A fair bargain…

A fair bargain... NHS_Training_in_Primary_Care_General_Practice

Are you happy that supermarkets know what you buy?

If you shop on-line, they keep a convenient list of what you bought last time, so you can click, ‘repeat’.  Convenient, isn’t it?

If you do your shopping in person, when you check out, they give you points on your loyalty card.  In exchange, they compile a list of what you bought.

All this means you give up a good chunk of your confidentiality.  

It’s not that somebody knows you buy spuds or bog rolls but maybe; a pregnancy testing kit, strawberry flavoured condoms, a bottle of Jack Daniel’s a day, or a gallon of ‘Just for Men, One-Touch-Brown, hair dye’…  might be the sort of thing you’d want to keep to yourself.

In exchange for your confidence and a few points, supermarkets amass data… know what you buy and when.  

Because they know where the stuff is arranged on their shelves, they work out how you walk around the store.  

They call it the customer pathway.

You give up your data, they improve, speed-up and slim-down their supply chain.  Cut their cost.  Oh, and you get a few points to save-up, towards your Christmas shopping-bill.  What’s not to like?

Do you buy on-line?  We all click the T&Cs box on Amazon, E-bay and elsewhere.  Do you read before you click?  I doubt it.  

By using their services you agree they can use your data.  Along with other data they build a picture of you; the things you spend your money on and where you are, when you do it.

In exchange you get a better service and better prices.

I once presented a conference on data.  I agreed they could use my post code, cards and data, to build my ‘customer-profile’, as the call it.

By connecting the data-dots they had; 

… the make of my car, where I bought petrol and Mars Bars (!), who insured it, my shopping habits, where I’d been on holiday, who I bank with, who my utility suppliers were, my income bracket, social class, gym membership, approximate health status and what purchases I was likely to consider in the up-coming twelve months.  

The best public health data that never gets used.

There followed a lively discussion on privacy!

I concluded, I didn’t much care.  However, a lot of people do care and I get that.

The use of data will be at the heart of how we wriggle out of Covid-lock-down.  There is no ‘good-way’ out.  However we relax will create public circulation.  That excites transmission which risks igniting the forest fire, again.

A better, but not perfect way, is to up the testing regime, test every household once a week plus contact tracing.

Contact tracing ended smallpox.  They tracked down infected people, isolated them.  Immunisation came later.  Sexually transmitted diseases, tuberculosis, measles, transmissions all interrupted by CT.

Normally performed by public health people, it, laboriously, involves interviewing infected people and tracing their movements and contacts to try and establish where infection comes from and where it’s going.

Sexual transmission is easy to track.  CV-19, is airborne… much more difficult.  It’s chaotic and a lot about probability and secondary transmission.  

It will be a nightmare to track and trace if we rely on PH people spending all day on the phone.  

Regional PH teams are excellent but they will soon be overwhelmed.  Even if they recruit thousands of out-of-work, enthusiasts and train them.  They might have to contact millions, twice a day, or more and rely on the recall of sick and stressed people.

The quick answer, for the most part, will be using bluetooth to make beacons out of our smartphones, to track our movements and warn when we’d been in proximity with someone who’d tested positive.

Privacy… well, yes this will touch a raw nerve.  Singapore did it on an opt-in basis, as did South Korea.  We’d need about 80% compliance and based on lock-down observance, I think we’d get it.  

With sunset clauses in legislation, open-source code for the software and data collation independent of government, say a university, it’s doable.  

There is already; Pan-European Privacy-Preserving Proximity Tracing, an open protocol designed for digital-contact-tracing of infected participants.

If we want to get our freedoms back, we will have to give up some of our privacy.  

Is that a fair bargain?

Have the best weekend you can and keep safe…

News and Comment from Roy Lilley

Contact Roy – please use this e-address roy.lilley@nhsmanagers.net

Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.