Beyond Hostile Worlds: The Multiple Sphere Ontology of the Digitalization and Googlization of Health

Abstract

The datafication and digitalization of health and medicine has engendered a proliferation of new collaborations between public health institutions and data corporations like Google, Apple, Microsoft and Amazon. Critical perspectives on these new partnerships tend to frame them as an instance of market transgressions by tech giants into the sphere of health and medicine, in line with a “hostile worlds” doctrine that upholds that the borders between market and non-market spheres should be carefully policed. This article discusses the two main limitations of the hostile worlds doctrine applied to this “Googlization of health”. First, the question of how to define personal health data, in order to decide which sphere they should belong to, is far from being resolved. Second, the presence of non-market values in the justification work carried out to legitimize these partnerships indicates the co-presence of other spheres. In order to move beyond these limitations, the article advances a framework based on a multiple, rather than a dual, sphere ontology that draws on Boltanski and Thevenot’s orders of worth and Michael Walzer’s theory of justice. I show how this analytical framework is better equipped to identify and address the numerous risks posed by the involvement of these corporations in health and medicine.