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There is a fine line between care and surveillance

Daniel Miller31 March 2020

Photo by Matthew Henry on Unsplash

When the ASSA team returned from the field, and we came together to collectively decide our ‘findings’. The title we gave to one of these findings was There is a fine line between care and surveillance. Today, thanks to the coronavirus, this has become a global finding. But anthropology has a good deal to contribute by examining the wider context of what hasn’t changed and what has.

On the one hand, this is an issue that pertains across the whole spectrum of human experience. A working definition of God, for many religions, would be a being who sees everything and cares for everyone. In a recent blog post, Wang examines the acceptance of surveillance in China in the light of traditions of a paternalistic Emperor and now Party. At the other end of the spectrum, there is the fundamental dilemma of contemporary parenting. The blog Parenting for a Digital Future is often a discussion of this balance. The reason that was a finding in respect to our own research was that it generally also applies to care for the elderly – it referred to the problem of simultaneously respecting the autonomy and dignity of older people, while also keeping a watchful eye.

If, on the one hand, this is a reflection of an age-old and ubiquitous truism, then, on the other hand, it has been hugely re-configured as a result of the smartphone. This was the other reason the phrase worked so well as a finding from our research. Never before has it been possible to follow every individual and every interaction at this detailed level, providing the minutiae for Big Data analysis. This has been the primary mechanism by which states have tracked who precisely needs to be in isolation following possible contact with the virus. It was states such as South Korea, where collective knowledge has generally been seen as a greater good than individual privacy which went furthest in this tracking of individuals through their smartphones. Most of our current discussions regarding the possibilities of both care and surveillance are premised on everyone using smartphones.

It is important to retain this anthropological sense of the broader context in order to help us find the balance we seek. As a recent article in The Economist noted, if we don’t want to justify mass surveillance in normal times, we need to see how democratic Taiwan has actually been just as effective as the autocratic mainland Chinese government in controlling the virus, though in stark contrast to the US. But we also need to respect the way some populations do experience surveillance as care, as Xinyuan Wang notes in her blog post. The key point here is the expression ‘there is a fine line’.

We hope that one of our contributions will be publishing the details of how care for older people via smartphones seems to operate within these sensitive contradictions of autonomy as against surveillance. These findings may help us when it comes to both informing and critiquing states and policymakers as they, in turn, learn their lessons from these extraordinary times.

Coronavirus and social isolation: 16 insights from Digital Anthropology

Georgiana Murariu20 March 2020

Source: Unsplash https://unsplash.com/photos/tDtwC11XjuU

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.