Digital Health and the Coronavirus Crisis: Three Sociological Perspectives
The advent of the novel coronavirus (COVID-19) pandemic has generated massive social and economic changes in people’s everyday lives, including their use of digital health services. Digital health technologies have rapidly expanded and new ways of monitoring health and providing healthcare have emerged that are customised in response to the pandemic.
As part of physical distancing measures, many countries have moved quickly to institute and dramatically expand telemedicine services so that people can contact healthcare providers online rather than attend surgeries or hospital waiting rooms. Online symptom or self-diagnosis platforms and apps have appeared to help people determine whether they are at risk from contracting the virus or needed testing or healthcare.
Digital technologies have also played an important role in population monitoring, containment and control measures. In some countries, a range of smartphone and social media apps have been developed for use in surveillance and mapping of symptoms and viral spread, contact tracing and enforcement of quarantine or self-isolation measures. Drones have been brought into service to monitor and disinfect public spaces and used to warn people they are violating isolation rules.
Social theory can provide some insights into how digital health technologies are being used to manage and control the pandemic and identify the social, cultural and political implications. Here I outline three major perspectives on digital health in the coronavirus crisis: the political economy approach, Foucauldian perspectives and more-than-human theory.
Political economy approach
The political economy approach is founded on the work of Karl Marx, whose critical scholarship published in nineteenth century drew attention to the social structures and social class-related inequalities that had resulted from the Industrial Revolution and the emergence of the capitalist economic system. Applied to contemporary digital health, a political economy perspective highlights the continuing disparities in the benefits offered by these technologies. While Marx focused on social class, social researchers have pointed out other social determinants of digital health use, including factors such as geographical location, gender, age, ethnicity/race and level of health or disability and digital infrastructure access.
A political economy perspective on the COVID-19 crisis emphasises that not all citizens have been able to engage with the digital health technologies that are on offer or to take up the practises of prevention that websites, apps and government advertising have advocated, due to social determinants such as social disadvantage, area of residence or lack of education. Neoliberal and free market capitalist political systems have been called to account and disrupted by the COVID crisis but have also operated to protect the privileged and profit from what was termed ‘disaster capitalism’ or ‘coronavirus capitalism’. These developments have included the rapid growth and expansion of digitised surveillance technologies that have often operated to blame and punish people for not being responsible citizens, even when their ability to conform to state imperatives were limited due to poverty, lack of digital access, overcrowding at home, fear of starvation or homelessness: particularly in low or middle-income countries.
Foucauldian perspectives
The scholarship of the late philosopher Michel Foucault has been influential in medical sociology since the 1980s. His concepts of biopolitics and biopower have been taken up to address health and medical topics. Rather than see power relations as always operating to subjugate or coerce people, as is the typical political economy approach, the Foucauldian perspective highlights the productive nature of power: how it brings knowledge and practices into being and action. Biopolitics and biopower refer to the complex power relations involved when state agencies such as government health departments, non-government and commercial enterprises and lay people and healthcare professionals work together to manage the health and bodies of populations
In response to the COVID-19 pandemic,Foucauldian-inspired critiques taking up the concepts of biopolitics and biopower have discussed the political dimensions of how social groups and populations (the ‘body politic’) as well as individual bodies were managed, disciplined and governed in the COVID crisis. For some commentators, governance responses to the pandemic, such as using software to collect, quantify and model the spread of the virus and apps and drones to monitor people’s health and behaviour, were evidence of a ‘radical biopolitics’.
Emphasising Foucault’s key principle that the exertion of power can be both productive and repressive, it can be argued that while some of the digital technologies adopted by governments to intervene in and regulate the pandemic were restrictive of people’s freedoms (such as the apps used to make decisions about whether people could leave their homes), this was part of a delicate balance sought by state agencies to ensure that the pandemic did not become out of control, so as to limit its effects of the health of their citizens as well as the economy. These measures, therefore, were designed to preserve and maintain good health in the population rather than simply or only a quest for political control.
More-than-human theory
In many areas of the humanities and social sciences, more-than-human theory (also referred to as ‘new materialisms’) have begun to make a major impact. As the term suggests, more-than-human theory devotes attention to the ways that humans come together with nonhumans to form collections (‘assemblages’) of things that generate forces and capacities for action. These nonhumans include living and non-living things such as other animals and plants as well as elements of place and space such as mountains, bodies of water and urban landscapes and human-made objects such as houses, furniture, food and clothing. Health-related assemblages might include humans coming together with things such as hospitals, medical clinics, pharmaceuticals, vitamins and fitness apparel.
A more-than-human perspective identifies that in the case of COVID-19, constantly changing ‘pandemic assemblages’ emerged as the pandemic ran its course. The virus itself (SARS-CoV-2) became a powerful agent of change, as it came into contact with humans and nonhumans (surfaces that were touched by humans) and rapidly moved from infecting the bodies of animals in Chinese wet markets to those of humans, and as humans began to infect other people. Strategies of containment focused on limiting people’s movements in space and place, as well as using a new testing regime to discover who was infected and encouraging people to engage in hygiene practices.
Together, these human and nonhuman agents generated affective forces and agencies that enhanced or diminished humans’ capacities for action. The capacity to protect oneself from the virus but also from affects of hopelessness or feelings of loss of control were important elements of the ways that humans engaged with not only digital health technologies such as telemedicine and symptom-checker apps but also social media, digital messaging services and video streaming platforms as ways of keeping in touch with others and engaging in education, exercise activities or working-from-home practices.
This perspective also emphasises the importance of recognising the non-digital elements that were part of digitised responses to COVID, thus broadening the scope of understanding how digital health operated during the crisis at the micro-political level. This includes the role played by such mundane objects as face masks, soap and warning signs in places such as homes, clinics, supermarkets and other public spaces.
Future research directions
A multitude of novel digital health technologies will emerge into the future, responding to new outbreaks of infectious disease as well as longstanding health problems. As the world deals with and moves into a post-COVID future, many issues related to digital health technologies will require continuing sociological investigation. The impact on the healthcare system and healthcare delivery systems will need to be examined. Detailed investigation into what digital health technologies were most useful and helpful to both lay people and healthcare providers, and which failed to live up to their promise, are required. The uses of surveillance technologies for monitoring the health and movements of citizens and populations should come under scrutiny if they are continued beyond the immediate crisis and need for containment. How social media and other online resources contributed to mental health and wellbeing during the pandemic and beyond is another important area for sociological research.
Photo by Brian McGowan on Unsplash
