Enough Is Enough? When Health Metrics Shift From Useful to Too Much

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Developing metrics where they are not needed can result in stigma and discouragement.
Developing metrics where they are not needed can result in stigma and discouragement.

Although metrics can be useful for tracking health patterns and creating incentives for positive health-related behaviors, researchers have begun asking the question, “When is enough, enough?”

Catherine A. Womack, PhD, of the Department of Humanities and Social Sciences at Bridgewater State University in Massachusetts, addressed this question at the American Public Health Association 2018 Annual Meeting, held November 10-14 in San Diego, California.1

Dr Womack looked at a 2017 article published in the New England Journal of Medicine2 that focused on promoting so-called “health-directed behaviors” — for example, taking medication or exercising — that “don't require relying on sporadic and brief clinician contact.” Because these behaviors are often personally-motivated and invisible to others (“private by default,” according to the research), authors David A. Asch, MD, MBA, and Roy Rosin, MBA, from the University of Pennsylvania, proposed that moving personal health information, like behaviors and body metrics, into the public sphere could create an “array” of social incentives resulting in improved health.

In their research, Dr Asch and Mr Rosin provide a number of examples of publicized health behavior, including an electronic pill bottle that would track, then broadcast, a person's medication adherence, allowing a spouse, friend, or family member to observe; a patient signing up to receive text message reminders to comply with perioperative instructions to improve surgical outcomes; or using leaderboard-based social competition to manage chronic diseases like diabetes or hypertension.2

While Dr Womack acknowledged the usefulness of metrics and health data in “tracking health and incentivizing health-directed behaviors,” she also shared 3 concerns surrounding the use of metrics: patient privacy violations, the potential for stigmatization and backlash, and the use of arbitrary, overprecise, and often irrelevant metrics for tracking health.

“Put in proper context, health data can be useful. But [data] need to be embedded in an explanatory framework in order to provide effective treatments and guidelines for promoting health,” she wrote.

Ultimately, Dr Womack argued that a focus on “arbitrary” data tracking is resulting in missed opportunities for health researchers to learn which mechanisms — behavioral, social, or physical, for example — form the bedrock of both positive and negative health behaviors.

“[C]reating metrics where they're not needed can result in stigma and discouragement of activity by those who are less fit (by metrics standards),” said Dr Womack. “For effective health promotion, we need information that is richer and denser than what is tracked by apps and devices.”

Click here for more news from the American Public Health Association 2018 Annual Meeting and Expo.

References

  1. Womack CA. Metrics gone wild? When more health data is definitely not better. Presented at: American Public Health Association 2018 Annual Meeting and Expo; November 10-14, 2018; San Diego, CA. Abstract 4031.0
  2. Asch DA, Rosin R. Engineering social incentives for health. N Engl J Med. 2016;375(26):2511-2513.
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