Open access image by Mohamed Hassan

Author: Charlotte Hawkins

As part of the ASSA project, we are currently working to publish a volume called: ‘An Anthropological Approach to mHealth: Health & Care in the Smartphone Age’. This volume consolidates insights from the team’s various anthropological initiatives in mobile health or ‘m-health’ – health-related uses of the phone – in diverse settings around the world. Drawing from an ethnographic perspective, we seek to contribute an anthropological understanding of mHealth, a growing industry often otherwise dictated by top-down priorities such as bespoke app creation. Instead, building from our own ethnographic insights about older people’s everyday uses of phones, and other studies stressing the evident importance of ‘informal mHealth’ (Hampshire et al., 2021), we illustrate a ‘smart-from-below’ approach which prioritises the everyday appropriation of phones and existing communicative apps for health purposes. We analyse the failures of conventional mHealth initiatives and the emergence of our alternative perspective, and how that led to several initiatives in which team members were themselves involved.

In this book, we offer a grounded ethnographic picture of mHealth in our various research contexts, with a view to broader global trends in population ageing, health and economic crises, the Covid-19 pandemic, declining public investment, increasing phone access, and global migration. This shows the potential of prioritising the everyday appropriation of mobile technologies in line with both social change and longer-standing care norms.. This is intended topromote an anthropological approach to support the relevance and effectiveness of mHealth going forward. We have already created a free online course (available here) for those interested in the topic but hope that the book will benefit other medical anthropologists and ethnographers interested in digital health, as well as digital health practitioners interested in social research around the design, implementation and evaluation of their work.

We have organised the book into three parts, reflecting what anthropology can offer for contextualizing, analysing and informing mHealth. Part one consists of three chapters concerned with contextualizing mHealth;

• Xinyuan Wang on mHealth practice in mainland China;
• Shireen Walton on visual digital communications about health during covid in Italy, and
• Laura Haapio-Kirk on social self-tracking in Japan.

This is followed by contributions analysing mHealth:

• Daniel Miller on googling for health in Ireland, and the ways it exacerbates existing disparities;
• Patrick Awondo on the failures of various mHealth initiatives in Yaoundé, Cameroon; and
• Pauline Garvey outlining the uses of phones to seek information and support around the menopause in Dublin, Ireland.

The volume concludes with three chapters informing specific mHealth initiatives:

• Alfonso Otaegui’s recommendations for scaling the ‘nurse navigator’ model in public oncological clinics in Chile;
• Marília Duque’s protocol for meal-logging and WhatsApp communications in Brazil; and
• Charlotte Hawkin’s and John Mark Bwanika’s work on a digital mental health programme in Uganda.

Taken together, the volume seeks to provide a grounded ethnographic discussion on the challenges and opportunities of anthropology for mHealth, and of seeking health and care in the smartphone age. We aim for publication in 2022 with UCL Press, follow ASSA on Twitter, Instagram and Facebook to keep updated.

References

Hampshire et al. (2021). Informal mhealth at scale in Africa: Opportunities and challenges. World Development, 139:105257, 1-23

I am currently writing a second book about Cuan, my fieldsite in Ireland. This will allow me to spend much more time presenting evidence for inequality, focusing on an area of social housing located in the middle of Cuan, that remains quite apart from most of this quite affluent middle-class town. Detailed study, however, reveals many nuances to any simple or dualistic presentation that just opposes these different segments of the same town. The overall rise in income and possibilities in Irish society over the last 50 years have impacted upon most of the population, though not all. Bob would never have expected to be able to live outside of social housing, having worked first as a butcher’s assistant and retired finally as a school caretaker, low paid work that precludes the ability to purchase a property. Yet in retirement, he found his true vocation as a poet and today is as comfortable at the opera as he in the betting shop.

The term class is quite a crude categorisation. I would argue that Ireland has a much stronger egalitarian ideology than here in England, laid across still evident inequalities. Many of the oral histories of individuals I recorded talk of the extreme poverty of their origins but alongside the love of literature and the arts. I didn’t feel that this film represented class mobility or a change in class identity, or even that actually Bob sees things in such terms. It seemed there was both something Irish about Bob and also much that was simply individual. This is an additional point. Bob doesn’t have to be typical of anything or anyone, but for the anthropologist, it is hugely important to acknowledge that he exists and that abstract discussions of class and inequality need to balanced by meeting people as individuals, in this case as Bob.

The film is included in the recent book I wrote with Pauline Garvey, Ageing with Smartphones in Ireland.