Communications of the ACM
U.K. Digital Health Infrastructure Is Stepping Up
Developments in both public and private sectors indicate the U.K. is on the cusp of critical advances in helping people get healthier through digital tools.
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Researchers at the University of Leicester in the U.K. are the latest to set conventional wisdom about clinical metrics on its ear. Their research, published in Mayo Clinic Proceedings last summer, discovered that one of the traditional measures of health and longevity, the body mass index (BMI), paled in comparison to physical fitness, measured by walking pace, as an indicator of longevity.
"Brisk walkers were found to have longer life expectancies, which was constant across different levels and indices of adiposity," the researchers wrote. "These findings could help clarify the relative importance of physical fitness and adiposity on mortality."
Coincidental to the Leicester research, developments in both public and private sectors indicate the U.K. is on the cusp of critical advances in helping people get healthier through digital tools. For instance, global sporting goods retailer Decathlon announced in September it was launching PLAY, a comprehensive searchable database of activities in the U.K., leveraging partnerships with facility operator Fusion Lifestyle and technology developer imin, which has been a driving force behind integrating the nation's activity data into open data platforms.
"Around five years ago or so, we had the ambition to create a user-facing application to help people find their sport more easily," imin co-founder Nishal Desai said. "For instance, there was no single interface that a squash player could use to find an open squash court anywhere in London at 4 p.m. on a given day. I don't want to find a list of all the courts; I can get that from Google Maps. Overall, it was a rather ridiculous situation to be in, where we on the one hand spend a lot of money to get people more active, but were lagging way behind other sectors, such as the travel industry, in easy-to-use booking technology."
To that end, in 2015 imin began advocating for open standards for physical activity data that would enable activity providers to publish, and individuals to easily find, anything from badminton games to road races; by 2017, the initiative, dubbed OpenActive, gained enough traction to become a national effort funded by Sport England and coordinated by the Open Data Institute.
London Leads
By 2017, too, the City of London had significantly increased its dedication to creating a technology infrastructure to improve citizens' accessibility to physical activity. Through its London Sport agency, it has not only taken the lead in publishing open activity data, but has also created a sport technology incubator that Alex Zurita, the organization's advisor for participation technology, said is instrumental in helping tech entrepreneurs meet the needs of public agencies' health and wellness goals.
"In essence, what we had seen prior was if we really wanted to drive London to be the most active city, one of the key things that needed to happen was to create more and closer collaborations between the public and private sectors, particularly entrepreneurs creating products that could make people more active," Zurita said. "There were a lot of entrepreneurs out there, but no structure to put an arm around them and ensure their products could scale quickly and be of real benefit to the public sector."
One of the first London-based technologies to receive seed money from the city — prior to the dedicated tech hub's creation — was Sweatcoin, a step tracker that converts steps into digital currency that can be redeemed for rewards when a user's goals are met. The rewards range from small items for meeting short-term goals to items as valuable as televisions or airline credits (which can take years of walking to earn). Shaun Azam, Sweatcoin's chief financial officer, also said the company recently rolled out rewards that users can redeem as donations to charity, which have become extremely popular.
Nationwide partnerships yield diffuse benefits
Mark Elliott, a professor at the Institute of Digital Healthcare at the University of Warwick in Coventry, has published the results of a study he conducted in partnership with Sweatcoin. Elliott said the partnership provided him with plenty of raw step data he can use in further work, while also supplying Sweatcoin with data from the university's research-grade accelerometers that met a development goal.
"They had two areas they wanted to work on," Elliott said. "One was how to develop algorithms that stopped people from cheating the system, like shaking the phone to artificially get their step count up. The other was looking at if we could quantify the behavior change the app was making to people's activity.
"We kept the smartphone data in parallel with the research-grade sensors we had, so we had high-quality walking data that could be correlated with the noisy data from the phones. And we gave that to Sweatcoin data scientists, who could create a machine learning model that could create an algorithm to do the verification."
Indeed, Elliott's research found that the platform had changed behaviors among the study's participants: analyzing data from 6,000 users of the app, he and his team found there was a sustained average increase of nearly 20% in daily step count over a 6-month period after users had registered with the app, in comparison with a 3-month period prior to downloading the app. Additionally, following a survey on a sample of the original 6,000 users, those who were classified as less physically active and overweight were found to be most likely to increase their daily step count when using the app.
Aggregating step counts from large numbers of users can also reap benefits for unconnected projects, Elliott said. For instance, one of his doctoral students is currently analyzing phone step count data to ascertain whether subtle changes in movement patterns can be detected in the early stages of osteoarthritis.
"The holy grail is basically collecting this data, passively monitoring it, and if there is a change, then you can notify the person and say, 'You might want to go see your doctor, because we've noticed this change in your movement pattern,'" he said. "That can be useful for early detection. You need that sort of background monitoring to do that because people tend to put off visits to their doctor until they are in so much pain they can't take it anymore."
Next 'steps'
The pioneers of the British activity ecosystem acknowledge it is still in its infancy, but can also point to steady progress in building resources for consumers, researchers, and activity and facility providers. London Sport and imin, for instance, have launched a clearinghouse for digital activity technology called active//choice, which is intended to be a complement to the British government's G-Cloud procurement platform.
"Every year, there's a huge number of innovative products created by both startups and established companies in this sector that never see the light of day because they can't get the visibility they deserve," the partners said about the site. "active//choice addresses that by putting all products, old and new, big and small, side by side on equal footin, so only the best products stand out from the crowd, not the ones with the biggest marketing budgets."
To Sweatcoin's Azam, the company's goal of reaching the largest possible audience fits well with the public sector's goal of getting more people active and healthy. For example, he said, while it may seem a given to reach out to those already active and who own wearable fitness trackers, there are more people who do not get enough activity and who still own technology that can help them get healthier—recent research from the Pew Research Center estimates 76% of the U.K.'s population owns a smartphone, while Hamburg-based research agency Statista estimates only 9.8% of Britons own a wearable health tracker such as a Fitbit. So for now, Azam said, the company is focusing on phones as the main conduit for its app, though it recently became Apple Watch-compatible.
Even individuals without any personal device to assist them with creating data can benefit from the new infrastructure of digital health. Under the auspices of the U.K. National Health Service (NHS) and its new drive to offer social prescribing—the delivery of community-based services and activities that can help prevent more expensive clinical treatments—the growing ecosystem of open data activity resources can help match people who need activity and facilities that offer it.
"Being active is a key component of social prescribing that keeps people moving, connected, able to work, able to volunteer, and getting out of the house," Kenny Butler, head of health and wellbeing development at UKActive, the national fitness industry association, wrote recently.
"For example, people who are susceptible to falls might be signposted to a dance class to help improve their balance or people with arthritis might be referred to a specific group exercise program. It is an innovative and growing movement, with the potential to reduce the financial burden on the NHS, and particularly on primary care."
Gregory Goth is an Oakville, CT-based writer who specializes in science and technology.
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