One of the problems with having any sort of debate on Twitter, about something as complex as Public Health, is there just isn’t room to make a coherent and nuanced point. This morning I was struck by @RoyLilley‘s blog post on the challenges that Public Health has to respond to in the face of the way that we live our lives. He makes good points, we do lead increasingly sedentary lives and our circumstances conspire against much of the advice in leading an active life.
Thinking about this point I somewhat flippantly responded that the growth of fitness apps embedded in all of our phones would create massive motivation for change, if people were aware of them. Perhaps it could be a role for Public Health England to promote their existence. It’s not a theory I can evidence other, than through my own personal experience, and that of people I know but it was interesting that it struck a chord with a few people (only a few).
Maybe it’s useful to clarify what I meant before talking about how this highlights a more general issue with Public Health and the wider NHS.
Smartphones are owned by 66% of the adult population in the UK (90% of 16 – 24 year olds). Because of the nature of phone development this tends to mean that all of these people are running phones with either Android or Apples iOS as an operating system. In turn that means that all of these people have access to either Google Fit or Apple Health. They’re free, you just download them and start using them. You don’t need any extra gadgets like watches, they record your activity and allow you to set goals and record what you eat.
The two main challenges (entirely reasonable challenges) are; they won’t work for everyone and is there any evidence that they work? In respect of working for everyone, no, of course they won’t work for everyone, but at zero cost they are certainly worth a go. One of the things that needs to be recognised, by the health community, is that a universal provision of service does not equate to universal solutions. Being flexible in how we address issues such as diet and exercise is the only way we will make progress.
As far as evidence goes, I think it’s a bit more complicated. Lumping all “fitness apps” together is misleading. There are many apps that purport to provide you with effective exercise regimes which can vary significantly in quality. In the case I’m trying to make I’m restricting myself to those few apps that are free available as core apps on the two most popular platforms. Essentially their focus is recording activity/diet and prompting you to set/meet goals. Is this evidence based? Keeping a diet and exercise journal on paper has long been a key element of improving health, the fact that you can automatically record data on an app doesn’t diminish the evidence.
The NHS does already promote some apps to people via NHS Choices. What I would like to see is greater awareness raising with GPs about what freely available apps do and how they can support those people who find them beneficial.
This leads onto, what I think is, an endemic problem within the NHS and Public Health. The obsession with innovating out of financial crisis creates strange barriers to adopting solutions that are already freely available. Significant time and money is regularly invested, by a cash strapped health economy, to find new innovations that will revolutionise services.
This investment ignores the two basic rules of innovation:-
Rule 1 – Innovation is expensive because more often than not you will fail.
Rule 2 – At no point in human history has anyone come up with an innovative solution starting from the point of innovating for the sake of it.
How does this relate to my point about fitness apps on phones?
If anyone in the NHS or Public Health were to suggest they wished to build an innovative app, to help people set goals and manage exercise; then it is quite possible that would easily be able to access any number of innovation funds. Would the same funding be available to seek ways of integrating already ubiquitous technology into existing services? I believe it would be much more difficult.
Cash savings from innovation are as rare as unicorns and efficiency savings. Innovation always looks good in presentations but anyone who makes a business case based on it better have a compelling response to why they have discounted all other solutions first.