1. Nick J Fox University of Sheffield
The micropolitical economy of posthuman health - what can the digital do?
Nick J Fox
University of Sheffield

2. I shall argue that ...
Digital health/illness technologies and the digitisation of capitalist economic production each reflect the increasing cyborgisation of organic bodies and inorganic things, information and concepts.
New materialist theories and methodologies can invigorate a post-anthropocentric and posthuman sociology of the digital, by micropolitical analysis of social production.

3. Ctrl+C (and Ctrl+V)

5. Digital
Pre-digital
Collect data.
Tabulate results.
Type a manuscript.
Publisher re-types it.
Hard copy printed and published.
Photocopy article.
Type the quotation and insert into new paper.
and so on ...
Generate data (e.g. from a monitoring device).
Ctrl+C
and so on ...

6. Are digital technologies merely transparent facilitating media
Are digital technologies merely transparent facilitating media? Or are they active elements within social relations?

7. The transparency of technology?
Sociological perspectives:
Technological determinism: technologies establish new kinds of social interactions and relations (the medium is the message - McLuhan, Toffler).
Social shaping of technology: Technologies are shaped by social, economic and scientific forces to achieve specific social and cultural objectives (anti-essentialist, constructionist - Williams and Edge, Mackenzie & Wajcman).
Technology as affordance: technologies are actively designed (shaped) to enable or frame specific interactions or forms of organisation (Gibson, Hutchby).
I shall explore this question from a different perspective.

8. Sociological anthropocentrism
These perspectives privilege sociological concern with social forces, structures, continuity/change and power.
Reflects a wider sociological anthropocentrism, which de-privileges concern with the material capacities of (digital) technologies.
Establishes a social essentialism (Timmermans and Berg, 2003).
Sustains a sociological dualism of human/non-human.
To study digital technologies, we need to cut across this dualism, as well as nature/culture; agency/structure; mind/matter.

9. Beyond sociological dualism
Avoid both social essentialism and technological essentialism that establishes digital technologies as deterministic or causal in their own right.
Let us look at the material capacities of digital technologies in specific contexts.
Explore cyborg body/technologies.
A QUESTION: do we really know what digital technologies (a smart-phone, a tablet or a Fitbit) can actually do?
And another: What might digital technologies do?

10. A (new) materialist ontology
Not pre-existing entities (e.g. an iWatch or a database), but relations that assemble.
Not attributes, but entirely contextual capacities.
Not agency but a capacity to affect or be affected.
Not systems of structures but fluctuating assemblages.
Not a politics of social forces, power and resistance, but a micropolitics of affecting.
Not texts or discourses but materialities.

11. Applying materialist ontology
Look at digital technologies in their contextual assemblages.
What capacities do they produce in bodies, organisations, things.
What is the micropolitical impact of a technology in terms of power, resistance, social order, continuity, change etc?
How might these micropolitics be changed by altering the contexts or other forces?

12. Digital health Personal health technologies (PHTs):
for use by a single individual, principally outside healthcare organisations;
enable self-tracking or monitoring of body functions or performance, either for self-care purposes or with medical oversight;
some may have capacities for associated therapeutic intervention;
may employ communication or networked functionality, using wireless internet or radio-frequency (RF) technology
(Fox, 2015)

13. 1. Biotech app to assess MS
Monitoring app to assist clinicians to assess multiple sclerosis progression at check-ups and prescribe appropriate medication.
What does it do? – multiple posture and gait monitors on patients’ bodies gather data over months, and crunch these to provide information to clinicians on disease progression.
The MS-monitoring assemblage:
body – monitors – app - clinician – pharma companies
Micropolitics: Provides clinicians with detailed data rather then depending upon patients’ memories and reflections on their physical condition; provides evidence to support prescribing decisions

14. 2. EU Splendid project
EU–funded project ( to reduce obesity among adolescents and young adults.
What does it do? – body sensors detect meal portion size, chewing and activity, and link via Bluetooth/phone to clinicians and public health professionals link, who provide real-time feedback and advice on nutrition and exercise.
The Splendid-assemblage:
body – food – terrain – sensors – phone - doctors – advice – population
Micropolitics: extends an individualising, biomedicalised model of health and illness; disempowers people from assessing their health needs, replacing this with a remote expertise with its own agenda; assesses ‘at risk’ populations.

15. 3: The ‘Vida’ app
Vida ( is a virtual care app, usually accessed via commercial platforms such as Fitbit and Apple Health.
What does it do? – shares users’ personal data from self-tracking monitors with Vida’s in-house online health and fitness coaches, who interact in real time and promote Vida’s health and fitness programmes.
The Vida-assemblage:
body – app – device – coach – health programme – company – shareholders – profit
Micropolitics - bodies become elements within an assemblage that turns health and fitness into ways to make money; outsources to a technology company the traditional tasks of a healthcare system to sustain health and fitness.

16. Digital capitalism (DC)
The facilitation of capitalist social relations (e.g. free trade, globalisation/localisation, privatisation, individualism) by digital technologies (Barassi, 2015).
Emergence of a capitalist knowledge economy.
Development of web-enabled digital technologies for commerce and marketing, and as a platform for consumerism.
These opportunities have made the digital technology sector a growth area for investment and take-overs (Schiller, 2011).
However, digital technologies are also a site of resistance, and can be used to challenge corporate power (e.g. Monsanto, fracking).

17. Digital capitalism and health
Efficiencies.
Health knowledge and data as valuable and hence commercial resources.
Monetising services.
Marketisation of health.
Consumerisation.
Opportunities for privatising/out-sourcing.

18. An aside: the 7-day NHS
The move to seven-day working has nothing to do with improving patent care.
It is about maximising efficient use of resources (staff, beds, therapy spaces) and providing ‘just-in-time’ health care.
Digital technologies such as near-patient monitoring devices, tele-care and implantable devices such as pumps and cardioverters will increasingly contribute to this model of health service.
They will also de-skill staff, reducing wages and opening up opportunities for private contractors to supply services.

19. Vida as exemplar of DC
Efficiency: reduces costs of providing coaching service (e.g. no centralised offices for staff, transport).
Facilitating commerce: brings coaches and consumers/clients together online.
Glocalisation: establishes a global market for a service which can still feel local.
An app for everything: digital tech creates virtual versions of existing businesses and business models.
Growth: reduces margins and increases volume of sales.

20. The micropolitics of DC
When seeking to understand the dynamics of digital health and digital capitalism, the unit of sociological analysis needs to be the assemblage, not the technology.
The micropolitics of these digital assemblages are emergent, as a consequence of what they can do in specific contexts.
These micropolitics produce the features of ‘digital capitalism’: thin margins, large volumes of business, high profits for owners/shareholders, and low wages for staff (Naughton, 2013).

21. What else can the digital do?
Micropolitical enables ‘reverse engineering’ of a digital technology to assess the capacities it produces and its consequences.
We can forward engineer technologies to produce different micropolitical outcomes.
This offers a less pessimistic analysis of digital health and digital capitalism.
Opens up possibilities for action and resistance, including digital activism and ‘citizen health’.

22. Digital activism We can engineer technologies to: Democratise data.
Reject biomedical model of health and illness.
Enable collective responses
Challenge health policy.
Organise against health corporations.
Organise against environmental polluters, purveyors of fast and processed foods etc.
Synchronise health and environmental sustainability.

23. ‘Citizen Health’
Use personal health technologies to subvert biomedical or corporate interests.
‘Citizen health ‘rejects an individualised approach to health and the monetisation of health and fitness.
Use PHTs to build networks of connected bodies and social formations that challenge biomedical health care and neo-liberalism.

24. Digital health at our service
Use networked digital technologies to:
Enable health and risks to health to be assessed across a locality or a social group.
Share data from a range of sources.
Notify communities of policy or risks;
Co-ordinate action and build coalitions;
Generate and implement policy.
These tasks can be engineered using currently available apps and shareware.

25. Conclusions
Digital technologies are neither determining nor simply shaped by social or economic forces.
We need to look at what they actually do, in the cyborg-ised contexts in which they operate.
This can provide an understanding of the dynamics of digital economies and the changes we are seeing as a consequence.
By changing the contexts, we can re-make digital (health) technologies to serve alternative purposes and to challenge capitalist and market relations.

26. The micropolitical economy of posthuman health