I'm no stranger to the appeal of the latest, greatest wearables and smart health devices. But as all this wellness technology become the norm, what does this mean for people who don't strap a smartwatch onto their wrists? If comprehensive health data—and the insights it provides—becomes a luxury good, the existing digital health divide will only get worse.
The basic infrastructure of modern healthcare—patient portals, appointment scheduling apps, prescription management systems—demands a level of digital literacy and access that not everyone can meet. Seniors may struggle with smartphone interfaces. Low-income families might rely on limited mobile data or shared devices. People with certain disabilities may find standard health apps difficult or impossible to navigate. And the problem compounds: Gonzales notes the populations most likely to face barriers with technology are often the same groups who may need that healthcare the most.
Fitness trackers are becoming the norm—for some
IN some circles, these devices have become simply how health-conscious people approach their wellbeing. Studies have shown that wearables can help detect abnormal heart rhythms, encourage increased physical activity, and provide early warning signs of illness. Some insurance companies offer discounts for users who share their fitness tracking data. Employers incorporate wearables into wellness programs.
The creation of a two-tiered information system is perhaps the most insidious aspect of fitness tech inequality. A person with an Apple Watch receives detailed daily reports about their cardiovascular health, activity levels, and sleep quality. They get alerts when their heart rate becomes irregular, or they can share comprehensive data with their physician that provides context for symptoms and conditions. Someone without these devices? They're left with subjective assessments and whatever gets captured during periodic doctor visits.
As more people in higher-income brackets adopt these technologies and share data with healthcare providers, medical understanding itself may become skewed toward populations who can afford comprehensive self-monitoring. If research studies increasingly incorporate wearable data, but if that data predominantly comes from affluent, educated users, the resulting insights may not apply equally across all demographics.
Another perspective
Think of the history of the healthcare industry's relationship with marginalized communities. The Tuskegee syphilis study, forced sterilizations, and ongoing disparities in pain management and maternal mortality have created a pretty understandable skepticism toward giving up data, to say the least. "Given the history of experimentation and exploitation of certain low-income populations, there's a natural distrust in these sub-groups," Gonzales says. "Maybe these demographics intentionally avoid third parties collecting their data."
Naturally, budget options for fitness tech do exist, and these options can help some people access these technologies. But even "affordable" options still cost money that many families simply don't have for what remains, technically speaking, optional equipment. When you're choosing between a $50 fitness tracker and groceries, the choice isn't really a choice at all.
The bottom line
Healthcare has become digitized, creating new opportunities for monitoring and intervention, but also new mechanisms for inequality. As fitness technology continues advancing, offering more sophisticated monitoring and more actionable insights, that fundamental inequality will only get worse. Because at the intersection of healthcare and technology, "the people who struggle with one are often the same people who need the other," Gonzales says.
The Apple Watch on your wrist may feel like a personal choice, a small investment in your personal wellness. But scale that up across millions of people and billions of data points, and individual choices become structural inequalities. Technology that was supposed to democratize health information may instead be creating new hierarchies of who gets to know what about their own bodies. And those who need that knowledge most may be the least likely to access it.
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