The latest Apple Watch costs $429. A basic Peloton Bike is $1,395, plus a $49.99 monthly subscription. Throw in a WHOOP membership at $149 annually, maybe an Oura Ring for another $349, and suddenly you’re looking at thousands of dollars to participate in what’s become the standard way many Americans approach their health. For some, that price tag is steep. For others, it’s a non-starter.
I’m no stranger to the appeal of the latest, greatest wearables and smart health devices. But as all this wellness technology become the norm, what does this mean for people who don’t strap a smartwatch onto their wrists? If comprehensive health data—and the insights it provides—becomes a luxury good, the existing digital health divide will only get worse.
The digital health divide
The issue starts well before anyone considers buying a fitness tracker. Digital equity in healthcare is already a fundamental access issue. “In many ways, access to healthcare means access to technology,” says Amy Gonzales, an associate professor in UC Santa Barbara’s Department of Communication. “Especially since [the COVID-19 pandemic], the healthcare industry relies heavily on technology for their services. Text reminders about your appointment, scanning a QR code to check in, needing an e-health account to see your test results, or some providers only being available via telehealth, and so on.”
The basic infrastructure of modern healthcare—patient portals, appointment scheduling apps, prescription management systems—demands a level of digital literacy and access that not everyone can meet. Seniors may struggle with smartphone interfaces. Low-income families might rely on limited mobile data or shared devices. People with certain disabilities may find standard health apps difficult or impossible to navigate. And the problem compounds: Gonzales notes the populations most likely to face barriers with technology are often the same groups who may need that healthcare the most.
Fitness trackers are becoming the norm—for some
Against this backdrop of baseline digital inequity, fitness trackers and wearables have gotten more and more popular. These aren’t essential medical devices in the traditional sense—nobody’s life support depends on their Fitbit—but they’ve become cultural markers of health optimization. More concerning, they’re increasingly becoming tools that provide genuinely useful health information that simply isn’t available to people without the resources to buy in. Heart rate, blood oxygen saturation, sleep stages, stress levels, and more: We’re living in a time of unprecedented insight into what our bodies are doing, if you can afford it.
IN some circles, these devices have become simply how health-conscious people approach their wellbeing. Studies have shown that wearables can help detect abnormal heart rhythms, encourage increased physical activity, and provide early warning signs of illness. Some insurance companies offer discounts for users who share their fitness tracking data. Employers incorporate wearables into wellness programs.
While this is promising for those who can afford it, others get left behind. “The digital divide is even more problematic with ‘bonus devices,’ or health ‘accoutrements,’ like smart wearables,” says Gonzales. If at-risk health populations are already at-risk for digital access, it tracks that this access gap is only getting wider.
The problem with ubquitous fitness tech
The creation of a two-tiered information system is perhaps the most insidious aspect of fitness tech inequality. A person with an Apple Watch receives detailed daily reports about their cardiovascular health, activity levels, and sleep quality. They get alerts when their heart rate becomes irregular, or they can share comprehensive data with their physician that provides context for symptoms and conditions. Someone without these devices? They’re left with subjective assessments and whatever gets captured during periodic doctor visits.
“If you don’t have the same resources to track your blood pressure, blood pressure, or physical activity,” says Gonzales, “you are certainly being left behind on useful healthcare.” Consider two people with similar cardiovascular risk factors. The one with a wearable device might receive an alert and seek immediate treatment, potentially preventing a stroke. The other person might not notice symptoms until a serious cardiac event occurs. Both deserved that potentially life-saving alert, but only one could afford the device that provided it.
As more people in higher-income brackets adopt these technologies and share data with healthcare providers, medical understanding itself may become skewed toward populations who can afford comprehensive self-monitoring. If research studies increasingly incorporate wearable data, but if that data predominantly comes from affluent, educated users, the resulting insights may not apply equally across all demographics.
Another perspective
Access isn’t the only lens through which to view this fitness tech. “There’s this implicit assumption that wearables are inherently good,” says Gonzales. “What about privacy risks?” After all, if you think you own all your health data, think again.
Think of the history of the healthcare industry’s relationship with marginalized communities. The Tuskegee syphilis study, forced sterilizations, and ongoing disparities in pain management and maternal mortality have created a pretty understandable skepticism toward giving up data, to say the least. “Given the history of experimentation and exploitation of certain low-income populations, there’s a natural distrust in these sub-groups,” Gonzales says. “Maybe these demographics intentionally avoid third parties collecting their data.”
So, the same communities that might benefit most from health monitoring technology may also have the most legitimate reasons to be wary of it. As I’ve previously covered, data privacy protections remain inconsistent, and the long-term implications of sharing detailed biometric data with corporations are still unclear. For populations that have historically been surveilled, exploited, or discriminated against, choosing not to participate in constant data collection might be a rational decision, rather than simply a matter of access. There’s something to be said for health approaches that don’t involve third-party corporations accumulating detailed records of your body’s functions.
Finding solutions
Naturally, budget options for fitness tech do exist, and these options can help some people access these technologies. But even “affordable” options still cost money that many families simply don’t have for what remains, technically speaking, optional equipment. When you’re choosing between a $50 fitness tracker and groceries, the choice isn’t really a choice at all.
All of this is to say that the fitness tech inequality problem can’t be solved by individual purchasing decisions or corporate discount programs. It’s embedded in broader questions about healthcare access, digital equity, and what we consider essential versus optional in maintaining health. Glucose monitors, fertility trackers, or blood pressure cuffs could more easily qualify as medical equipment, where an Oura ring is still a luxury good. Addressing the gap requires reimagining what counts as necessary healthcare technology. Otherwise, we could be approaching a future where your ability to detect health problems early, track chronic conditions, and optimize your fitness depends on whether you can afford a monthly subscription.
The bottom line
Healthcare has become digitized, creating new opportunities for monitoring and intervention, but also new mechanisms for inequality. As fitness technology continues advancing, offering more sophisticated monitoring and more actionable insights, that fundamental inequality will only get worse. Because at the intersection of healthcare and technology, “the people who struggle with one are often the same people who need the other,” Gonzales says.
The Apple Watch on your wrist may feel like a personal choice, a small investment in your personal wellness. But scale that up across millions of people and billions of data points, and individual choices become structural inequalities. Technology that was supposed to democratize health information may instead be creating new hierarchies of who gets to know what about their own bodies. And those who need that knowledge most may be the least likely to access it.
