Fitbit or Groceries? The Challenge of Wearables in Underserved Populations

May 20, 2016

“I haven’t been exercising as much this month.” I’d failed at inspiring yet another patient to be more active. She was a middle aged women working two jobs to help support her family. What next? Do I recommend a wearable?

The choices we make everyday impact our health. Individual behaviors can lead to significant disease states including high cholesterol, obesity, and diabetes. The HealthyPeople 2020 campaign identifies individual behaviors as one the key social determinants of health. Similar to our behaviors, our income level plays a direct role in how healthy we are. Lower income patients tend to have the worst health outcomes. Diabetes, for example, depends not only on our individual behaviors, but also our socioeconomic status. Patients living in the lowest income quintile with median household income of $32,679 have the highest rates of diabetes. Can technology change the behavior of our underserved patients?

If we take a look at the digital health marketplace, fitness trackers are among the most visible patient-facing digital health tools that promise to promote healthy behaviors. In 2015, the spending on fitness trackers rose by 110 percent. Spending increased to $1.46 billion in sales in 2015, up from \$692 million in 2014. However, though my low income patient with diabetes could benefit from the promises of wearables, the marketplace is not priced for her. The average cost of fitness trackers is \$100. Given the competing priorities of low income patients, compare that to the cost of weekly groceries for a family of four, $129.

When you are working to meet your basic necessities and keep yourself healthy, are fitness trackers worth it?

Data on the significant health benefits of fitness trackers is lacking. Furthermore, if fitness tracking technology can lead to such notable behavior modifications, why isn’t the market advertising simple solutions like pedometers? I wonder if it might have to do with the cost of a pedometer being as low at \$2–3.

With the importance of both behavior and income on health outcomes, the challenge of fitness trackers is to prove their benefit among low income patient populations with the worst health outcomes and competing financial strains.

This post also appeared on Tincture Magazine on May 17, 2016.