Cultural change is hard, but it can happen -- and it can even be directed to happen through propaganda (including marketing and advertising), regulation, and incentives.
Today, technology can help. McCray cites Amazon.com as a model of a system that tracks used behavior and adjusts its advice accordingly to get the user to do something that Amazon desires. Why not do the same with lifestyle and health data?
Google Now and Facebook are similar examples, though so far they are less active in trying to persuade users to take action. But research from the University of British Columbia shows how marketing technology -- sentiment analysis, Web tracking, and so on -- and big data analysis can be used to secretly influence user behavior.
The sources of that data now exist, notes Joseph Kvedar, director of the Center for Connected Health at the Partners HealthCare hospital system in Massachusetts. Sensors are readily available for all sort of health tracking, such as for blood pressure, steps walked, glucose levels, and body weight. As wearable technologies like Google Glass, the purported Apple iWatch, and sensor-laden clothing become available, what we can monitor about ourselves may astound today's generation.
Vendors at the Wireless Life Science Alliance event talked about monitors embedded everywhere: a bed that tracks when you're in it (in case you can't get out, sleep restlessly, or take increasing bathroom breaks) and even your weight, stoves with burners that report if they remain on for more than a predetermined period (in case a forgetful person risks burning down the house), and doors that track whether they are open and closed and when they are used.
Many of these monitors already connect to smartphones and computers, where their data can be analyzed by individuals, not just their caregivers, to provide feedback on their health and identify deviations and progress to goals. Insurers such as Progressive and Allstate already use such monitoring in cars to identify and reward "good" drivers, and presumably identify and punish "bad" ones.
To improve Americans' health, Kvedar essentially suggests combining self- and provider monitoring, better risk assessment via big data and genetic profiles, and a culture of self-improvement and healthiness.
Even with such tools, most of us won't act
Such feedback works well, Kvedar notes -- for a while. The truth is a small percentage of people proactively use such self-monitoring data -- usually limited to data-driven, improvement-oriented personalities common among athletes.
The rest of us ignore that data (when was the last time you stepped on a scale?) or give up after a couple weeks of well-intentioned but short-lived effort (when was the last time you went to the gym or used that pedometer?). Most people wear a pedometer, for example, for just two weeks, notes Harry Greenspun, senior director of health technology at Deloitte's Center for Health Solutions.
Our inability to stick to it is why both McCray and Kvedar see the need for an Amazon-like quiet manipulation to get us to act in our own best health interest. Successful behavior manipulation doesn't push people too far or too fast, notes Deloitte's Greenspun: "If you set a goal that is too high and give feedback on their low progress, people stop." You actually kill any possible progress by pushing too hard, a lesson e-commerce and other successful online feedback systems have learned and applied to their own digital experiences.
If you make it a social effort, you're 10 times more likely to meet your goal, Greenspun says -- but when it comes to health care, that social motivation is often missing. People may share their weight-loss successes or pedometer readings, "but it is unrealistic to expect people to share their illnesses, like the rash they got in Vegas," he says.