Blog post by ASSA (Anthropology of Smartphones and Smart Ageing) team

We recently conducted nine 16 month studies on the use of smartphones by older people, which is the main source of insights here. You can read more about the project here.

This is a summary of insights from our previous research intended to be on benefit for individuals or institutions considering  digital health initiatives for older people. It is a preliminary list and we hope to deepen our contribution through subsequent blog posts.

Additional insights are also drawn from Daniel Miller’s The Comfort of People (Polity, 2017), a book about the social universe of hospice patients, which includes recommendations for how to use new media to assist isolated older people to maintain social relationships.

1) USE EXISTING APPS

Our research found that older people are often very reluctant to use a new app. When trying to assist older people in using online resources it is best, if possible, not to suggest new apps. Find a way of achieving your aims through an app they already regularly use, such as WhatsApp.

2) EMPATHY

Social isolation has been a common experience for older people, especially those who have lost a partner. Isolation is particularly common in the UK. One result of this virus is that people of all ages are now experiencing isolation. They may thereby gain greater empathy with the lived experience of older people living alone or in isolation.

3) POLYMEDIA

Our research shows that today each individual has particular preferences for how they prefer to communicate. For example, a person might be fine with the webcam, but only if you text first so that they are prepared. It is important to learn about an individual’s media preferences and then respect these.

4) FORUMS

The hospice research found that people who are struggling (in that case it was mainly cancer patients) find forums of considerable value. But they divided into two equal groups. One group only wished to exchange such intimate problems when the forum was entirely anonymous; the other was only comfortable communicating with identifiable others. We need to develop and proliferate both kinds of forums.

5) FREQUENCY, NOT CONTENT

For many older people what matters is not what is contained in communication, but its frequency. Knowing that people are interested enough to make some kind of contact is far more important than anything those people actually say.

6) THE FINE LINE BETWEEN CARE AND SURVEILLANCE

This point applies to personal relationships, where older people may appreciate being in constant contact, but care greatly about autonomy and dignity. It also applies to the macro level, as where some people regard China’s response to the virus as unacceptable authoritarianism, and others see it as an entirely justified expression of how a state cares for its citizens.

7) SMART FROM BELOW

Most policy suggestions are implemented by policy experts in a ‘top-down’ manner, thereby affecting the bulk of the population, but the widespread use of digital technologies produce a democratising of creativity and ingenuity. Anthropologists seek to learn from the creative responses of ordinary people, accumulate examples (e.g. https://covidmutualaid.org/) and use these to educate others.

ASSA will soon be publishing a 150-page manual of protocols on how to use WhatsApp for health, created by Marilia Duque, who is a researcher on our team. These are not her own ideas, but best practice examples gathered from 16 months of observing how older people in Brazil used smartphones for health purposes. We need to establish platforms where people can share what they are learning from the creative response of ordinary people.

8) CARE AT A DISTANCE

Digital technologies have made the practice of care at a distance commonplace. This occurs in different ways. For example, working with older people in China and Japan, we found they have shifted to much greater use of visual communication, such as stickers and short videos, as a way of expressing care. These people found it easier to convey affection through these means, rather than through more conservative traditions of face-to-face encounters.

9) WHATSAPP SUPPORT

Today many people form WhatsApp groups with family and friends to support isolated people or patients. This is highly effective. So we need to ensure that everyone is aware of its benefits. Marilia Duque is advocating a system of `WhatsApp Angels’ in Brazil in response to the virus. As it happens, Whatsapp has already created a ‘Coronavirus Information Hub’ which includes examples of how to use the app to stay in touch with loved ones or seek up-to-date health information on the virus. The Information Hub can be accessed here.

10) WEBCAM

In a phone call, older English people traditionally tend to say they are fine, even if they are at death’s door. There are many advantages to connecting via webcam, which allows one to see how a person is actually doing. Many might find it helpful to have their webcam switched on even when people are not actually talking, since this is more akin to co-present living together.

11) NON-TECH-SAVVY ELDERLY PEOPLE

Coronavirus is about to cause a crisis for those elderly people who may never learn to use smartphones, as access is stopped for visitors to care homes. A helpful device is the Amazon Echo Show, since it can conduct webcam conversation through simple voice commands such as ‘Echo, videocall Mary’. Set-up requires another person using an Alexa App and is quite complex but the technology does work.

12) FACEBOOK

Facebook has shifted from a young person’s platform to use more by older people and community groups. At this point, the main advice is for young people to remain on Facebook where they will be able to share more family information, jokes, and other material with those older people.

13) CONFIDENTIALITY IS LESS IMPORTANT

The hospice research mentioned above suggested that, so far from protecting people, an obsession by institutions with privacy and confidentiality has become a major source of harm. People who are ill were more concerned to ensure that relevant people were informed about their condition, rather than that strangers might also know about their condition. Privacy is important, but tight controls over data because of concerns over litigation can cause considerable harm to patients.

14) PATIENCE AND PATIENTS

Older people may want and need to learn about how to use smartphones and similar skills, but they mainly reported that young people do not help teach them. They become irritable and impatient and take the phone away to make changes. With social isolation it will become even more important to help people learn to do things for themselves.

15) KITEMARKING

Googling for health information is now a ubiquitous part of how people respond to illness or the fear of illness. Users, influenced by commercial sites or scare stories, can end up more anxious and misinformed. Kitemarking has improved with the foregrounding of more authoritative sources and is promising to do more. Google have already implemented this, prompting UK-based internet users to consult the WHO and NHS pages when the term ‘covid 19’ is entered into Google. However, Google health enquiries are still often headed by commercial and sponsored sites.

16) A GLOBAL EXPERIMENT

Right now, the world is embarking upon a vast global experiment, by default: a massive shift of education, work and sociality to online. This is an important time for digital anthropology to try to help assess any associated problems that arise from these strategies, as well as any long-term benefits.

The last decade has witnessed the rise of the Smart City. Smart Cities, as they are broadly conceived, encapsulate the increasing embedding of technology into the urban infrastructures of cities across the globe^[i]. The smart city concept can best be understood as a constellation of features and potentials made up of big data, algorithmic governance and automated urban management^[ii], as well as citizens’ active engagements with technologies beyond mere ‘networked urbanism^[iii]’. Certain strands of scholarship on smart cities has claimed that the smart city represents a ‘techno-utopian fantasy’, bringing together neoliberal urban visions directed at economic growth and prosperity and efficient and equitable urban governance. Strands of this scholarship have highlighted the acute contradictions of smart urbanism, including its very different expressions across global North and South and digital divides^[iv]. Scholars working in human, urban and social geography have been particularly influential in understanding smart cities by exploring how people actually respond to new tech, amidst the wider context of big data and the digital/wider infrastructures that underpin the way cities are run and managed, as well as the kinds of social and spatial patterns that these systems produce^[v].

The city of Milan has been widely recognised as a leading innovator of urban smartness. Roberta Cocco, Councillor for Digital Transformation and Civic Services of the Municipality, suggests that Milan’s leading position in Italy on the technology front comprised of four pillars:

1) digital infrastructure (preparing the ground for transformation, including Wi-Fi, 5G and broadband),

2) digital services for citizens (to assist in public administration and bureaucracy),

3) digital education (to support citizens’ digital literacy in order to access digital services),

4) digital skills (promoting within the municipality and cross-sector partners to boost employment and careers)^[vi].

Cocco views Milan as a ‘model of experimentation’ in technological urban innovation, echoing a consensus within the municipality that other Italian cities will follow suit.

For example, through the first Milan Digital Week in 2018^[vii], the city has been publicising itself as a leading smart city, hosting numerous international events, (Figure 2), and symposiums ^[viii].

Milan’s status as a leading smart city was evident in its winning the inaugural Wellbeing Cities Award^[ix], having implemented 16 new projects that claim to promote wellbeing for the city and its communities. These range from art and education initiatives to the regeneration of particular areas of the city.

Ethnographic research conducted on the ground and online provides an opportunity to challenge this top down agenda. For example, Katrien Pype’s ethnographic research in Kinshasa, the largest and capital city in the Democratic Republic of the Congo, counters this with a perspective from the ground up, examining how residents engage with technology, combining their own expertise and creativity to produce variegated ways of “being smart in the city”. Pype asks:

‘Who is smart? And who is not? How does mastery over entering technologies relate to local repertoires of authority, power, and prestige?”^[x]

In my Milan research I have tried to explore processes of ‘smartness’ from above and below, and their inter-relatedness, with a specific focus on the response of middle and older age adults.

Routine practices in the culturally diverse neighbourhood I carried out research in included googling for health, navigating the city via geolocative maps and free WiFi zones in public space and institutions such as libraries, arranging community events, or engaging in daily WhatsApp communications.

My research shows how the use of smart city services is contingent upon socio-economic circumstances, accessibility of roaming data, WiFi, and connection speeds, and how people respond to technology in their lives. At the same time, the concept itself continues to be being challenged, as seen in the following student protest slogans in Milan during labour day protests in 2019:

 

Understanding the smart city speaks to the heart of our project and its commitment to examining the meaning of the term ‘smart’ by explaining and understanding more broadly what ‘smartness’ is, and is becoming – and for whom – in the city and beyond.

 

 

[i] Datta, A. ‘The Digital Turn in Postcolonial Urbanism: Smart Citizenship in the Making of India’s 100 Smart Cities’. In Transactions of the IBG. DOI: 10.1111/tran.12225

[ii] Leszczynski, A. (2016).  Speculative futures: Cities, data, and governance beyond smart urbanism. Environment and Planning A, 48, 1691–1708. Levien (2013). Regimes of Dispossession.

[iii] Graham, S., & Marvin, S. (2001). Splintering urbanism: Networked infrastructure, technological mobilities and the urban condition. London, UK: Routledge.

[iv] Luque-Ayala and Marvin (2015). Developing a Critical Understanding of Smart Urbanism’ in Urban Studies 52(12): 2106-2116.

[v] The work of Ayona Datta on Smart Cities https://ayonadatta.com and digital urban transformations in India https://ayonadatta.com , and Gillian Rose on smart cities and the (visual-digital) production of knowledge continues to be particularly insightful: https://www.urbantransformations.ox.ac.uk/project/smart-cities-in-the-making-learning-from-milton-keynes/

[vi] https://www.morningfuture.com/en/article/2019/04/17/smart-city-milano-roberta-cocco/596/ (Accessed: 19/11/19).

[vii] Milan has long been known for its world famous annual fashion week and design weeks, but since 2018 it has introduced ‘Milan Digital Week’, reflecting the city’s increasingly digital-orientated focus and shifts in the image of the city as predominantly fashion capital to the recent emergence as a digital capital, certainly of Italy, but also more broadly within Europe. https://www.milanodigitalweek.com

[viii] The founding of the ‘Milan Smart City Conference’ in November 2019 is a notable example of this contemporary push towards developing Milan’s leading reputation as a global smart city in the contemporary technological moment of the launch of the first applications for 5G. Three core concerns of the 2019 Milan Smart City Conference are stated as: ‘Infrastructure’, ‘Security’ and ‘Smart Mobility’. See the conference website here: https://www.smartbuildingitalia.it/en/smart-city-conference/

[ix] https://www.smartcitiesworld.net/news/news/milan-crowned-top-city-for-wellbeing-4212

[x] Pype, K. (2017). ‘Smartness from Below: Variations on Technology and Creativity in Contemporary Kinshasa’ in Mavhunga, C, C. What Do Science, Technology And Innovation Mean from Africa?; pp. 97 – 115