FORUM On MODELIng
agement approach to health [ 13].
Far-fetched? An impossible change?
Emerging trends support self-management
Self-management has always existed. Americans
spend billions of dollars each year on health
foods and diet programs. A doctor reported, “ 20
to 30 percent of my patients are into some type
of supplements or ‘nutraceuticals’” [ 14]. Deloitte
reported that 20 percent of consumers used
alternative therapies [ 15]. Kaiser reported that 33
percent of consumers had “relied on home rem-
edies or over-the-counter drugs instead of seeing
a doctor” in the past 12 months because of cost
concerns [ 16].
Several factors have begun the process of
reframing health as self-management. The U.S.
healthcare system is out of control; manag-
ing costs requires a focus on what the medi-
cal profession calls outcomes. The public has a
growing awareness that well-being is more than
healthcare. The fitness and exercise movement,
elements of the DIY (do-it-yourself) movement
like the Quantified Self group (http://www.
quantifiedself.com/), behavior-change programs
like Weight Watchers, and more progressive pro-
grams for managing chronic conditions like the
Stanford Cardiac Rehabilitation Program [ 17], all
point the way to self-management.
The shift to self-management is also supported
by changes in the Internet and related technolo-
gies. Melanie Swan reported, “Individuals are
becoming more engaged in a variety of self-testing
and self-management of conditions, symptoms,
genomics and blood biomarkers, behaviors and
personal environmental factors. Individuals could
dramatically expand their use of web-based tools,
devices and health-based social networking plat-
forms as their awareness increases, costs drop,
financial incentives arise and automated tools
proliferate” [ 11]. The Internet and related technol-
ogies are also making it easier for people to have
conversations that support self-management.
Imagine online social-network applications
creating communities of support around dis-
eases, chronic conditions, and fitness. Of course,
health-based social networks have already
begun; what’s surprising is just how many there
are [ 18]. Other social network applications serve
broader audiences while also offering health-
related components [ 19].
Social networks are dynamic; they can gener-
ate collective action. In addition to individuals
experimenting on themselves, groups of people
with similar conditions—people joined together
through online social networks—may sponsor
or conduct research. Already, online social net-
works have begun to affect clinical trials, helping
researchers find participants and helping partici-
pants compare outcomes.
Imagine several sensors monitoring each
person. Already nearly continuous monitors
are available for pulse, steps walked, and blood
glucose, at relatively low cost. More types are
on the way. Many of these sensors send data to
the Internet, either directly or through mobile
devices or desktop computers, which forward the
data. Withings sells a Wifi Body Scale that sends
your weight to Twitter each time you weigh your-
self [ 20].
The sensor revolution will change the way we
view data and ourselves. Children born in the
next decade may look back across a lifetime of
data. We won’t be able to ignore how we’re doing;
we’ll always know. Continuous feedback may
provide micro-motivation—the ongoing aware-
ness we need to live healthier lives.
Imagine personal-health dashboards, applica-
tions for tracking your sensor data based on the
Web or mobile phones. (Your mobile phone may
become a server at the hub of your body-area
network.) Health dashboards will provide trend
graphs, comparisons with goals and norms, and
alerts when things change suddenly or move
toward unsafe levels. Health dashboards will
be just one of several dashboards in our lives,
including those for finance like mint.com, home
networks like Pie Digital, and home energy man-
agement like the demo Intel showed at CES 2010.
In a way, social-network sites, like Facebook, are
also dashboards—for friends and message man-
agement. Health-based social networks and per-
sonal health dashboards seem likely to combine
and reinforce one another.
Imagine big data-mining software learning from
all the data stored in health dashboards. (Big data
is computer-industry jargon for huge databases of
information generated on the Web; data mining is
jargon for the process of correlating data to gener-
ate value. Google’s page-rank algorithm, which
bases relevance on counting links to a Web page,
is a classic example of big data mining.)

[ 11] Swan, M. “Emerging Patient-Driven Health Care Models: An Examination of Health Social Networks, Consumer Personalized Medicine and Quantified Self-Tracking.” International Journal of Environmental Research and Public Health 6, 2 (2009).

[ 12] Evenson, S. and Breslin, M. “Exploring Healthcare: A project between Carnegie Mellon’s School of Design, Continuum, and Mayo Clinic.” Touchpoint: The journal of service design. 1, 3 (2010).

[ 13] Mehta, R. “A Billion Little Experiments,” November 2009. Available from http:// www.zumelife.com/ pdf/A Billion Little Experiments.pdf [ 14] Haig, S. “Can Turmeric Relieve Pain? One Doctor’s Opinion.” Time, 13 July 2009.

[ 15] Deloitte Center for Health Solutions. “Deloitte’s 2009 Survey of U. S. Health Consumers: Key Findings and Strategic Implications.” March 17, 2009. http://www. deloitte.com/assets/ Dcom-UnitedStates/ Local Assets/ Documents/us_ chs_2009SurveyHealth Consumers_ March2009.pdf/ [ 16] Henry J. Kaiser Family Foundation. “Kaiser Health Tracking Poll.” July, 2009. http:// www.kff.org/kaiserpolls/ upload/7945.pdf/ [ 17] The Stanford Cardiac Rehabilitation Program (SCRP) has shown that nurses working as health-coaches (helping patients set goals and change behavior) significantly reduce rates of repeat heart attacks. The SCRP has also shown that involving patients in peer group activities helps motivate change.