Foreign Policy Blogs

Angry Birds: m-Health Edition

Apologies for skipping out on my last post; I was on vacation in one (two, actually) of those places where there’s no Internet, no cell phones, and no TV, which is really the only way to get a vacation anymore.  Which means that I didn’t get any news about anything until Tuesday morning.  And now, while the Internet, Twitterverse, and other media are ablaze with news about Osama bin Laden, it’s hard to find anything else about which to write.  However, life (and blogging) must go on.

A couple of weeks ago, I wrote about the potential for social media innovations to play a role in global health and human rights.  I’ve come across a couple of interesting pieces recently, so I thought I’d revisit the topic.  One of Patrick Meier’s recent posts put forth the “Piggy Bank Theory of Digital Activism,” that as m-banking services increase, it becomes more difficult for a dictator or repressive regime to cut off or restrict access to mobile and Internet networks (m-banking, or mobile banking, means doing your banking, whatever that is, by SMS/text or mobile Internet.  Recently, I found myself in Greece for a business trip with a colleague from Kenya, who managed to pay her bills and her domestic help on her dinky Nokia–in Sierra Leone, we called those “No Care” phones–while we were walking through the airport).

Meier links this to Christopher Kedzie’s “Dictator’s Dilemma” and Ethan Zuckerman’s “Cute Cat Theory.” The former theory postulates that, in this (or any) new information age, a dictator faces a choice: open his/her country up to Internet/new forms of communication/etc. and take the risk that these will have a democratizing or revolutionary effect on the population (Egypt, perhaps?), or keep the country closed from outside influences and remain cut off from the world (the North Korean route, mostly).  The latter theory puts forward the idea that since most people are accessing the Internet for entertainment purposes–i.e., looking at pictures of cats that look like Hitler–shutting down access to the Internet turns regular citizens into dissidents, who learn to get around firewalls and use proxies.  As Zuckerman writes: “Every time you force a government to block a web 2.0 site – cutting off people’s access to cute cats – you spend political capital.”  Meier’s thesis takes this a step further, pointing out that cutting off access to basic services like banking (which is now so widely available as m-banking in much of the developing world) creates an even greater dilemma for the dictator.

I’d like to piggyback further off the work of Kedzie, Zuckerman, and Meier and ask: what about m-health?  Of course, this poses a slightly different problem.  Let’s look at one of the most common forms of m-health: reminders and information disseminated through text message about health, specific diseases, and a particular person’s health needs and/or medical appointments (for example, tips about healthy eating, information about HIV testing availability, and texting a pregnant woman to remind her to come in for a pre-natal check-up).  Unlike cell phones and the Internet (and all those lolcats), m-health is not ubiquitous, or at least, not yet.  Furthermore, the demand for health and health care as a basic human right is not as strong as that for free speech.  It’s the difficult reality of health equality.  Shutting off access to text messaging/SMS services would create broader anger over not being able to communicate than over the fact that you forgot your dentist appointment.  We’re not ripe for a revolution built on the back of m-health (or maybe not even Twitter, depending on who you’re listening to).  It doesn’t help that many of the people who can’t or don’t access health care are marginalized due to poverty, social status, gender, race, sexual orientation, etc., and therefore have less of a voice.  Until we at least have a stronger push for the implementation of the human right of health, it will continue to fall by the wayside.

At the same time, increasing access to m-health could further democratize society, much as the Internet and mobile networks have done (theoretically).  More m-health could mean healthier people, but it could also mean better informed people who see their access to health care as a right, not a privilege.  The Internet has increased the world’s appetite for information, which, in theory, translates to a hunger for unfettered information (though China’s done a pretty good job countering that argument) that can turn to popular anger and outrage when that access is cut off.  Similarly, m-health reminders increase access to health information, and, theoretically, to health care, though much of this is so new that m-health effectiveness remains to be proven.  And we’re still talking about communities that really only get upset when their entertainment is cut off, just as the students at my university yawned at outrageous sociopolitical events but then got up in arms when the school banned alcohol at Homecoming–back to Zuckerman’s Cute Cat Theory.  But I can’t help but think, in this exciting, uncertain era, where ways of communicating, disseminating information, and performing basic tasks seem to mutate and shift with each passing month, that there’s some hope for spurring demand for quality, accessible health care through m-health.  Maybe we’ll all be playing games that quiz us on what the symptoms of TB are, an Angry Birds: m-Health Edition, in between checking Facebook and tweeting.  But maybe we’ll also learn that health is a human right, and that we should be demanding it.



Julia Robinson

Julia Robinson has worked in South Africa at an NGO that helps to prevent mother-to-child transmission of HIV and in Sierra Leone for an organization that provides surgeries, medical care, and support to women suffering from obstetric fistula. She is interested in human rights, global health, social justice, and innovative, unconventional solutions to global issues. Julia lives in San Francisco, where she works for a sustainability and corporate social responsibility non-profit. She has a BA in African History from Columbia University.