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.

Joshua Foust used to be a foreign policy maven. Now he helps organizations communicate strategically and build audiences.