Personalized Health Technology and Public Health: A Call to Action

The world’s largest technology companies— Apple, Google, IBM, Microsoft, and more—are making population health a core focus of their businesses. They're recruiting top talent from technical disciplines, but there is a shortage of new hires from the nexus of public health and information technology. Public health professionals and researchers need to take notice.

Digital health technologies like wearable devices and smartphone apps are exploding. According to IMS, the number of health and wellness apps more than doubled to 165,000 between 2013 and 2015. Wearable fitness trackers and smartwatches are also experiencing huge growth in sales, with estimates that worldwide shipments of watches and trackers will reach 110 million by the end of 2016.

Together, these apps and devices are generating incredible amounts of data, much of which can be used to study and promote health.

Many chronic diseases are linked to unhealthy behaviors, including lack of physical activity, poor nutrition, tobacco, and excess alcohol use, and a recently published study found that less than 3 percent of adults in the US maintain a healthy lifestyle, defined as being sufficiently active, eating a healthy diet, not smoking, and having a healthy body fat percentage. Thus, driving behavior change related to diet and physical activity could reduce both disease and economic burden attributable to chronic conditions. Evidence is emerging that wearables and smartphone apps can be effective tools for these behavior changes.

In addition to facilitating changes in behavior, the data generated by these technologies might also provide valuable insights into health and wellness at a population level. A recently published New York Times editorial described this data stream as, “the largest and most comprehensive observational health trial ever conducted.” While this data cannot replace randomized controlled trials and traditional observational studies, it could help uncover patterns and identify insights into successful health promotion efforts. This could improve existing models and generate new causal hypotheses.

Some forward thinking researchers have already begun to integrate wearables into their studies, with many clinical trials currently using Fitbit in some capacity. Fitabase, a web platform for the collection, analysis, and export of data from Fitbit devices, has already assisted researchers and other healthcare institutions in over 100 research studies.

There are numerous challenges, however, to using these technologies in the context of public health.

While the U.S. Health Insurance Portability and Accountability Act (HIPAA) protects medical information, existing laws in the United States do not cover data generated by most personalized health technologies. A study of diabetes apps in the Google Play store found that 81 percent did not offer privacy policies. For the subset of apps that did offer a privacy policy, 17 percent of the provisions said the user's data could be disclosed to advertisers.

Aside from the challenge of privacy, socioeconomic inequalities present a major obstacle as well. While older, lower income populations stand to benefit the most from such health promotion efforts, younger and more affluent individuals are generally the early adopters of these technologies. But innovative companies like Omada Health and Talk Space are making an effort to ensure that these technologies reach those who need them most.

The role of well-trained public health professionals is crucial to foster dialogue on these challenges. Public health graduates are also more attuned to the issues and complexities that make the “disruption of healthcare” particularly challenging.

Leading voices in public health, including the U.S. Centers for Disease Control and Prevention and The Lancet have called have called for changes to public health curricula. Although most public health programs offer statistical programming courses like SAS and Stata, curricula generally do not include deeper technical skills. Some programs have options for specialized training in public health informatics, but gaps in skills and knowledge persist.  

Public health programs need to better integrate and collaborate with technology and computer science disciplines. These efforts will make public health graduates more competitive in the job market and ultimately better equip companies to address today’s pressing public health problems through technology.

My colleagues Gillian Christie, Derek Yach, and I recently co-authored a viewpoint on this topic along with Abdul El-Sayed, Executive Director & Health Officer at the Detroit Health Department and former Columbia University professor. Read more here: The Importance of Computer Science for Public Health Training: An Opportunity and Call to Action.

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