Many of us wear smartwatches with tracking technology to monitor our step counts, sleep, oxygen saturation, even menstrual cycles, to help detect health issues early. Now wearing them has become part of the MAHA agenda, which is deeply troubling news.
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It’s six a.m., and the birds are chirping as sun streams through the slatted blinds of your bedroom window. An alarm sounds. You roll to your side, reach to hit snooze — but not before you consider your performance in bed the night before.
No, not that kind of performance. You’re thinking about your sleep. A quick glance at the app on your phone indicates that it was pretty good, but still, there’s always room for improvement.
You tick through your behaviors from the day before: hours of sun exposure and avoidance of blue light, caffeine and alcohol consumption, physical movement. Before rolling out of bed, you make plans to modify your schedule for the day to improve your stats for tomorrow.
Many of us are wearing Apple watches, Fitbits, and other smartwatches with tracking technology to monitor our health markers without giving it a second thought. There are good reasons to monitor our health markers, according to Dr. Jessilyn Dunn, assistant professor of biomedical engineering at Duke University, who researches the development of test tools and infrastructure using biomedical and health data for early detection, intervention, and prevention of disease. Her work focuses on health-tracking wearables, and, as she explained, this technology can help us more fully understand what health — and deviations from health — look like.
And right now, the NIH’s All of Us Research Program (a program focused on precision medicine and tailoring healthcare treatment to individual needs) only uses data from a sliver of the population. If the entire population were wearing these devices, she emphasized, we would have a much more representative and broad sample size that could expand the scope of public health research.
But there is a reason to feel uneasy about this right now. This past summer Robert F. Kennedy Jr., the Secretary of Health and Human Services, declared that wellness wearables are a key part of the MAHA agenda. In four years, RFK Jr. hopes to have every American utilizing a wearable wellness device. The biometric wearable devices RFK Jr. wants to have on each American can track everything from sleep quality to step counts, glucose levels to oxygen saturation — even menstrual cycles. While on the surface that might seem innocuous, his intentions are anything but.
Because RFK Jr. has signaled he has more nefarious plans with technology that can surveil us. “Wearables are produced by companies that then have rights to the data,” Dr. Dunn said. A mandatory opt-in raises serious concerns about privacy. Companies gathering data about sensitive subjects such as menstrual cycles, pregnancies, and sexual lives, especially when paired with geographic location, can be intrusive and dangerous.
There are measures that can be taken to protect individual privacy, Dr. Dunn added. Binarizing variables through a process called abstraction would be critical to maintaining the privacy of individuals if this health-tracking initiative were to be implemented on a population-wide level.
Still, the consequences of having political actors potentially monitor individuals to see whether they miscarry or abort a pregnancy cannot be overstated. Millions of people track their menstrual cycles with such apps as Flo or Clue, but these apps can be used to penalize anyone seeking, or even considering an abortion as they track the stops and starts of periods. Now, even miscarriages are being scrutinized to determine whether they too are abortions.
Likewise, the collection of health data could also affect insurance coverage and access to care in terms of who is approved for or denied treatment. RFK Jr. has been making noise about how this private health information for Health and Human Services might be used in the creation of databases: This past spring, he proposed an autism database. This health data collection appears to be more of a registry — and a “slippery slope to eugenics” in its strong potential to be misused and deter people from seeking diagnoses and care, despite Kennedy’s insistence that it’s just for “research.”
Kennedy, like many in Trump’s administration, is a believer in “longtermism,” a philosophical position that concerns itself with genetic fitness that values the future of humanity over the present. Perhaps it can better be described as “eugenics on steroids.” RFK Jr. has historically held anti-vaccination stances, making the repeatedly disproven and inaccurate claim that childhood vaccines have contributed to a rise in autism — even though he admitted that he and his children have all been vaccinated. His stance toward autism, too, is rooted in ableism, claiming that autism “destroys families.”
History may not repeat itself — but it often rhymes: There are many parallels to be drawn between today’s white nationalist political response to racial reckoning and the historical events of the 19th century. The American eugenics movement arose after the Reconstruction Era. This white reclamation of power followed a period of expanded rights for Black Americans. Eugenics, which literally means “good in stock,” encouraged the “right” (White) races to reproduce. As Kate Manne notes in Unshrinking, the eugenics movement led to “the systematic sterilization of people of color and disabled people, among others.”
Still, RFK Jr.’s eugenics-like tracking is, at least for now, less concerned with racial purity and more about “survival of the fittest.” Though he battled heroin addiction for years, RFK Jr. has advocated sending those suffering from substance abuse and mental health conditions to wellness farms. These wellness farms quite literally suggest putting neurodivergent individuals out to pasture by having them work the land to grow organic food and participate in other forms of manual labor. This, too, has historical precedent, eerily mirroring movements in the 1890s when people deemed “feebleminded” (individuals with epilepsy and other mental health conditions) were sent to colonies to work the land. These interventions did not actually improve the lives of the patients sent there. Instead, they led to societal ostracism, resulting in eugenics-like treatment, including forced sterilizations.
Given RFK Jr.’s other proposals that hark back to eugenics initiatives, making America healthy again through the use of wellness wearables could be perceived as less about encouraging robust research across large population sample sizes and more about increased governmental control of individual bodies — with potentially devastating consequences.
Not only do wellness wearable devices raise significant privacy concerns, they might also serve as a distraction in public policy. RFK Jr.’s emphasis on wearable devices as a means toward improving health is just one example of the ways that he and those who share his wellness paradigm have shifted public health initiatives toward a focus on individual behavior rather than community action.
RFK Jr.’s initiative is focused on tracking individual behaviors as key contributors to health outcomes, rather than on social determinants of health such as economic stability, education and health care access, neighborhood and built environments, and social and community contexts.
While some of us can take portions of our own health into our own hands, many others cannot. Rather than fixating on personal step counts, we could consider cultivating safer, walkable neighborhoods. Rather than obsessing over sleep scores, we could consider paying people livable wages so that they wouldn’t have to work multiple jobs, or normalizing later school start times to improve teen sleep.
To make America actually healthy again, we need to build healthy community systems, not by mass surveilling individuals with technology. Public health can improve when we envision and enact policies rooted in freedom and abundance, rather than restriction and micromanagement.