Wellness Is Not An NHS Issue

Magicians call it misdirection - it’s when they get you to focus on one thing while they are doing something else.

The current focus on the NHS demands for more funding is also an example of misdirection. The focus should be on exploiting technology for public health, rather than relying on the NHS to tell us if we are healthy. We can use technology to help us self-manage our wellness and when we are not well, to then seek NHS help.

I scanned the gadgets in my house and realised that I can measure my blood pressure, levels of oxygen saturation, heart rate, heart rate variability, amount of sleep, quality of sleep and the glucose levels in my blood because I track what I eat. I know the amount of protein, carbohydrate, fat, fibre and nutrients I consume.

I can even scan my own brain waves and use this information to help me get into a more meditative state. The device I wear on my wrist and have on my bike tracks how much exercise I have done and at what intensity, and because most of these devices all talk to the same app, I have data demonstrating my health over time going back years in an easy to read format.

I have this data as I’m an enthusiastic amateur ultra-distance athlete, keen to optimise my performance. If I needed to, I could share this data with a clinician and seek advice if I was concerned about an abnormal reading.

The ingredients of success

With Fitbit-style devices measuring more data and more accurately, a single device can track what’s happening and flag when something appears wrong, meaning we can self-monitor and for the most part self-manage our health before things go too far. It’s not about us becoming doctors.

Instead, it’s allowing technology to do the complex analysis and give us a simple personal dashboard of our state of health and knowing what to do to adjust our lifestyle to keep things on track. These devices alone are not enough. Just because we are now more aware does not mean we will do anything about it. We also need to incentivise people, and to establish good habits. For this you need three things:

A cue - the thing that triggers the habit

Routine - what you do once the cue is triggered

Reward - the buzz of having completed the routine

The reward for keeping yourself healthy could come in the form of a device displaying when you hit the target number of steps walked. We could learn from coffee shops and their loyalty card schemes that work on the notion of goal proximity theory - the closer you are to completing the card, the more coffee you are likely to buy.

Delayed gratification could come in the form of reduced taxes. Each visit to the doctor, dentist or hospital costs substantial amounts of money. If you look after yourself and avoid the need to use these services, then you should share in the savings made.

It’s not just the government that should be rewarding ‘well’ behaviour but companies too. Reducing absence due to sickness should come with a bonus and be part of an individual's annual review. To make it more fun we need to learn from the success of computer games, whereby we make a game on the exercise of maintaining wellness.

We’ve done it before

To drive better healthcare and move away from our dependency on the NHS may seem like a tall order, but we’ve done it successfully before. The fact we now all wear seat belts in cars was a function of a sustained campaign of communication, education and finally legislation. The same will be required in this instance. We need to help people understand the basic principles of wellness.

The FAST campaign aimed at helping people recognise when someone is having a stroke is an excellent example of how we can be educated around a specific issue. Secondly, we need to educate people into the routine we wish them to follow. It’s not about using the technology, it’s about what to do when the technology alerts you to an issue.

The alertness monitoring systems in new cars is a great example. They can sense when you are beginning to show signs of fatigue at the wheel and alert you that it’s time to take a break.

The algorithms and technology that underpin these systems are complex and despite all of which is irrelevant to the driver, the key thing is the simple alert on the dashboard advising you for your own safety and that of other road users, to take a break.

We need to make it a requirement in law that you take care of yourself and we have plenty of existing legislation that already demonstrates this is possible.

We also need to ensure the technology is measuring consistently, reliably and accurately to make this work. We’re not there yet but it’s getting close. The optical sensors that measure heart rate in wrist devices are good at recording heart rate but not determining heart rate variability.

The way devices monitor sleep still need some work to match the data from the current gold standards of measurement. Above all, we need to continue to integrate these technologies into single devices that use a common language to communicate with the users’ preferred application and we need to make the process as easy as possible.

The cultural norm

It’s not a question of ‘can we do this?’ Early adopters of such technology have proven it’s possible. The question is how we make this a mainstream cultural norm that means it’s simply the way we do things.

If we continue to focus on the NHS as the principal focus for resources to ensure our health and well-being and abdicate responsibility to others, we are missing a trick. That’s good for magicians, but not so useful for us.