inauthentic messages.
I’m glad you’re reading, Matt, and look forward to future comments.
Pritpal
Thanks for your response Pritpal.
I’ve also been considering that an important rationalisation for presenting what people actually want rather than what experts, brands and influencers say they need, is that the majority of people still don’t seek out preventative measures (in health or business, but particularly in health I believe) — they wait until they have strong physical or emotional symptomatology before seeking help. However, in seeking to present solutions based on what people want presently, it should provide health care (and business) providers the ability to actually do more good by building a preventative approach into the solution.
Conversely, one potential downside of a wants-based approach is that while people generally want to be healthy (or at least feel good physically), many people also want fast, easy relief of symptoms (e.g. headaches), so they’re happy to take something like panadol/nurofen and ignore the real ongoing issues (often lifestyle-based). Some will want to be able to get drunk every Friday night and still stay healthy. Some will want to eat McDonalds every day and yet still want to feel good (failing to understand the connection between their emotional health and their physical intake). These wants clearly conflict, so I wonder if education is the only answer, or if there will ever be enough pressure on big corporations to “clean up” their offerings?
And, perhaps a little off-topic here, another question I have is around the projected profitability (and subsequent fear of loss of income) when influencers, health care providers and big brands (such as pharmaceuticals) may have around the “prevention” (wellness) approach — will they avoid transparency and genuine preventative and wants-based solutions because of the perceived likely loss of future income?
Dear Matt,
Yes, I agree that engaging people on what they want presents opportunities for “prevention”, as it’s currently defined by the health care industry. I think, however, what’s key to this is the mutual respect that comes with starting from where people are, rather than telling them where they should be.
It’s certainly likely that people will want unrealistic things, something that is perhaps fuelled by media and the prevailing culture. However, I don’t think that’s something to fear at this stage. What matters is that we start the dialogue and then see what “problems” there are to solve.
I am not a great fan of “information” as a solution. I tried to use information to improve the delivery of care when I was the Medical Director of Map of Medicine, but the truth is that the drivers of change first need to be understood. Interestingly, a lack of information was rarely the issue. Wider incentives have to be aligned to truly create change.
I think the potential loss of income that you allude to (and no, it’s not off-topic at all) is a very big issue, and I think it plagues providers’ thinking as much as the pharma industry’s. That’s in part why I have described Wellth as being new value – by starting in a place where there is no proprietary ownership of value we can at least start the dialogue and experimentation.
Thank you for your excellent questions, Matt.
Pritpal
Thanks Pritpal.
In saying that you’re not a fan of information as a solution per se, it was very clarifying for me. I’ve been pondering the info-marketing “revolution” in relation to healthcare/wellness, and realise that clearly it is not enough — many millions of dollars are spent by consumers on wellness information, yet the intrinsic health challenges still remain for the most part. After all, it is only ever action, not knowledge, that creates results.
Partly I feel that real change in people’s state of health may only happen when a cultural shift occurs, putting substantial pressure on big industries like food and pharma to veer towards supporting people’s health rather than just satiating their desires. But I’m concerned that it will be a very long time before there is enough cultural pressure to enact that sort of top-level change.
So, I guess that brings it back to what you’re saying — that coming alongside people (both healthcare consumers and providers), starting where they are at and creating a genuine dialogue to understanding drivers does seem to be a key starting point.
It feels slightly overwhelming though — are there points of greatest leverage to initiate understanding and eventual change? Does a cultural shift need to happen first with healthcare industry/providers, or do you think it will be consumer-driven?
In any case, I’m obviously out beyond the verge of my personal knowledge here, so I look forward to reading your future articles to gain further insight and watch it all unfold in your capable hands.
Best regards,
Matt C.
Dear Matt,
You’re as expert as anyone else in this area. Firstly, you can probably describe what you want to achieve in your life (or in the next year) and hence what role health might play in that. You’re an expert in yourself.
Also, no matter what people say, be they behavioural economists, data scientists, epidemiologists, whatever, we’re in unchartered territory here. There are small projects out there leading the way, but none of us really know how to deliver the radical changes we need in health care. Indeed, one of the biggest problems I have encountered in trying to “explore” this space is that people think they know. They don’t.
Yes, it’s overwhelming. I often feel the same way. However, I think that what I’m hearing from the Wellthcare Explorers is enough to fashion a few “pilots”, preferably in communities at the fringes. This will make it possible to “see” what all this looks like, at least for that specific community. The more pilots we can get the more we can learn what works, as a rule, and what’s specific for different communities.
I’ve enjoyed this debate. Keep asking questions. In due course I am going to change the strap line on the homepage to something like: “Wellthcare: exploring the role of health care in society” as that’s what we’re really doing here.
Thanks again.
Pritpal