Peter Orszag has an interesting column about the devices he uses to monitor his health and help him change his health behaviors. For example, he has a scale that wirelessly sends his weight to a computer. Weighing yourself regularly and recording it helps you lose weight. But this is a hard habit to sustain. Making the task easier by automating the data recording makes it more likely that you will form the habit, and it's the sustained habit that helps you lose the weight and keep it off.
So, these tools are great, because improving health behaviors is critical to preventing and managing disease. But the problem, Orszag argues, is that
the new technologies may widen gaps in life expectancy. Americans are living longer than ever -- but, as documented in a recent National Academy of Sciences report (“Explaining Divergent Levels of Longevity in High-Income Countries”), people with more education and income are enjoying much more rapid increases in longevity than others are. Among 50-year-old men, for example, those in the highest education group are now projected to live almost six years longer on average than those in the lowest education group -- and this differential has been rising sharply... The leading explanations for this involve health behavior -- including diet, exercise and smoking... If the new personalized health technologies wind up being used disproportionately by people with more education and income, driving that group toward even better health, they will probably cause the gap in life expectancy to widen still further.
So, why would the new technologies be more likely to be used by the well-off and better educated? To some degree, the well-off will get the tools first because they have more money to spend on the gadgets. If the gadgets really work, though, insurers would have an incentive to subsidize access to them.
This won't completely solve the problem. An exercise gadget by itself won't make you exercise (believe me on this one). The tools are going to work better for those who already have a matrix of skills in health-related behavior. For example, a heart rate monitor is really useful for someone putting 100 miles a week into preparing for a triathlon, but it's a waste of money for a casual cyclist. Many eHealth tools are technologies for increasing our control over our behavior and directing it towards health. The educated already have more self-control, in part because the education system tends to advance those who come to it with these skills, and in part because these skills are part of what education trains. eHealth tools are more likely to be taken up by the educated, because they amplify skills the educated already have.
This is depressing, but not hopeless. If this argument is right, health inequalities are produced, in part, by inequalities in education. So we have to attack both to succeed in raising everyone's well-being. We can do something about inequities in education, first of all by giving all children access to preschool, an experience that is particularly valuable for the formation of skills in self-control.