A new mobile app called Healthyday is meant to help you map illness in your neighborhood. You can log on, and based on crowd-sourced data, see a visual representation of who has a series of common ailments on your street—from garden-variety colds to the flu and chicken pox. Another app called Sickweather, allows you to chart local illness the same way you check the weather. We can now navigate our way at home and abroad—checking for germs and possibly seeking out only “disease free” venues.
Centuries ago, if someone had the plague or another infectious disease, a red “X” or cross would be placed on their door so that people would know to avoid entering. In the future, we won’t have to do that—we will have an app that maps illness instead.
Healthyday has promised to take the “guesswork out of your health symptoms by determining what illnesses nearby people may have. It can show you where the most cold, flu, and allergy symptoms are present.” This can, of course, help you figure out whether you share the same ailment as your neighbor. If you wake up feeling rotten, and check your phone, this may help you figure out what you have, and if you live far away from a doctor, this might help with your diagnosis, or help you figure out whether you do need to make a trip to a doctor fast—if, for example, you see that everyone down the street has food poisoning from the block party.
Healthyday and Sickweather are just two examples of a growing type of application created for mobile devices as part of a new business plan—mobile health (“M-health”)—which allows for medical information and at times, diagnosis, to be achieved using mobile phones. These apps do sound nifty—but it also seems a bit awkward and downright invasive to be able to use geolocation to determine who in your neighborhood is sick—and it may lead to bad forms of social interaction or shunning that we want to avoid.
In this column, I will look at Healthyday and the evolution of new M-health apps that use publicly crowdsourced data to “map” illnesses and diseases. While these apps would show promise if they helped us track a single disease or pandemic (e.g., flu, or Lyme disease), or a true public health crisis (e.g., Ebola), their use for mapping everyday aches and pains may, for now, be of limited use and pose significant privacy concerns.
Pandemics and Beyond: The Evolution of Mobile Health “Maps”
Since the 2014 Ebola outbreak and the more recent MERS outbreak in South Korea, public health concerns involving the transmission and spread of disease are now a global industry.
So, in light of recent outbreaks, the world is looking at mobile health—defined as the use of mobile technologies to support and advance health care and health systems—as a potential solution for global health care problems in 2015.
The idea of mapping illness has been an important tool in public health as a means of identifying where outbreaks of disease have occurred, and then being able to try to track illness, and also to provide vital services. The iTunes Store offers an app called ebolatracker, for example, that maps the course of the outbreak that started in 2014.
Closer to home, the U.S. Centers for Disease Control (“CDC”) have their own app called FluView. This allows users to monitor levels of influenza across the country. With this application, you can explore Influenza-Like Illness (ILI) activity levels across the nation, view ILI trends over several weeks, and get on-demand access to state health department websites for local flu data. FluView gathers its data from more than 3,000 health care providers in all 50 states, the District of Columbia, and the U.S. Virgin Islands, reporting more than 30 million patient visits each year.
During summer and camping season, many users may avail themselves of the various Lyme apps such as Lyme Disease Tick Map track the prevalence of ticks in different areas. Researchers at Yale University have used various data to create an application that maps the number of infected ticks at the location of the user. If ticks are determined to be present, the user is given a list of precautions to avoid tick bites and is provided with a tick detection guide showing photos of ticks and how they appear at various stages of their life cycles.
Other mobile apps attempt top track a large range of outbreaks. HealthMap’s Outbreaks Near Me application provides the “latest real-time disease outbreak information at your fingertips. Open the app and see all current outbreaks in your neighborhood, including news about H1N1 influenza (“swine flu”).” The app even has an outbreak-reporting feature. If you know of an outbreak not yet mapped, you can be the first to report it using the app’s outbreak reporting feature. You will be credited, and your report will be featured on the website. You can now gain social capital by being a disease detective.
Do We Need to Map the Common Cold and Other Frequent Ailments?
The aforementioned apps have been lauded for providing travelers, government officials, and and everyday citizens with timely and relevant data about major public health issues. In rural areas, countries with less public health infrastructure, and for travelers, this real time mapping of disease can be valuable. They also allow people who are in affected communities or areas to report incidences of illness with their smartphones, thus crowd sourcing the geography of illnesses.
Of course, this requires people to diagnose accurately. This may be easier when it comes to very specific diseases; it becomes less so when one compares colds to allergies to sinus infections. How can a consumer know what illness she has without consulting a health practitioner?
But we have a new evolution of mobile apps that don’t focus on major public health crises or on specific diseases we may want to monitor, but instead focus on mapping health in our daily environment.
Sickweather is an app that uses social media and public reporting as part of its data set to predict and map more everyday sickness. Its website notes: “Everyday thousands of people around the globe update social media sites like Facebook and Twitter when they (or someone close to them) get sick. Just as Doppler radar scans the skies for indicators of bad weather, Sick weather scans social networks for indicators of illness, allowing you to check for the chance of sickness as easily as you can check for the chance of rain.”
Sickweather also provides real-time alerts whenever you enter a “sick zone.” Consumers receive reports on up to 19 illnesses, including flu, Norovirus, pink eye, and whooping cough. Users are also encouraged to “be social” about their illnesses, reporting out via social media and contributing to the data that Sickweather gathers. Who knows, in the future, Sickweather might also be able to map zones that are “unvaccinated” or where fewer children have gotten recommended shots.
You can access Sickweather with your phone or even your new Apple Watch. Apple Watch users can assess the relative health of a current location with “Sick Score”, the app’s contagion sensing index.
Healthyday is the most recent mobile health app to be launched. It was created by a Johnson & Johnson product development subsidiary. The app uses an algorithm to identify illnesses that are “trending” in an area and send alerts to local users. Its algorithm aggregates information from doctors, web searches, social media, and self-reporting consumers.
Users can see whether people in their neighborhood are sick and what they may have, and are encouraged to take precautions to avoid sickness. For example, on a given day in Seattle or Toledo, the map might show any number of reported allergies and sinus infections, displaying where illness is, as a location pin on a map. For now, as with Sickweather, Healthyday also allows users to report conditions like the common cold, flu, strep throat, pink eye, bronchitis, and chicken pox. Healthyday does encourage us to become malady voyeurs—it calls on us to “see if other people in your neighborhood are sick, and what they have.”
Should We Be Using Apps to Track Everyday Illness?
For germophobes, the app may be a dream come true. They can walk out of their house and chart the healthiest route to work or school and avoid streets where people are ill. But for the rest of us, how useful will it be to know who has a cold on our street, or whether Johnny next door has pink eye? There also may be high demand for those of us with voyeuristic or prurient interests. They provide us with something else to gossip about over dinner.
I would want to use some of their specific disease trackers—the Lyme disease one, for example. But I’m not sure I want to start looking to see who is sick in my neighborhood. Once I had the data, what would I do with it? Would I start trying to figure out whose house was a “pin” on my phone’s map? Would I treat my neighbor differently if I saw that there was a reported illness in their house?
Would certain neighborhoods be tainted with any negative connotation if they did have a high or frequent incident of illness? This data might be useful for public health officials, but different viewers for less desirable purposes might use it. Would my boss keep tabs on me by using the app? If I called in sick, would I be expected to sign on and post my ailment? Alternatively, if I did do so, would it lead to any kind of repercussions if I had not disclosed my ailment at work but reported for duty?
Consumers will need to think twice before posting their own data as part of the crowd-sourcing feature. We will also need to figure out how our data might be used if we do share with a doctor or other health care provider; of course they might share anonymized data that gets reported. But how anonymized? If we live in a small town, it may still lead to pins being placed that cause people to make inferences about us, or if public health data leads to “disease” maps that cause people to avoid a neighbor—to use the old saying, “avoid something like the plague”.
There are already apps that may lead to discrimination—explicit or implicit—like the app that maps “sketchy” neighborhoods; now have apps that, while serving a purportedly beneficial function, also create maps of misery, and because of different things like poverty and other socioeconomic factors, may lead to different patterns of illness that cause us to discriminate or to view people in 19th century Dickensian ways.
Will insurers offer us discounts if we agree to map our illnesses? Just as our driving will be monitored, will this be another way that industry will generate data that is useful to their own risk assessments?
One hopes that whether a neighborhood has more reported illnesses will never be used to make decisions about our employment, or insurance premiums, but we should not rule out such ideas as fanciful. Once data can be collected, the context for which it was originally gathered can change with the creation of new business models or algorithms.
The Future of Apps That Map Illness
At present, the mobile health revolution is just beginning. Individual ideas mapping, or using mobile devices to track individual health are surely valuable innovations. But there are some downsides to treating disease like the weather. It’s one thing to check to so it if it raining outdoors; it’s quite another to check to see if the street is full of sick people. Will we start carrying umbrellas as well as face masks to ward off contagion as well as rain?
Some members of Congress have already asked questions about location-tracking apps and raised questions about privacy and security. M-health and mapping apps raise similar and perhaps even more serious questions about privacy and security as well as about how such data might be used in ways that are discriminatory or against public policy.