By Sarah Riley, April 2020
In this Book Review, Sarah Riley provides a review of Digital health: Critical and Cross-Disciplinary Perspectives by Deborah Lupton. This is the third review of the books from the Critical Approaches to Health series co- edited by Kerry Chamberlain and Antonia Lyons, and published by Routledge, in association with the International Society for Critical Health Psychology. (ISCHP members receive a discount on the purchase price of books in the series.)
New technologies often trigger polarised expectations: either utopic dreams or doom-related fears. In Digital health, Lupton offers instead a measured review of digital health technologies. With an encyclopaedic knowledge, she provides an insightful and thorough overview of past and present technologies. She shines a light on the vast landscape of digital health, as well as how scholars and users (and sometimes scholar-users) have thought about these technologies.
The book begins with an overview of theoretical frameworks used to think about digital health. This provides an excellent summary of key analytical concepts and how they have been applied to digital health and sets the scene for subsequent discussion of: (1) digitally produced ideas of healthy citizenship and the ‘digitally engaged patient’; (2) how digital technologies produce new forms of embodiment; (3) the implications of Big Data for health; (4) how digital health use is socially structured; (5) the lived experience of digital health; and (6) the digitalised workplace for medical and health professionals.
In each chapter, Lupton provides a sense of the ubiquitous spread of digital health technologies as well as: (1) the significant implications these technologies have for how we can understand ourselves, our health and our bodies, and (2) how they inform our interactions with other people and institutions, including health providers, government, and corporations.
Themes of surveillance, power, control, utopic visions and problematic realities, and the complexities of vast systems intersecting between commercial, government and individual interests, run through the chapters. These themes are considered carefully in a nuanced way, allowing Lupton to explore the possibilities of digital health, including areas of concern.
To do this, Lupton reviews an extensive literature. Her lists of different kinds of digital health are extraordinary. She also handpicks examples of research, using these to show how digital health technologies work, and what possibilities they enable or close down. For example, she discusses how the visual has taken precedence over other forms of medical knowledge. Where once doctors might have touched or even smelt us as part of their diagnosis, now this work is done through digital equipment and sometimes across digital space in ways that prioritises and produces new ways of visualising the body.
Lupton’s analysis highlights how technology informs or structures our interactions with each other or our bodies, and creates new ways to experience the body. She offers a considered exploration of the affordances of digital health, and how they structure human experience and behaviour in relation to health, often in ways not predicted by those developing the technology. For example, blood sugar measures designed to give people with diabetes control over its management can be experienced as reinforcing an ill identity, rather than producing the envisaged freedom.
Digital Health also shows how technologies we might be familiar with are integrating and creating more cross-platform interactions. Cross-platform integration is designed to increase efficiency and user-friendliness, but also opens up security and surveillance concerns. Such integration and embedding of technologies into everyday health care also poses risks for being labelled a ‘disengaged’ patient if one opts out and excludes those with less access to digital technologies (e.g. due to disability or poverty).
A key thread running through much of the book is how little people know of where their data go or how little input they have into the design of the digital technologies they are invited to use. Another is the problematic interactions between commercial interests, neoliberal healthism, government health promotion, and individualistic psychological theories of health behaviour.
The darker side of commercial practices are also revealed when Lupton discusses ‘unbranded social media engagement’. This industry term describes clandestine pharmaceutical company entities engaging in social media interactions to ‘prime’ a market by starting online conversations about illness or treatments without declaring commercial interests.
Lupton tends to offer an authoritative but neutral review of the technologies she considers, but I particularly enjoyed those moments when she directed the reader towards an interpretive position, offering her insights as a critical analyst. Similarly, I would have liked more integration of the theoretical framework chapter with her subsequent review of the empirical work. The flashes where she does this were particularly useful.
Overall though, this is a tour de force, finishing with a chapter on future directions for research that contributes to the aim of this book: a manifesto for an interdisciplinary field that Lupton calls ‘Critical digital health studies’.
A longer version of this review has been published in Feminism & Psychology.
About the author
Sarah Riley is a Professor in Critical Health Psychology at Massey University, New Zealand, where she leads a Masters in Health Psychology Programme. She is an interdisciplinary researcher, located in psychology but drawing on sociology, cultural and media studies to address questions of gender, embodiment, health, youth culture and citizenship. Sarah is particularly interested in the psychological impact of neoliberalism and postfeminism, examining these through a range of post structuralist analytics and qualitative methods such as discourse analysis, visual and participatory methods. Her work has been funded by the EU, ESRC, EPSRC, British Academy, Canadian Social Sciences and Research Council and charities, and includes the co-authored books Critical Bodies (Palgrave, 2008), Technologies of Sexiness (Oxford University Press, USA, 2014) and Postfeminism & Health (Routledge, 2018), she is currently writing Postfeminism & Body Image (Routledge).