Apple has been setting up a health system parallel to public health for years. The question is whether public health will do something about it.

I haven’t worn a watch of any kind on my wrist for years. Partly for convenience, partly for not having another device to distract myself with. The paradox is that I find it more and more advisable to wear or give a smartwatch, precisely because of the leap they have made in monitoring our health in recent years.

The other day, Dr. Miguel Ángel Cobos Gil, a prestigious Spanish cardiologist, told us at a press event that “the Apple Watch provides more parameters than anyone admitted to a coronary unit.” It made me think: we already have very reliable medical technology in our pockets, on our wrists and even in our ears. And now what?

A parallel system to saturated healthcare

Healthcare in Spain has just concluded a few days of strike in which they demand improvements in a system with problems: saturated primary care, insufficient personnel, underfinancing or territorial fragmentation are just a few.

Spain is not the only one like this. Countries like the United Kingdom, Canada, Italy or Portugal are struggling with similar situations, and if we look at Latin America or Asia the photo even it gets more complicated.

It is no coincidence that Apple has spent years setting up a whole parallel health system through its best-selling devices. You can now take a medically approved EKG with Apple Watch In a few minutes, the iPhone notifies you if you have risk of falling when analyzing how you walkand AirPods are increasingly looking more like a smart sonotone.

Apple is the one that is taking the most solid and visible steps, but it is not the only one. Samsung integrates teleconsultations, a game to detect Alzheimer’sbooking diagnostic tests and ordering medications at Samsung Health —starting with Indiawhich is no coincidence—; Huawei gives you ten health parameters in a single gesture with its Watch 5; Google bets on a medical coach with AI on top of Fitbit and Pixel Watch data. Almost the entire tech sector is looking at the same place.

Useful technology to help us with our health is already here. The problem is how to make all that data that our devices give us use for something in a collapsed public system.

Your doctor doesn’t have time to look at the data on your watch

And now we have been in this house for ten years: We have a lot of information about preventing diseases and devices that can help us do so. However, there is still no effective system to address it. Cobos Gil summed it up bluntly: “urgent care works.” When something really goes wrong, the system responds. The problem is before, in that period of time where an asymptomatic disease could be detected and treated with a change in habits or a simple medication, but where the family doctor cannot dedicate fifteen minutes to you if he does not see something serious or actionable.

Hypertension doesn’t hurt. Atrial fibrillation does not warn.

And this is exactly where technology comes in—or should come in—. A smartwatch does not sleep, has no waiting list and does not need you to go see it: it passively monitors whenever you wear it, accumulates months of data and notifies you when it detects an anomaly.

Cobos Gil mentioned something that illustrates the difference well: a conventional cardiac holter monitor must be taken for about 24 or 48 hours, and many times it does not capture anything because the arrhythmia does not appear in that time window. With three months of data from the Apple Watch, he says he’s gotten diagnostic information he otherwise wouldn’t have had, and has even “had to anticoagulate patients who were cleared by a Holter monitor.”

This gap is especially relevant for the older population, especially if they live alone. Spain is aging fast and a silent heart attack, a fall, or an arrhythmia that is accelerating are situations in which the time between the event and medical attention is everything, and in which not having a family member or caregiver nearby—the child in another city, the grandchildren in another country—creates a very vulnerable situation for these people.

These are situations that happen. In Applesfera we have just told the case of a lady who suffered a fall due to an epileptic attack in Torremolinos and his Apple Watch helped everything end in a scare.

The striking thing about this is that hospitals already do this type of monitoring in extreme cases. When a modern pacemaker or defibrillator is implanted, the hospital monitors the patient remotely and can intervene if something goes wrong. A watch like the Watch takes that logic from the hospital to home: it allows a son in Madrid to see in real time if his mother’s heart in a town in Teruel is beating strangely, or to receive an alert if she has fallen and hasn’t gotten up. It is not medicine of the future. It is medicine of the present waiting for the system to learn to incorporate it.

The limit that no one has set

What Apple, Samsung, Huawei or Google have built so far is the beginning. Apple has been working for years on non-invasive blood glucose monitoring —without being punctured, through optical spectroscopy—and the most solid rumors suggest that could come to the Apple Watch in 2027 or 2028. Before that, I’m pretty sure we’ll see an AI-powered medical assistant built into the Health app — known internally as Mulberry Project— trained with your real clinical data. Tim Cook has been repeating for years that the Apple’s greatest contribution to humanity will be in healthcare. What it doesn’t say is exactly how far.

Because the question that these devices do not answer is one that seems very important to me: Where do they set the limit for themselves, and who sets it for them from the outside? Early detection of neurodegenerative diseases through writing or voice patterns? Analysis of emotional biomarkers? Food intolerances? None of this is science fiction; everything has active projects inside or outside of these companies. And none has made a public statement about how far they want to go, nor has any European regulator yet proposed a specific framework for health generated by consumer devices.

There is a big difference between public healthcare and that parallel system that Big Tech is building: you pay for public healthcare with taxes and you can modulate it with votes in elections. You accept Apple’s health ecosystem when you purchase the device. Be careful, I’m not saying this is bad — the services are real, the clinical evidence exists and the European General Data Protection Regulation offers some coverage—, but it does mean that a decision with enormous consequences for millions of people is being made in Cupertino, Seoul or Shenzhen without any parliament having debated it.

The watch already knows if you have hypertension. It now detects if your heart beats irregularly. It already measures whether your hearing is deteriorating. What there is not is a response from the public system to all this: how to integrate this data, how to train doctors to use it (and not underestimate it), how to guarantee that those who cannot afford a 400 euro device are not left out of a layer of prevention that for others is automatic. I think that is the real challenge. And at the moment, no one is solving it.

In Xataka | The European Union regulates too much. We don’t say it, the European Union itself admits it