Health Surveillance Is Terrifying And Avoidable, If We Want

A few years ago, the social theorist Shoshana Zuboff wrote a series of papers about what she called “surveillance capitalism.” The basic idea, she wrote, was “an emergent logic of accumulation in the networked sphere,” which was leading to the inextricable linkage of capitalism as an economic system and the pervasive, violating use of surveillance against the wishes and outside the knowledge of the people who exist in that system.

At first, Zuboff focused most of her energy on Google, documenting how that company’s massive dominance of the internet and of personal data had created a “Big Other,” which is an unaccountable and invisible power structure outside government control. In her new book, titled The Age of Surveillance Capitalism, Zuboff expands her critique into Silicon Valley firms more generally, and details the pernicious nature of the business model that presents a product or service as “free” so long as the user signs over the entirety of their digital footprint to be monetized outside their purview using opaque methods.

“Surveillance capitalism,” she writes, “unilaterally claims human experience as free raw material for translation into behavioral data. Although some of these data are applied to service improvement, the rest are declared as a proprietary behavioral surplus, fed into advanced manufacturing processes known as ‘machine intelligence’, and fabricated into prediction products that anticipate what you will do now, soon, and later. Finally, these prediction products are traded in a new kind of marketplace that I call behavioral futures markets. Surveillance capitalists have grown immensely wealthy from these trading operations, for many companies are willing to lay bets on our future behavior.”

This is, in essence, a form of cognitive colonization, whereby we are being hacked into making decisions and behaving in certain ways without really being aware of it (consider the extremely malignant behavioral incentives of social media influencers, for example). Just as important, Zuboff notes, is how this evolved economic system exists outside of democratic accountability — there is no mechanism to vote Google out of the internet, for example, nor is there a way to prevent Amazon or Facebook from consuming everything in their path because of how rapidly they became super-large and seemingly too-big-to-fail (and too appealing for our money-driven political system to spurn). As a result, we can see some tech firms strategically choosing to collaborate so as to fend off even the first hints of regulation that have come from the EU.

But it isn’t just Silicon Valley that engages in surveillance capitalism. While fake news, state-run disinformation, malicious health misinformation, relentless consumerism, and so on, are how we normally think of the negative consequences of this system, it is infiltrating our lives in much more insidious ways.

The Washington Post recently profiled a service of UnitedHealth Group, whereby employees are compelled through economic incentives and indirect threats to their continued coverage or even employment to wear fitness tracking devices 24 hours a day so their bosses can monitor how physically active they are. It is presented as a voluntary service, but the reality is quite different: if you have to choose between employer-provided health insurance, or even employment in general, and submitting to continuous surveillance by your employer, it’s pretty obvious what most people will choose.

The story begins with a creepy message from the family owner of a company in Texas, congratulating a 51-year old man for walking 6,000 steps in a day 3 weeks after his triple bypass surgery. And soon, we learn that there is a dark side.

“[T]he volume of highly sensitive health data scooped up from individual employees is exploding,” the Post writes, “raising privacy concerns and adding a new dimension to the relationship of workers and their employers. Often the information is not covered by federal rules that protect health records from disclosure [emphasis mine]. And when it’s combined with data such as credit scores, employees are giving up more insights about themselves than they realize.”

This is another form of surveillance capitalism, where the right to even hold a job is predicated on the employee’s submission to pervasive, continuous surveillance. These devices ostensibly monitor your sleep, the number of steps you take, how much you exercise, and with newer devices even your blood pressure and ECG profile.

From the perspective of UnitedHealth Group, there is a sound, if discomfiting, logic to imposing the devices on its insurance users — their actuarial tables show that more active people cost less money, because they tend to use medical services less. And while this is true (more fit people get sick less and tend to have fewer chronic issues like hypertension or depression), it is very much not clear that strapping a FitBit to someone is the best way to get them active and healthy.

Wearable fitness trackers are extremely inaccurate about caloric burn, which is an important measurement when tracking weight loss. If you can’t track how much energy you are expending during the day, you might not know how much to reduce your food intake in order to secure a healthy and sustainable amount of weight loss. The step counting is inaccurate, too — you can spoof most devices by swinging your arms really fast to simulate walking and the inertial sensors inside the device won’t know the difference.

In reality, the decision to get fit has very little to do with taking some extra steps during the day. The government subsidizes junk food so heavily that it is cheaper to eat processed garbage than fresh vegetables, yet we wonder why Americans are so overweight. We build sprawling suburban cities that are dangerous to walk or bike through and are pockmarked by cavernous warehouse stores that displaced smaller, local shops, and wonder why people are so sedentary and car-bound instead of active and walking.

But let’s go deeper. At a fundamental level, American work culture is fundamentally unhealthy, even without a creepy boss monitoring your FitBit data. The obsession with growth over profit has left most workers with no real gains in income for decades; the push toward using contractors instead of salaried staff makes everyone feel insecure and anxious; and the abusive price gouging by insurance companies makes almost everyone financially precarious and terrified of losing a job.

Young people are hit really hard by this. The punishing rate of student debt to acquire the bare-minimum college degree needed to simply enter the workforce means people start their adult lives at a serious financial disadvantage which makes negotiating pay precarious and uncertain. Because of bad housing policy that relegates wealth creation in home value, young people pay far more for far less housing than their parents or grandparents did, which puts them at a further disadvantage.

Strapping a FitBit to your wrist to keep UnitedHealth off your back won’t solve this stuff. And the challenges it presents aren’t  just limited to people in their early 20s. We have no national parental leave policy, which means childrearing is exorbitantly expensive (from infancy to lost income to the punishing cost of college), yet people wonder why the birthrate is dropping like a stone.

And consider this, too: America is the most overworked developed nation in the world. Overworking is really bad for your health — yet huge insurers like UnitedHealth aren’t pushing to reduce working hours, employment insecurity, or even provide mental health services so people can cope in healthy ways with the extreme stress of participating in the workforce. No, they are instead threatening rate increases if people who are already in a precarious situation don’t consent to pervasive monitoring by someone who isn’t bound by federal privacy laws to respect their health data.

This is the insidious logic of surveillance capitalism that Zuboff is describing. The issue of unhealthy lifestyles in America is a solvable problem — through democratic institutions, building cities to be more people-friendly and less business-friendly, and changing workplace culture to be more accommodating of people’s private lives and health. It’s hard work, and it might make some billionaires have a few million fewer dollars at the end of the year, but it isn’t some inscrutable mystery. But there is no business case for doing so, because it will make the largest businesses in our country, which essentially control our political system, slightly less large.

It would be nice to see insurance companies take their massive lobbying budgets and push for things like healthy food programs, the development of walking paths and bike trails, better housing policy, more generous family and personal leave, and shorter work weeks. All of those things would do wonders for the health of this country. But it might not make them as much money — they’d certainly lose money if people got so healthy they didn’t need to spent 17.9% of the national GDP on healthcare. Instead, they are choosing to destroy the last remaining refuge from surveillance capitalism we have left: our health.

It doesn’t have to be this way. But the refusal to look at the bigger picture is a systemic issue in our political system — we don’t seem interested in solving the higher order problems we face, just putting bandaids on what’s in front of our faces that week. And until that mindset changes, we will lose and lose and lose any remaining vestiges of privacy, personal agency, and free choice we once had.