LYN WHITFIELD ON MOBILE HEALTH

There is no clearer indication of how far British politics has shifted to what used to be the right than the public health white paper, issued last November.

Choosing Health is barely about public health at all. Instead, as its title implies, it is about the choices that people make in a consumer society and how these might be influenced to create a demand for healthier options the market can respond to.

Specifically, it is about providing more information and advice, and more support for people who want to change their lifestyles. There will be health 'stock-takes' to help people assess their health, personal health guides to set out the action they and other agencies need to take, and health trainers to help them take it.

What does all this have to do with IT? Well, although much of the national programme for It is effort is focused on managing acute care, there is growing interest within the Department of Health in how IT can be used to support chronic-disease management and public health.

The white paper, for example, promises to create a new information service, Health Direct, and suggests that personal health guides could be held electronically on Health Space, which is part of NHS Direct and due to be integrated with the NHS care record in 2007.

Meanwhile the three-year information strategy, Better Information, Better Choices, Better Health, goes much further, setting out strategies to help people make informed choices on everything from operations to lifestyle.

However, if the government really wants to move markets, neither of these papers go far enough. Both, for example, tend to equate technology with websites or digital TV, and to see these as channels for delivering and storing information.

Neither expend much ink on the ubiquitous mobile phone, much less the new positioning and tracking technologies that might be built into it, and both are curiously silent about how technology can be used to create new types of community.

These are not blind spots for the private sector. Chocolate companies, Coca-Cola and McDonald's were all criticised last year for sending advertising texts to children's mobiles. Tesco has invested heavily in the 'personalised diet technology' of a US company, which includes a website on which dieters can record progress, message boards on which they can exchange tips and secure e-mail links to experts.

And on the horizon, mobile phone companies want to get into heart monitoring, and product-tracking companies see a market in recording the contents of shopping baskets so people can be advised on what to buy, or put back.

If the affluent use these new services to further improve their diets and lifestyles, and the poor do not, inequalities will widen. The government doesn't want that, but it is reluctant to redistribute resources too openly, or to restrict the activities of private firms.

Its logical alternative is to work on the demand side, which is the route the public health white paper takes. But to do this successfully, it will need to think more creatively about how to engage and influence consumers, not least through IT.

A personal health guide backed up with e-mail and message board services might be a start. However, the big and unanswered question is whether the state is really in a position to work in this way.

People are strangely willing to let Tesco know a lot about them and to let it influence what they eat. They are (rightly) more wary of government and even the mildest of health promotion messages is met with cries of 'nanny state'.

Will highly personalised, ITenabled advice and support prove acceptable? And if it does, where are the resources going to come from?

Consumerism as a vehicle for policy delivery is an interesting idea.

The detail and implications are far from being worked out.