Building H Newsletter | We're Gonna Need a Bigger Fitbit

Fast Company recently published an article, from researchers Scott Conger, David Basset and Lindsey Toth, looking at physical activity around the world over the past couple of decades. Fitness tracker sales soared for years without boosting physical activity, analysis shows. In the studies they examined, which covered eight industrialized nations and were conducted from 1995 to 2017, they observed a fairly consistent pattern of declining physical activity in both men and women and in each of the countries. The decline amounted to a net loss of 1,100 steps per person per day over the 22 years. Most concerning, perhaps, is that the declines were worse among children (35% more than adults) and adolescents (nearly 250% more than adults). Daily step counts among adolescents actually dropped 30% overall. All of this against a backdrop of increasing sales of fitness trackers, which rose from $14 billion a year in 2017 to $36 billion in 2020.

The authors note they didn’t look at changes among individuals who used fitness trackers, but rather at studies that examined population levels of activity. They also note that there are many reasons why fitness trackers can be useful for some people by creating greater awareness of one’s overall activity levels. Their conclusion, though, is that fitness trackers can be a facilitator – but not a driver – of behavior change. Their study did not seek to pinpoint the causes of the declines in activity, though the studies reviewed offered a variety of possible explanations, from increased screen time, changes in availability of PE classes in school and decreases in the number of children and youth who walk or bike to school. In the US, some changes are quite prominent: the authors cite studies showing an increase in screen time among adolescents from 5 hours per day in 1999 to 8.8 hours per day in 2017 and a 75% reduction, between 1969 and 2009, in the percentage of K-8 children who walk or bike to school.

The study’s findings speak to the core of why we founded Building H  – because tools to help individuals, absent bigger changes in our environments, simply aren’t enough. Back in the 2010s, both of us – Thomas and Steve – had been fully engaged in digital health. Thomas wrote a book about the new world of data-driven health and founded two digital health startups; Steve, with his colleagues at Robert Wood Johnson Foundation, supported work to explore and promote the promise of improving health behaviors by having people more engaged in collecting and understanding data about their behaviors. And there were lots of reasons to be excited: Silicon Valley, which had so transformed  other industries, began paying attention  to health and healthcare. There was a sense that individual empowerment would come from access to better information and feedback; and there were exciting techniques, like gamification (see our last issue) and social comparison, that could stoke people’s motivations. And yet, by the latter half of the decade, as there seemed to be little progress in population level health outcomes, we both started having nagging feelings that that promise might go unfulfilled. Beyond the new fitness trackers, apps and websites providing health information, the really big, life-altering technologies, like cars, TVs, and smartphones, reinforced other behaviors that had much more powerful, even dominant effects on people’s health. In one of these conversations, Thomas recommended that Steve read Daniel Lieberman’s A Story of the Human Body, an evolutionary biologist's take on health and modern life. Lieberman’s central point is that we have created a modern world for which humans are unsuitably evolved and that that mismatch explains the current high prevalence of chronic diseases that used to be quite rare among humans. Grokking that point was transformational for Steve – it spoke to the fundamental nature of the problem and to the size of the resulting challenge. As he thought at the time, “Damn, we’re going to need a bigger Fitbit.”

Which takes us back to fitness trackers. The fundamental problem with the Fitbit (and we’re not picking on Fitbit here any more than any other tracker) is that while it can tell you how many more steps you need to reach your goal – it doesn’t make it any easier to get those steps. It’s an ingenious piece of engineering, but it ultimately lacks ambition. It assumes that the world we create will be unhealthy and that the people in it will have trouble getting enough steps. It takes that as a given. It challenges people to overcome this unhealthy world and to seek those steps despite it – rather than aiming to remake the world to be healthy in the first place. 

So many efforts to improve public health are rooted in the idea of getting people to care more about health, to digest and act upon more information about health, to monitor their health behaviors and be vigilant in adhering to healthy regimens. But what if we could instead create a modern world that doesn’t require that level of attention? A world in which people didn’t have to work so hard to be healthy but could focus instead on living? In which fitness trackers would seem completely unnecessary? In his Netflix special, Dan Buettner noted that the “blue zones” – the five places in the world where people were living the longest – were places that have evaded or delayed what he called the “corrosive forces of modernization.” What if we could create a world where modernization wasn’t corrosive? It’s not a question of whether we have the engineering and design talent to do so – it’s a question of how we choose to apply it.

Let us know what you think — comments are open below.

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