Analysis: Digital Health Companies Aren’t Solving the Right Problems

Many of the digital health solutions being offered won't solve the problem of our unhealthy lifestyles, says the Robert Wood Johnson Foundation's Stephen Downs. (Antonio Diaz/iStock)

Digital health is booming. The market that includes health apps and wearables will increase around 1,200 percent over the next eight years, according to one forecast.

So what’s propelling this surge in demand? “A growing proliferation of chronic diseases, namely diabetes, cancer and heart ailments … ” the report says.

Not only is this trend alarming, said the Robert Wood Johnson Foundation’s Stephen Downs at the recent Stanford Medicine X conference,  but many of the solutions offered by digital health companies are not going to help.

In this age of the Fitbit, Downs said, digital health companies are focused on monitoring the consequences of our notoriously sedentary lifestyles. But what is really called for from innovators is to stop treating symptoms and start remedying the roots of the problem.

“The system needs to be re-engineered!” said Downs, chief technology and strategy officer of RWJF, a philanthropic organization focused on health. “We don’t need an app that counts steps, because that really just tells you that your day doesn’t naturally incorporate the time and space to walk.”

Progress = Inactivity

Downs is of the opinion that some of our most cherished and widely used inventions have resulted in a kind of apocalypse of inactivity: Automobiles helped create pedestrian-unfriendly suburbs; washing machines provided leisure time — to watch more TV. And the appearance of the remote control meant we no longer even had to get up to change the channel.

Even our thumb muscles have been given the day off since digital assistants like Siri gained the ability to write our text messages, he noted.

All these things, combined with an automobile-driven, fast food culture, said Downs, have contributed to a national diabetes epidemic and a stunning rise in obesity rates.

We Need Stuff Like This 

So how to remedy the roots of the unhealthy environments we’ve created? Downs says engineers and designers in all industries should be thinking about their products’ effects on our health.

He cited the Changing Places group at the Massachusetts Institute of Technology media lab as a project that’s attempting to create core solutions that fundamentally change human behavior. One of the lab’s initiatives: designing ways to feed people healthier diets through urban farms that make use of city spaces. (Imagine crops growing on the sides of buildings, for instance.)

Crops grown on the side of a building could help foster urban farming.
Crops grown on the side of a building could help foster urban farming. (MIT CityFARM)

The MIT researchers claim their techniques could not only completely eliminate the massive amounts of water used by agriculture, but also render unnecessary fertilizers and pesticides.

Downs also pointed to a food delivery service called Blue Apron as the kind of upstream innovation that can have a positive effect on health. The company sends a box of fresh food to your doorstep, with all the ingredients and spices to cook a meal at home. Not exactly fast food — but faster food with better nutrition.

“This is about finding solutions for people that are more compelling than the patterns that we have established,” he said.

A furniture company like the San Francisco-based Steelcase can have an impact, too, Downs said. The company designs chairs, lamps and tables that are intended to inspire movement, remove stress and improve focus.

Even ride services such as Uber and Lyft, Downs said, might lead to healthier lifestyles if they influence urban dwellers to ditch their cars altogether — someone who no longer has a car sitting in their garage may be more inclined to walk or bike.

One caveat: Downs said the problem with many of these solutions is they’re prohibitively expensive for most people.

“People who are innovating like this really need to think about price points that are available for the masses, not just the well-off folks in Silicon Valley.”

Analysis: Digital Health Companies Aren’t Solving the Right Problems 11 October,2016Lesley McClurg

  • I’m glad you ended the article with the point about costs. If the average Fitbit wearer can check steps at 3:00 p.m. and use that information to make the decision to take a walk instead of a doughnut break, that’s real progress. Urban farms are a wonderful idea, but the concept doesn’t create change today for that ordinary individual.

  • Tamara

    so why not focus all our ceativity, business innovation, design thinking, vc investing, start-up culture in areas where there is the most need – urban and rural areas with a demographic that have high mortality, morbitity, chronic disease, rates. Why can’t we design digital health, technology, wearable, robotics solutions that shows improvements in their health outcome? Why isn’t it important enough to study their behavior, understand how they engage in their own, how to improve their emotional/ mental wellbeing? When will we start building startup accellerators in lower socioeconominic urban and rural neighborhoods?

  • Steve Downs

    Tamara and Rebecca — thank you for your comments. I agree with you both. It is so important to focus on these areas of highest need. I’m arguing that we need to think long-term and challenge the environments and the norms that currently conspire to make it hard to be healthy. For example, technologies that prompt you to take more steps or to take in fewer calories don’t make it easier to take more steps or eat better. Making those healthy choices easier choices (whether through price, convenience or attractiveness) is the challenge I’d like to see the tech world take on.

  • Joe Gough

    Bravo Steve! As a former school teacher turned digital health entrepreneur, I see the classroom as the last frontier of mandated opportunity. Children must attend school. Lower income children will inevitably matriculate at poorly funded public schools. These schools do not have the faculty, nor the resources to provide best in class STEM education. Therefore, if we continue to endorse (with our silence) this ineffective cycle, the resulting hereditary poverty will continue to plague social progress. HOWEVER! If you break this cycle by focusing on the pieces of the educational model that do not require massive technology investments or high priced faculty, you can carve out solid ground for the social ladder. In our competitive race for international STEM success, we lost sight of key social underpinnings like Home Economics. The very concept of having a homeroom where the table is set for the day is gone. Home Economics was a class that showed students with limited role modeling the path to success in domestic affairs… That’s gone now. Homerooms were also a place where current events were discussed. Now that we have fake news stories, planted propaganda, and fabricated twitter feeds from the highest bastions of leadership, homeroom and Current Event classes have taken on new level of importance. But there’s more… Communications, Sociology, Social/ Public Health, Psychology, Behavioral Design, Design Thinking, Social Media, etc. These may seem like less powerful academic pursuits at first blush, but when you consider the jobs in Sales, Marketing, Education, Media, Advertising, Creative, Pop Health, Public Health, Social Work, and most importantly DESIGN of all things, you realize that lower income students could easily find jobs in these arenas. It’s the life skills that they are most deprived of in lower socioeconomic conditions. Bring back a mandated and dedicated commitment to holistic life skills in public education. It will make public school students better prepared than private school students for REAL life, because private schools will never go back into the psychosocial model. They are too focused on getting 18% of their students into the Ivy League (and I’m referring to my own alma mater). After teaching in both public and private schools during the STEM panic, I can tell you unequivocally that a focus on STEM distracts resources and attention from MUCH more important life skills. Who is going to rise to the CEO spot first? The 99th percentile engineer that whines for a raise every month and cannot show up on time… Or the 85th percentile project manager that understands people, teams, behavior, overcoming adversity and always applies what they know with conscientious maturity? It’s a no-brainer… Stop trying to improve upon weakness and start doubling instructional efforts on the inherent strengths.

  • Corinna West

    My business lost a business pitch competition to 2 of these pointless innovations. We explain how and why mental health innovation, in pariticular, doesn’t help mental health service receipients.


Lesley McClurg

Lesley McClurg reports for KQED Science primarily on medical and mental health with a sprinkling of stories about space, environmental toxins and food.

If there’s a natural disaster brewing Lesley can usually be found right in the midst of a catastrophe. She’s reported on disastrous floods, fires, droughts and earthquakes.

Her work is regularly rebroadcast on NPR and PBS. She is an Edward R. Murrow and Emmy award winning journalist. The Society of Environmental Journalists recognized her beat coverage of California’s historic drought.

Before joining KQED in 2016, she reported for Capital Public Radio, Colorado Public Radio, KUOW and KCTS in Seattle.

You can find her on Twitter at @lesleywmcclurg.

You can find her KQED medical science stories, her environment stories, and general news stories.

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