Consumer Health Has a Market. It Doesn’t Have a Modality.
Researched and written in conjunction with Claude. All ideas mine. Future writing will be all my own words, unless otherwise noted.
Function Health has raised over $300 million to sell $499 (now $365) annual lab panels to healthy people who want to track their biomarker trends. The company’s pitch is early detection and optimization — find the signal before it becomes a symptom. It is, by the standards of consumer health, a celebrated product: well-designed, clinically grounded, venture-backed, growing fast. And the disruptive logic is sound: today’s $499 panel becomes tomorrow’s $20 screening tool, integrated into primary care and employer programs, catching disease earlier across entire populations. That’s how disruption is supposed to work. Start premium, ride the cost curve, become infrastructure.
But disruption in consumer health has a delivery problem.
In the same country where Function Health is scaling, roughly half of Americans prescribed statins for diagnosed cardiovascular disease stop taking them within a year. Medication adherence for hypertension — the single most important upstream intervention for heart disease and stroke — is worst in the populations where those conditions kill most: lower-income adults, Black Americans, rural communities.
These are not people waiting for a cheaper lab test. They have the diagnosis. They have the prescription. The tools exist and many are already affordable. What’s missing is everything around the tools: the support, the access, the trust, the daily-life infrastructure to follow through.
Consumer health has built a sophisticated market — and a genuinely promising pipeline of innovation that could, over time, democratize access to better diagnostics and earlier intervention.
What it hasn’t built is the delivery layer that gets any of this to the populations where health outcomes are worst. That gap — between the innovation and the delivery, between the market and the need — is the central challenge of the industry. And closing it requires thinking about consumer health in a fundamentally different way.
The Distinction: Market & Modality
Consumer health means two very different things, and the industry almost never separates them.
Consumer health as a market is what most people mean when they use the term. It’s the products and services people buy in pursuit of better health: fitness memberships, supplements, wearables, telehealth, diagnostics, longevity protocols, mental health apps. It is a market in the ordinary sense — companies build products, consumers purchase them, value is exchanged. It is large (north of $450 billion in the U.S.), growing, and overwhelmingly oriented toward people with discretionary income, digital literacy, and a self-concept that includes health optimization. The market rewards novelty, aspiration, and willingness to pay. It has produced genuinely useful innovations. It has also concentrated those innovations almost entirely in the top income quintile of American society.
Consumer health as a modality is something different. It means reaching people through consumer-facing channels — community, commerce, digital platforms, physical spaces people already use — rather than through the clinical system. It is a delivery mechanism, not a product category. The insight is simple: the traditional healthcare system reaches people episodically, reactively, and through institutional touchpoints (doctor’s offices, hospitals, insurance networks) that large segments of the population use poorly or not at all. A modality approach asks: how do you deliver health impact through the channels where people actually live — gyms, workplaces, churches, phones, retail, social networks — rather than waiting for them to show up in a clinic?
This distinction changes everything: who you design for, how you distribute, what you measure, and what business model is viable.
Where the Market Points vs. Where the Burden Lives
The consumer health market directs capital and innovation toward a population whose health outcomes are already improving. The populations with the worst outcomes are largely invisible to it.
By income: Consumer health spending is heavily concentrated in the top two income quintiles. A Whoop membership is $239/year. A Levels CGM subscription is $199/month. Telehealth GLP-1 prescriptions through platforms like Ro or Hims run $200-$300+/month before insurance. Even “mass market” products like Noom ($70/month) or an Apple Watch ($399+) assume a consumer with meaningful discretionary spend. Meanwhile, adults in the bottom income quintile have roughly double the diabetes prevalence of those in the top quintile, 30-40% higher rates of cardiovascular mortality, and significantly worse hypertension control at every stage — awareness, treatment, and adherence. (CDC NDSR 2022; Chetty et al., JAMA, 2016; AHRQ National Healthcare Quality and Disparities Report.) The market is building for the top. The burden is at the bottom and in the middle.
By race: The consumer wellness industry’s customer base skews white and affluent. Its marketing, product design, influencer ecosystems, and retail distribution reflect this. Black Americans, who face heart disease mortality rates 30-40% higher than white Americans and diabetes prevalence 60%+ higher, are not the target customer for the vast majority of consumer health products. Hispanic Americans — the youngest and fastest-growing demographic in the country, with elevated diabetes risk and some of the lowest health insurance coverage rates — are similarly underserved. The products exist in one America. The burden exists in another. (CDC WONDER; AHA Circulation 2023 Update; KFF coverage analyses.)
By geography: Consumer health infrastructure — boutique fitness studios, functional medicine practices, health-focused retail — concentrates in urban and suburban markets with high household incomes. Rural America, where heart disease mortality is 20-25% higher and provider shortages are accelerating, is largely a consumer health desert. The market follows density and disposable income. The need follows the opposite gradient. (Moy et al., MMWR, 2017; Rural Health Information Hub.)
This is not a failure of any individual company. It is the structural logic of consumer health as a market: you build for people who will pay, you distribute where margins work, you grow where the customer acquisition economics are favorable.
The disruptive cost curve is real, and it’s accelerating. Hims CEO Andrew Dudum has publicly claimed he’ll drive comprehensive lab costs toward zero. Fullscript is building Function-type capabilities to enable whole-person health journeys across the practitioner landscape. Peter Attia’s clinical argument — earlier, more aggressive screening and intervention, statins at 35 rather than 55 — is well-supported by evidence and would benefit enormously from cheaper, more accessible diagnostics.
But cheaper tools don’t solve the delivery problem. We already know this, because we’re already running the experiment. Statins are generic and nearly free. Blood pressure cuffs cost $30. Diabetes screening is covered by most insurance plans. The tools are available.
The populations with the worst outcomes still aren’t reached, still aren’t engaged, still aren’t adherent — because the barriers aren’t primarily technological or financial. They are structural: trust, access, cultural relevance, daily-life infrastructure, and the absence of sustained support between clinical encounters.
The supply side and the modality approach are not in opposition. One makes the tools cheaper. The other builds the delivery layer that gets them to the people who need them.
*The problem is that the industry is funding the supply side almost exclusively — while the demand side remains largely unbuilt.
What a Modality Approach Changes
If you take consumer health seriously as a modality — as a way of reaching people, not just selling to them — the design questions shift fundamentally.
Different target populations. The market asks: who will pay $50-$200/month for a health product? The modality asks: who is currently unreached by the clinical system and could be reached through consumer channels? These are overlapping but very different populations. The second and third income quintiles — roughly $30,000-$100,000 in household income — are perhaps the most important and most neglected segment. Too wealthy for Medicaid in most states, too constrained for the consumer wellness market, often carrying high-deductible insurance plans that discourage preventive engagement. They are not destitute. They are simply not the addressable market as currently defined. A modality approach puts them at the center.
Different distribution. The market distributes through apps, DTC e-commerce, and premium retail. A modality approach distributes through the places underserved populations already go: gyms (including budget chains and community facilities), workplaces, faith communities, barbershops, community colleges, dollar stores. The research on “community health worker” and “promotora” models in public health has shown for decades that trusted, embedded, culturally relevant touchpoints outperform clinical outreach for hard-to-reach populations.
Different unit economics. The market optimizes for high LTV per customer: get someone to pay $100+/month and retain them. A modality approach may require radically different economics — lower revenue per person, higher volume, blended funding models (employer-sponsored, payer-funded, philanthropic, government), and value capture through outcomes (reduced ER visits, improved chronic disease management, lower disability claims) rather than consumer willingness to pay alone. This is harder. It is also where the actual scale opportunity lives, because the underserved population is vastly larger than the optimization market.
Different success metrics. The market measures engagement (DAU/MAU), retention, and revenue. A modality approach measures health outcomes: blood pressure controlled, A1C reduced, screenings completed, hospitalizations avoided. This is not a philosophical preference — it is the basis for reimbursement, employer buy-in, and any model that doesn’t depend solely on consumer spend.
The Hard Part
None of this is easy, and I don’t want to pretend otherwise. The consumer health market is built the way it is for rational reasons. Affluent consumers pay more, churn less, and are easier to reach through digital channels. Lower-income and working-class populations are harder to engage, more expensive to serve, less likely to self-identify as “health consumers,” and operating under daily constraints — financial, logistical, psychosocial — that make sustained behavior change genuinely difficult.
A modality-first approach to consumer health requires building for populations with lower willingness to pay, lower baseline engagement with health products, and lower trust in health institutions. It requires creative funding models, deep community integration, and a tolerance for unit economics that would make most consumer health investors uncomfortable. It requires designing products and experiences that fit into lives shaped by shift work, food deserts, caregiving demands, and the accumulated stress of economic precarity.
The reason this hasn’t been built is not that no one has thought of it. It’s that it’s structurally hard. But “structurally hard” is not the same as impossible — and the need is enormous.
What Comes Next
This is the lens I’ll be using throughout this publication. In a companion piece published today — The Heart of the K: Cardiovascular and Metabolic Health in a Divided America — I map the first major outcome domain in detail: where cardiovascular and metabolic disease burden falls by race, gender, income, and geography, and where in the chain from awareness to outcomes the system breaks down. Future pieces will do the same for mental health and substance use, cancer screening, musculoskeletal health, and maternal health.
The goal is not another disparities report. It is a specific, evidence-based argument about where consumer health interventions — deployed as a modality, not just a market — could have the greatest impact. And alongside that research, the honest account of trying to build a company on this thesis at 50, with all the uncertainty that entails.
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Sources
- CDC WONDER / National Vital Statistics System
- CDC National Diabetes Statistics Report, 2022
- AHA Heart Disease and Stroke Statistics — 2023 Update (Circulation)
- Chetty et al., “The Association Between Income and Life Expectancy in the United States, 2001-2014,” JAMA, 2016
- AHRQ National Healthcare Quality and Disparities Report
- Moy et al., “Leading Causes of Death in Nonmetropolitan and Metropolitan Areas,” MMWR, 2017
- KFF analyses of health insurance coverage by race/ethnicity
- Rural Health Information Hub — rural health disparities data
*Consumer health market sizing draws on multiple industry reports (McKinsey, Rock Health, GWI). Specific product pricing reflects publicly available rates as of early 2025 and may have changed. Health outcome data reflects 2019-2023 estimates depending on source.