Not all users wear smart watches: on digital design and health inequalities
When I worked at DfE, we had large ‘you are not your user’ posters on the wall around the office. While they were helpful visual reminders — certainly they jollied up the place — it was quite rare to hear anyone assume what our users needed based on their own preconceptions. Our users were teachers, or aspiring teachers, we were not. Generally it was acknowledged that teaching was an extremely hard job, and that we shouldn’t presuppose the needs of those who chose to do it.
Health is a different matter. Almost all of us interact with the health service in some way. Most of us have the App. It is extremely common to hear people talk about their own experience in meetings. That’s not a bad thing: lived experience can breed empathy, and sometimes an annoying thing we notice about the NHS App is annoying for others too.
It goes awry when we start assuming that things we want or need are things our users need. This is particularly important in prevention: if we design for people like us, we not only miss an opportunity to make things better, we actively make them worse by widening the gap between the healthiest and the least healthy. Already, a woman living in Kensington and Chelsea can expect to live until 86.5, compared to 78.9 in Blackpool.
Let’s remember: only 37% of the UK population own and use a wearable device (smart watch etc). Despite that, people refer to the opportunities offered by wearable devices without considering what will happen to those who don’t own them. This isn’t to say there isn’t an opportunity for people with long term conditions to use wearable devices to manage their health, surely there is. But, any digital service that relies on the user already owning one is immediately leaving behind most of the population.
A related but different tendency is to assume that people are unhealthy because they don’t know better. Our role as digital teams is, then, to educate them. Our hand on their wrist guides them from a hamburger to an apple in the supermarket. Again, this is misguided. People don’t choose the hamburger because they don’t know it’s unhealthy, and us popping up to tell them it’s unhealthy won’t stop them choosing it.
Our health is shaped by complex interactions of many factors: our work, where we live, our ability to access care when we need it. As the King’s Fund puts it, some groups have “less opportunity to lead healthy lives”.
Our role as digital teams should be to create more opportunity to lead healthy lives. For busy people juggling complex priorities, this might look like enabling them to get their blood pressure checked at the same time that they have their AAA screening, and sharing the result with their GP. It might be as simple as knowing that people from some diaspora spend the summer in their country of origin, and timing their Diabetic Eye Screening invitation for when we suspect they’re in the UK (as one Diabetic Eye Screening service in London already does to great effect).
When we assume we know what our users need (their VO2 max in the NHS App via their wearable! Or, education not to eat hamburgers!) we miss the simple but helpful things we can do to create more opportunities for healthier lives.
