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Health and Ethics – by Pauline Garvey

Laura Haapio-Kirk1 August 2019

Author: Pauline Garvey

The current advertising slogan for Gaelic Sports Clubs is ‘Where We All Belong’. The girl is shown holding a hurl for the sport called camogie. Gaelic sports including camogie for women and hurling for men have a huge national following, all-Ireland finals easily fill the national stadium with 80,000 spectators.

 

Why is it important to be active, or is it important to be active in specific ways? In recent years there has been mounting focus on health and wellbeing, as evident in the launch of the ‘Healthy Ireland Framework’ (2013-2025) a Government-led initiative that aims to enhance the population’s health. In this initiative health is presented as a public good, of individual and social concern. In the face of troubling temptations that arise with modern lifestyles the launch of this framework explicitly carries an ethical imperative: individual health, it asserts, affects the quality of everybody’s life experience. It is for the collective good to maintain one’s health. The approach recommends that the way to enhance wellbeing is less by focussing on the negative and more by highlighting what one can do to stay well. It recommends, in other words, a focus on the positive instead of the retribution of a poor quality of life that comes with bad behaviour.[i]

Often such initiatives focus on activities. From my fieldwork with middle-class Dubliners I have learned that staying well and being healthy is often talked about as routinised and collective in nature. People gather to walk, run or do yoga and the group aspect is an essential ingredient in the diverse efforts to stay healthy. When people talk of ‘activities’ they are often referring to group activities rather than solitary ones. Lots of keep-fit activities like walking or running can be done alone, yet they seem to be more successful when done with others. Respondents who attend tai chi classes might attend with a friend, and even if they don’t join these groups to extend their social networks they seem to prefer them to following a YouTube course online. This is interesting because it implies there is an added feel-good factor to the demonstration of healthy living beyond the benefits that come with social interaction. It is not just about being healthy, I suggest, but pursuing health in the company of others carries an added benefit in a cultural context where consensus is highly valued.

Younger respondents who have children report emphasis on mindfulness in schools where the health and wellbeing of children and young adults is couched as a social and spiritual category as much as a physical one. The National Council for Curriculum for example states that in ‘health promotion, health is about more than physical health and wellbeing. It is also concerned with social, emotional and spiritual health and wellbeing.’[ii] What we are seeing therefore is an interesting blurring of health, ethics and even spirituality to the degree that it is difficult to discern their distinctions.

 

References:

[i] A Framework For Improved Health and Wellbeing 2013 – 2025, available online https://assets.gov.ie/7555/62842eef4b13413494b13340fff9077d.pdf)

[ii] The National Council for Curriculum and Assessment. https://curriculumonline.ie/getmedia/007175e5-7bb7-44c0-86cb-ba7cd54be53a/SCSEC_SPHE_Framework_English.pdf

The place of WhatsApp in the ecology of care

Marilia Duque E S26 August 2018

Author: Marilia Duque

Dr. Gusso uses WhatsApp Business at Amparo Health Clinic (Photo: Marilia Duque)

In 2015 a PwC research report suggested that the Brazilian m-health market would reach $ 46.6 million while a GSMA report forecasted that 45.7 million Brazilians would benefit from mobile health projects (see here). In 2017 the scenario was even more optimistic. According to Statista, Brazil was expected to become the largest m-health market in Latin America with revenues of around $ 0.7 billion. These numbers explain the impressive amount of m-Heath startups and startup Incubators I’ve seen in Sao Paulo (see Eretz.bio, for example). But they don’t explain why after 7 months of fieldwork I still couldn’t find the people who are actually using these m-health apps. Instead, I found an intensive use of WhatsApp among my informants, filling the gaps in communication and making a huge impact on the ecology of care which we address in this project.

For example, every day early in the morning, Ms. M (54) sends a good morning message through WhatsApp to four lady-friends older than her. “It is like volunteer work because I know they are lonely and that message will make them happy and socially connected”, she explained. Ms. D (66) also starts her day sending a WhatsApp message. But in her case, the message is sent to her only daughter who lives in France, as a sign that she spent the night well. She is supposed to send this message every day before 10am otherwise her daughter will call a friend to check on her. “Some people say my daughter abandoned me, but the truth is that she is closer than many of my friends’ children who just live nearby”.

That is the same in the case of Dr. J., a physician who works in Sao Paulo and uses WhatsApp to take care of his 93 year-old father. After having a stroke, his father moved to Dr. J. brother’s house located two hours away.  Dr. J. created a WhatsApp group to talk to his brother and to his father’s caregiver. He gives her all the instructions she needs, and she updates him with information such as what his father ate, how he slept, how much water he drank, how much he exercised and how he was feeling. After a few months, he could tell how improved his father was and he explained how WhatsApp helped him and his family to feel safe and engaged.

Dr. K. also uses WhatsApp to provide care at distance. He works in my field site as a generalist providing ambulatory care to old people. WhatsApp allows him to give orientation about what to do when patients don’t feel well, and he can also ask them to go to his office if necessary. In many cases, he said, he can solve problems providing only care at distance. Dr. K. believes that the simple fact that the patients know they can use WhatsApp to contact him makes them feel safe and comfortable.

WhatsApp is also helping clinics to manage people’s health. Amparo Health, for example, is a clinic that uses WhatsApp Business to connect patients to doctors. The patient pays a monthly fee to have access to low-cost exams and to specialists like ophthalmologists, gynecologists, dermatologists, nutritionists and psychologists. What is new here is that all procedures and exams are coordinated by a generalist, who is available on WhatsApp. Dr. Gusso, the head physician at Amparo Health, explains that because the clinic business model is based on membership, they have no interest in demanding unnecessary exams or appointments. Doctors are paid by the hour and not by performance and that includes time to answer WhatsApp messages during the morning and afternoon. At the end of the day, he said, they are using WhatsApp to provide care at a distance, helping people to stay healthy, to feel safe and to save money. Prevent Senior, a health insurance company, also uses WhatsApp to make patients’ lives easier. In cases where treatments require on-going medication, patients can use WhatsApp to ask for new prescriptions. They can receive their prescriptions at home or they can go to the doctor office to get them, but with no need to schedule an appointment.

WhatsApp is the primary method of communication for 96% of Brazilians with access to smartphones. And among my informants older than 60 years old, that is also the app they use the most. Now imagine what can be achieved if WhatsApp features are explored to make the communication between health insurance companies, doctors, patients, caregivers, family and friends healthier too.