From hostile worlds to multiple spheres: towards a normative pragmatics of justice for the Googlization of health

Tamar Sharon

doi:10.1007/s11019-021-10006-7

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 seeks to outline the limitations of this common framing for critically understanding the phenomenon of the Googlization of health. In particular, the mobilization of a diversity of non-market value statements in the justification work carried out by actors involved in the Googlization of health indicates the co-presence of additional worlds or spheres in this context, which are not captured by the market vs. non-market dichotomy. It then advances an alternative framework, based on a multiple-sphere ontology that draws on Boltanski and Thevenot’s orders of worth and Michael Walzer’s theory of justice, which I call a normative pragmatics of justice. This framework addresses both the normative deficit in Boltanski and Thevenot’s work and provides an important emphasis on the empirical workings of justice. Finally, I discuss why this framework is better equipped to identify and to address the many risks raised by the Googlization of health and possibly other dimensions of the digitalization and datafication of society.

Highlights

In recent years, the large consumer technology companies that have become the predominant architects of our digital environments have swiftly moved into the health and biomedical sector, positioning themselves as important facilitators of digital health and medicine
In line with the Googlization of earlier areas of human activity (Vaidhyanathan 2011),1 this Googlization of health (Sharon 2016) typically raises a series of apprehensions among critical scholars of digitalization and datafication. These include concerns about privacy and data protection, i.e. will these companies share personal data with advertisers, insurers or employers (Zuboff 2019)? Concerns about the use of personal or publicly generated health data for financial profit, i.e. how will these companies monetize their investments in the health domain (Powles and Hodson 2017, 2018)? Concerns about the new gatekeeping function these companies may have in accessing valuable health datasets, i.e. will the datasets they help generate be open to all (Boyd and Crawford 2012)? And concerns about the growing concentration of power of these private corporations in traditional public sectors like health and education. These concerns are underpinned by an understanding that the Googlization of health, as a phenomenon that emerges at the intersection of digital capitalism and digital health, invokes an uncomfortable merging of what are often held to be by nature or by normative design separate spheres of human life—the market and health
This is not to say that it has no value: it is helpful in broadening critical perspectives on this phenomenon beyond the narrow lens of privacy harms, insofar as it situates this phenomenon within the political economy of data and the commodification of health data

Summary

Introduction

The large consumer technology companies that have become the predominant architects of our digital environments have swiftly moved into the health and biomedical sector, positioning themselves as important facilitators of digital health and medicine. In line with the Googlization of earlier areas of human activity (Vaidhyanathan 2011), this Googlization of health (Sharon 2016) typically raises a series of apprehensions among critical scholars of digitalization and datafication These include concerns about privacy and data protection, i.e. will these companies share personal data with advertisers, insurers or employers (Zuboff 2019)? The first part offers a brief overview of the hostile worlds doctrine as a long-established and prevalent framing in philosophy, social theory, ethics and more recently critical data studies It discusses an important shortcoming of this framing when applied to the Googlization of health.

The hostile worlds doctrine and its limitations

Orders of worth and the plurality of common goods

Conclusion