If, like me, you watched last month’s 2018 Olympic Winter Games on television, you may recall a particular Apple ad that seemed to run during most commercial breaks.
The Dear Apple commercial presents a montage of athletes and everyday people reading personal tributes to their Apple Watch for facilitating their athletic training, rehabilitation, medical treatment, and even life-saving health alerts. I have a similar story.
I have worn a smartwatch for about two years — not the Apple Watch, but one of its competitors. I love it, mostly for the biometric data it collects that helps me track my physical activity levels. I know that these devices are not perfectly accurate in all contexts.
But my ability to monitor broad trends in things like my heartrate, daily steps, and stairs climbed has helped me take more ownership of my activity levels and overall physical health. I am healthier because of it.
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Late last year, I experienced a routine viral respiratory infection that quietly triggered a much more serious health condition. The new condition went undetected for months, even while it visibly wore me down. I made lots of excuses for my degrading health, such as increased stress at work after recovering from Hurricane Irma.
When others suggested I see a doctor, I was initially stubborn, thinking that this was all due to temporary factors. But my smartphone changed my mind: The app linked to my smartwatch revealed an undeniable and dramatic spike in my resting heart rate that coincided with the onset of that respiratory infection. I saw my doctor, and four anxious months after that infection, everything was under control.
The problem is, this story doesn’t necessarily have a happy ending for the tens of millions of Americans, much less the billions of people around the world, who cannot afford a smartwatch (or similar technology). The Apple Watch caters to a wealthier consumer, with the latest models ranging from $300-$600, and is thus out of reach for many families.
This is just another brick in the wall that is known as the digital divide, the socio-economic disparity in access to information and communication technology, which in turn can shape health outcomes. As with genetic testing and other new health technologies, the benefits often disproportionately go to those with better means.
Some nonprofit programs, such as Miami-based One Laptop Per Child (OLPC), aim to overcome the digital divide by putting technology directly in the hands of low-income communities around the world (OLPC’s first US project was at Miami’s Holmes Elementary School).
Scientists and policy makers have started to explore how digital technologies such as smartwatches present tradeoffs for health equity. New mobile health technologies (often referred to as mHealth) hold great potential to eliminate health disparities by connecting lower-income populations with better information and providing new ways to deliver medical services. But in a market-based economy, the opposite can happen. A recent study in India found that in communities where increasingly more residents owned mobile phones, those without a phone (who thus tended to have lower incomes) were less likely to have access to a private doctor, as services increasingly targeted higher-tech residents.
Free markets help spur innovation and the creation of new products like smartwatches in the first place, and we don’t want to constrain that. But companies have a natural incentive to act responsibly and ensure that their products do not exacerbate existing inequalities: a healthier and wealthier America (and world) means more Apple customers, right?
So, Dear Apple (and competitors): our nation is, in many ways, reeling from an ever-growing wealth gap that affects education, employment, and health and wellness.
We all make our own decisions, but I want to live in a world where an inner-city teenager at least has the same tools for staying healthy as I do. Your products further empower those with access.
Please don’t accidentally make it worse for those without. Let’s find ways to put economical versions of smartwatches and health trackers in the hands of our young and lowest-income residents. Let’s help people make more informed healthy choices that yield a lifetime of dividends and reduce the digital health divide.
Justin Stoler is assistant professor of geography and public health sciences at the University of Miami.