The Economist - UK (2022-05-07)

4 Technology QuarterlyThe quantified self TheEconomistMay7th 2022

In  America  smartwatches  are  catching

on as fast as did early mobile phones (see

chart  1).  In  2021  about  one  in  four  Ameri­

cans was estimated to own a smartwatch or

fitness tracker. The rate is similar in lead­

ing European adopters such as Britain and

Finland.  The  number  shipped  in  North

America  more  than  doubled  from  2015  to

2021. In western Europe and China it more
than  tripled  (see  chart  2).  In  2019,  Apple
sold  more  watches  than  the  entire  Swiss
watch industry. Some 400m devices a year
(of all brands) are expected to be sold glob­
ally by 2026, up from 200m in 2020.
There has long been a gap between the
parts  of  Western  societies  and  economies
that  look  after  people  when  they  are  sick
and the parts that help them stay healthy.
Wearable  devices—and  the  technologies
that they enable—are starting to bridge thatdivideintwoways.On
the one hand, they are making life more medicalised,withpeople,
for  the  first  time,  keeping  an  eye  on  thingsliketheirnocturnal
heart  rate.  On  the  other  hand,  they  are  usheringina shiftinthe
balance of responsibility between medicaltreatmentprovidedby
clinicians and what patients do to improvetheirhealth.
The covid­19 pandemic accelerated theprocess.Wearablesen­
tered the lives of more people and took onnewroles.Withgyms
closed,  exercise  shifted  outdoors  and  manypeopleboughtthem
for the first time, to keep track of how muchtheywalked,ranand
pedalled. A parallel trend was that lots of consumersbegantosee
these devices as tracking specific areas of theirhealth,notmerely
their  activity  level.  Before  covid,  wearableswereoften“whatwe
might call disposable”, says Ranjit Atwal fromGartner,a research
firm. People would buy them for no particularreason,wearthem
for a short time and put them into a drawer.Itwasunclearhow,or
indeed  whether,  the  market  for  such  deviceswouldmature.The
pandemic changed that because many peoplehadtobemonitored
at home for health reasons. Doctors in AmericaandEuropestarted
seeing  more  elderly  patients  with  smartwatchesthatrelatives
have bought for them in order to track theirhealthandsendalerts
of any problems. 
All this is assisted by the fact that peoplearemoreusedtohav­
ing technology help monitor and manage theirlives.ai­assistants
like Siri and Alexa are no longer a noveltyusedbya bravetechie
minority. Things that reflect how intimatelya deviceknowsyou,
like personalised playlists, are starting to feellesscreepy.
The benefits are noticeable. A round­upbyresearchersinDen­
mark of more than 120 studies of personal­activitytrackers,which
includedhealthy people and those with va­
rious  health  conditions,  concluded  that
wearing  the  devices  makes  people  move
more.  The  improvements  are  modest:
about  1,200  more  steps  (around  800  me­
tres, or half a mile) daily, 49 more minutes
of vigorous exercise per week and 10 min­
utes less sedentary time per day. But phys­
ical activity is so important that even small
changes can matter a lot. Studies that have
followed people for 4­10 years have found
that increasing steps by an extra 1,000 per
day reduces mortality by between 6% and
36%, with the biggest impact among those
who are most sedentary. 
Such  results  have  convinced  some
American health insurers to give away fit­
ness  trackers  and  smartwatches  to  their
customers.  UnitedHealthcare,  one  of  the

biggest,saysthat59%oftakerslogexercise

foratleastsixmonths.Forcomparison,

gym­membershipretentionratesdropoff

a cliffaftertwoorthreemonths.

Doctors in America and Europe are

startingtowarmuptotheideathatwear­

ablescan help themtake better careof

theirpatients.Profit­orientedhealth­care

systems,likeAmerica’s,smellgreatereffi­

ciency.Insteadofaskingpatientsifthey

aresleepingbetter,forexample,doctors

cansimplylookupa chartfroma wearable

device.SeveralhospitalgroupsinAmerica

thatcareformillionsofpatientsaresetting

upsystemsthatmakewearablesa seam­

lesspartofclinicalcare.Finland’scitizens

can link theirwearables and otherper­

sonalhealthdevices(suchassmartscales)

withtheirnationalhealthrecords.

Marketanalystsexpectthat,inthenextfiveyears,thewear­

ablesmarketwillsplitintotwocategories:medical­gradedevices

approvedbyregulatorsforpeoplewithchronicconditionswho

needtrackingwithgreatercareandaccuracy,anddeviceswithless

sophisticatedfeaturesforhealthypeoplewhowanttokeepaneye

ontheirmetricsandbeabletospotproblemsearly.Leadingmanu­

facturersareexpectedtoofferincreasinglyspecificdevicesfor

groupssuchaschildrenandtheelderly.

Qualitative,too

Thisreportwillexaminethetechnologiesthatarepavingtheway

forthistransformationofhealthcare.Thesensorsandalgorithms

thatunobtrusivelymeasurethingsaspeoplegoabouttheirdaily

livesarebecomingmoresophisticated,turningwearablesintodi­

agnosticdevices.ai­basedappsbuiltonthedatastreamingfrom

people’swristsaredispensingpersonalisedadviceonwhattoeat

forlunchorwhentogofora walk.Interactiveappsbackedupby

clinicalevidencearebeingprescribedastreatmentforallsortsof

ailments,justasmedicinesare.Someofthemworkbetterthan

conventionaltherapiesaimedatthesameproblem.

Wearablesarealsotransformingdiseasesurveillanceandclin­

icaltrialsfornewdrugs,byshowinghowpeopleexperiencea dis­

easeora treatmentintheirdailylives.Theymakeitpossible,for

thefirsttime,totakethetemperature,ormeasurethepulse,ofa

populationratherthananindividual.

Thereareplentyofproblemstoberesolved.Chiefamongthem

are concerns aboutprivacy anddiscrimination based onthe

healthdatafromwearables.Digital­healthproductsbuiltonthe

dataarestillvariableinquality,thoughitisgettingeasiertosort

thegoodfromthebad.Regulatorsaretry­

ingtostrikea balancebetweenprotecting

consumersandnotsuppressinginnova­

tion,whilealsolearninghowtoregulatea

digital­healthecosystem.

Butfewdoubtthatthebenefitsfrom

wearableswillbehuge,evenifthedigital

carethattheymakepossiblewillremain

supplementary to conventional medical

treatments.About80%oftheburden of

diseaseinAmericaiscausedbylifestyle

factors,andmanypoorercountriesarenot

farbehind.Drugsworkasintendedinonly

30­50%ofpeople.Formanydiseasesthere

arenotherapiesatall.Digitalhealthcare

candealwithmanyoftheseproblems.To

appreciatewhatitcan achieve, thebest

place to start is the technologybehind

wearablesensors.n

Trackingthetrackers

Shipmentsofsmartwatchesandfitness trackers

Per1,000people

2

Sources: CCS Insight; UN Population Division; World Bank

*Canada and US (excl. Mexico) †Developed markets ‡Forecast

16

12

8

4

0

20114 15 16 17 1918 20 21 22‡

Asia-Pacific†

China

Eastern

Europe

Western

Europe

North

America*

Learning fast

United States, technology adoption

% of households

Sources:Asymco; D. Comin and B. Hobijn, 200; Deloitte

1

100

80

60

40

20

0

1903 20 40 60 22200080

Smartwatch

Automobile

Telephone

landline

Electric power

Computer

Internet

Mobile

phone