(by Stefania Capogna) App and wearable devices were discussed on June 18, 2020 during a Digital Conference promoted by the DiTES (Digital Technologies, Education & Society) and DASIC (Digital Administration and Social Innovation Center) research centers, Link Campus University, in collaboration with AIDR (Italian Digital Revolution Association).
The aim of this plural Round Table with guests from academia, the corporate world and civil society was to reflect on the way in which interactions with these technological artifacts change the scene and relationships in personal care and safety.
From the Immune App to wearable technologies for contact tracing, we are witnessing the development of scenarios and possible futures, both by the creators of these socio-technical devices, and by the end users who, in interpreting and acting on the functionalities tools, redefine their uses, fields and methods of application.
As Veronica Moretti (University of Bologna) recalled, the discussion on the ambivalences presented by these technologies brings to mind the Foucaultian philosophical hypotheses, the image of the Panopticon, the total institutions, the self-discipline aroused by the awareness of being scrutinized at all times. Digital surveillance, although much more pervasive and present than the "ideal prison", takes on a "sweet" and invisible character. It is not perceived in everyday life, but is constantly present in our lives, suddenly breaking onto the scene in today's discussion, penetrating many spaces of our private sphere. One of these is health traceability which makes subjective freedom appear as "dangerous for one's own safety and that of others". Hence the double reading on the need to use these devices and their applicability in various contexts. In the fragile balance between the purposes useful for personal and collective security and the possibility of entering the sphere of intimacy and individual freedom, the ambivalence between control and protection is at stake.
For this reason it is interesting to reflect on the use of the Apps in everyday life and in the workplace. In this regard, Francesco Miele (University of Padua) focused on their use in health monitoring, such as through the use, by companies, of bracelets to guarantee worker safety, or apps for monitoring health habits and daily lifestyle.
Well, what future scenarios open up in the collection of employees' vital signs? And for what type of use?
These are just some of the questions raised in the discussion which also touches on the theme of trust, awareness, reliability of the infrastructures that hold these data, the risk fueled by the new frontiers of online crime, etc.
Crucial issues that deserve careful, thorough and widespread reflection that must be confronted with the always possible risks of perverse, unwanted, involuntary effects, such as those feared by the scenarios of total control in the "Big Brother" style. Scenarios accompanied by the possibility of trading personal data for consumer purposes, inducing data driven market needs, connected to speculative forms of the health industry 4.0. This phenomenon is fueled more or less consciously by the widespread tendency to transfer personal data in exchange for digital services. Wellness-related apps are one of the most distinctive examples. They are Apps, to which we can serenely allow the monitoring of our daily lives, the geolocation of our movements, hoping to achieve greater well-being and the improvement of our lifestyle.
The experimentation of the Immuni App for the control of the pandemic, which was accompanied by strong elements of perplexity and skepticism, is placed on a different level. The most relevant concerns, as Beba Molinari (University of Catanzaro) said, concern the traceability of individual people to counter the spread of the virus, in consideration of the fact that the function of this device is to be able to "report" the infected, allowing reconstruct the evolution of the contagion spiral, using bluetooth or GPS geolocation. The evidence of being able to be continuously geolocated through the Smartphone has fueled the debate on the value of this App. A debate that has revealed a clash of values and priorities in the dichotomy of social security and personal freedom, in consideration of the fact that the effectiveness of the The application is based on the use of GPS, in order to make the "proximity map" effective, to quickly track the risk of outbreaks. Despite the critical issues and the ongoing debate, 16 million citizens have downloaded the App from 2,5 June to today.
However, the Immuni App represents only one element, perhaps not even the most important, of a radical transformation of the National Health System which for several years has already walked towards the challenge of a reconversion aimed at enhancing all the opportunities provided by the digital Health plan. .
A plan, as explained by Alessandro Di Falco (CONSIS), which calls for a strong strategic and prospective planning that is able to put the citizen / patient at the center and the need for him to be the owner and manager of his health data.
How many times does the citizen really have access to his health data?
How many times in case of hospitalization are our vital signs collected and do we accept informed consent about the therapies?
How well informed is this consent?
How much does the fragmentation and dispersion of health data weigh on public health and on the subject?
Each citizen, in a variable way according to age and personal experience, has a complex clinical history. A story dispersed within a variety of structures (hospitals, laboratories, professionals, general practitioners, etc.) that do not dialogue with each other and which, for the most part, are not even fully handed over to the data holders. Even the best technological application in a scenario in which health data are not organized, and the infrastructure assigned to manage them is uneven from North to South, and fragmented from Region to Region, makes it difficult to see the vaunted Healthcare 4.0. Healthcare that would like to be closer to the citizen and capable of offering quality services and safety protection.
Certainly a distinction must be made between the apps dedicated to wellness and those dedicated to care, research and healthcare in the strict sense.
The set of this second group of sanitary type devices is not yet sufficiently known and studied. There is not a sufficient understanding of how it can contribute to redesigning the network of relationships and assistance on the territories. But at the same time it opens a window on the topic of remote diagnostics, robotic diagnostics, telemedicine etc. The Immuni App is therefore only the pinnacle of the infinite possibilities to rethink the system, leaving a glimpse of a deeper and more complex transformation that opens up great challenges to the changes prompted by the scenario of digital healthcare.
What emerges from the discussion is that the digital transformation of the health system is played at different levels on which it is perhaps necessary to build opportunities for convergence.
In the first place, the question of the narrative that develops around these technologies arises, and how this narration influences the formation of a public opinion and the agenda setting around the theme, leaving leaked the responsibility of the bodies of institutional and non-institutional communication .
In the second instance, the need to start thinking about these technologies in terms of 'ecosystem' is highlighted, through an 'ecological' approach that can foster dialogue and exchange. The theme of local, national and supranational infrastructures and architectures is closely connected to this point, which not only influence the design of these technologies but which must also act as guarantors towards citizenship, for example with respect to the theme of data ownership , their protection, encryption, transparency, certification of the App etc.
Furthermore, the Covid-19 emergency has brought to light, placing it on the level of public debate, the question of invisibility and the pervasiveness of technology that makes possible a form of control that is less and less physical and material, therefore increasingly subtle and hidden. A form of control in which it is not known who controls who, for what purposes, for the benefit of whom. A control capable of penetrating even the intimacy of the person, the personal and emotional sphere and therefore, therefore, also very violent.
The example of the Immune App and the contrast that is played out in the contrast between centralized management and decentralized management makes it clear that the introduction and adoption of technology within the governance system of the Healthcare System is played in the space of a dual polarity policy, i.e. stretched between the central system (the national level) and the local system (the regions), to which is added a third polarity, exercised by that vast plethora of private individuals who hold the technology, the data, the algorithm of data analysis etc ..
Of course, this opens up a scenario of possibilities but also the risk of new forms of social injustice. Injustice caused by the serious digital divide that afflicts our country and the 'global village' itself, and which is measured not only in terms of accessibility to infrastructure, but also in relation to the scarce digital culture and skills that afflict a large part of the population, also involving many professionals.
The fact remains that technology is certainly an ally, it is a resource but it is not self-resolving, it is not the panacea for all ills. There is a need to direct a process of "domestication" and socialization to technologies that accompany people to approach them as active subjects, able to exercise their conscious agency, their freedom of choice and their critical thinking within the framework of a personal and collective responsibility.
This shifts the reflection on the level of training, education, inclusion and accompaniment of people to the appropriate and conscious use of these tools.
Finally, the economic and social crisis caused by the pandemic has opened a window on the so-called "invisible" ones. Some are invisible by choice because they choose (they know how to exercise the right of choice) not to be tracked; but most of them represent only the sum of human and social frailties that find their peak in digital simply because they are excluded.
Digital thus represents the new invisible city wall that separates the 'elect' from the 'excluded'. But at the same time it can also represent the tool by which to reach the most distant. This means that you cannot think of addressing the issue of apps and wearable devices, or any other technology, exclusively in technical terms. Technologies, as always in every age, re-propose the theme of the conflict of power.
History teaches that the government of technology allows the exercise of power over people, society and the economic system. For this reason, the issue must be addressed through the lens of "the ecology of social and material relations" that distinguish the hyper-technological and digital society that pervades us and pervades our lives and our communities. But above all it must be faced in terms of an idea of the future.
What model of society do you intend to design and build?
What vision of humanity?
What subjectivity can be expressed, and how, in the complex framework of socio-technical-material relations of the care system 4.0?
The experience of the emergency and the analysis of the criticalities connected to the use of the Immune App, and of any treatment technology, shows that the success of the application depends on sharing towards a common perspective. The theme of the ethics of co-responsibility then becomes central, which is summarized in the common willingness to build responsibly, each in his role and his possibilities, the daily life of our community life. An everyday life made up of mutual interdependencies in which each needs the other to exist and exist.
It is in this framework of interdependencies that move in the new digital socio-material space that the challenge of the doctor-patient relationship is also being played today and which will be the subject of the Digital Conference on June 25th.
Stephanie Capogna - Associate Professor and Director of the Research Center Digital Technologies, Education & Society, Link Campus University and Head of AIDR Digital Education Observatory