Games are an ideal way to engage people in activities that promote healthy lifestyles and tackle their health problems head-on. Accessing these activities through games can make them more attractive and effective because games are designed to be fun, easy to access, and give players a sense of control and safety that is sometimes lacking in more traditional health services and products. The field of Games for Health is at a take-off point. We present this mosaic of solutions for Games for Health at this critical time to promote such innovative approaches that improve health.
Consider what’s in a game: A strong interactive computer or video game provides a serious challenge that players must overcome to reach a goal, usually with fun and some learning along the way. At their best, games for health create experiential scenarios that channel what players learn during the game into smarter choices outside the game. Superb graphics and clever storytelling, applied to high-stakes issues such as cancer remission and natural disaster preparedness, make games for health anything but kids’ play. Though games for health are serious, they only work when they’re fun. Sometimes, they surprise you without intending to, like the calorie-burning benefits of playing Nintendo’s Wii or Konami’s Dance Dance Revolution.
Games for health, like the best social enterprises, have tremendous potential for profit and behavior change. Additional research into games for health can only prime and improve the marketplace for the next generation of ideas and products.
This mosaic highlights some important dimensions of games for health, and we hope it inspires new ideas and new research about play that improves health.
Innovation Principle: Create Experiential Scenarios to Make Smarter Choices Outside the Game
Barriers to Building the Games for Health Marketplace:
Insufficient Evidence that Games Can Improve Health and Management of Chronic Diseases
: Do games for health work? This fundamental question motivates all stages of development. Doctors, as a sort of consumer, need evidence that games for health improve patient compliance and patient management of chronic illness. Corporate and start-up game developers also are more likely to invest in developing games for health if research demonstrates that games can help manage patient health and there is provider acceptance. Day-to-day health management means customers become attached to the product, and loyal customers can provide guaranteed sales. As with developing any health product, early evidence of success invites future research partnerships and investments. But insufficient evidence may reflect a sort of chicken-and-egg problem, in which product development stalls without motivating data, and research can’t advance without new products to evaluate. Innovative players in this field can pair product development and piloting with strong research and evaluation.
Games Face a Dual Stigma, Which Limits Their Potential Customer Base and Distribution: Several dynamics inhibit development of the games for health marketplace. Two kinds of stigma limit the traction of games for health. First, old thinking brands electronic games as vacuous, if not harmful to learning. Second, game companies with a loyal youth audience fear they will tarnish their ‘cool’ reputation if their games start to feel overloaded with good-for-you messages. Both approaches do a disservice to games for health, which are not simply games with public service announcements tacked on.
Confined by this prevailing stigma, entrepreneurs may underestimate the potential customer base and distribution channels for games for health. Some developers assume people are unwilling to pay for a game associated with health, while others think that health games can’t sell in an entertainment store. But these are symptoms of a more fundamental problem: a game with a poorly defined purpose and limited concept of its audience. A well-defined game that addresses a new problem will likely identify a new audience for games. For instance, seniors living in nursing homes are not the typical game consumers. But they may rush to a game that helps them live more independently, and communicate their aches and pains to family members. Similarly, doctors may be new consumers of diagnostic games, and their offices may be new distribution channels to reach patients. Insurers could also speed up patient recovery with games, as CIGNA has done by distributing HopeLab’s cancer awareness game Re-Mission to doctors.
Product Design Is Oriented Toward Consumption not Application : Most health care products, like pharmaceuticals, are designed to be consumed – we don’t interact with them or engage with our drugs on anything but a functional level. Similarly, most games are designed to entertain and be used – but not to teach us anything but how to play the game. This one-dimensional sensibility manifests in many companies’ product designs. And such products then have limited applications. But what if games were re-conceptualized -- developed to easily help casual gamers apply what they learned? The challenge, and the brilliance, of games for health is their design to promote learning and change behavior, all while entertaining. To do this successfully, games should be easy to learn, or at least easily engage the player. When a product’s gadgetry frustrates, rather than helps, patients, it loses its purpose and potential customers. Rules and operation should be, at best, subtle background features.
Narrow Corporate or Public Policy Mission : New companies often have narrow missions in order to focus on their core business. Game developers focus on entertaining and health sector agencies focus on treating illnesses. But such silos of narrow missions can limit product development, and new applications of existing products. In addition, it can lead to ignoring potential customers and their needs, such as the contingent of aging Baby Boomers, who want independence and control over their health rather than to passively be treated by a doctor. Big game companies like Nintendo have recognized this new market, with brain agility games such as Brain Age. Narrow public policy missions also can miss opportunities to develop games or characters to reach citizens online in the growing social networking and virtual community sites such as myspace or Second Life.
Physical Health: Managing disease and maintaining motor control, biological systems and fitness : Most illnesses involve some loss of control, because the patient has lost strength or range of movement, or because cellular or muscular systems are not working optimally. Games offer an ideal environment for the patient to reassert control over their body, by learning new adaptive ways of managing their illness. Even for less serious situations, such as improving fitness, fun exercises and escapist experiences in a game may deliver better results and keep consumers engaged over the long-run than monotonous activities at the gym.
Emotional Health: Tapping Affect, empathy, imagination, and introspection : Mental and emotional health is important for its own sake, as well as for its effect on physical health. Online environments can provide the shelter of privacy that allow people to name and tackle the source of their struggle, such as peer support groups in online communities to manage chronic illness. Games in particular provide helpful metaphors for people to be simultaneously introspective and engaged.
Cognitive Fitness: Sustaining memory, neurological function, and logical reasoning : Staying fit and agile cognitively is a key driver of overall health. Better than lifelong math homework or expensive drugs with side effects, games can be a natural solution to keeping the brain active. Games that require sharp reasoning and rapid calculations are relatively easy to produce, from crossword puzzles to more sophisticated online brain-teasers. These can be distributed through family doctors and set up at senior centers as social activities.
Community Health: General well-being and awareness of common foundation for information and support: Health is a social phenomenon— not only because diseases spread but also because poor community well-being can undermine safety and security. Innovations in this dimension can increase awareness of human behaviors – personal as well as industrial actions – that undermine well-being. They also can provide information and tools to identify and tackle disease vectors, from poverty to viruses.
Environmental Protection: Protecting natural resources and food supply : As we learn more about how toxins and pollutants can dull even the sharpest of minds, there is increased urgency to prevent environmental upset and contamination. Sustainable living often seems a daunting task and unattainable for the average person. But games that inform and illustrate the impact of specific behaviors can allow people to practice new choices, such as different foods and transportation options. Through practice, they can discover their ability to reduce their environmental footprint, which can instill long-lasting changes in how we live.
Dance Dance Revolution is keeping feet tapping at game arcades across the globe. This music video game challenges players to tap their feet on a dance pad with panels. Players press the panels with their feet in response to the arrows that appear on a screen in front of them. The arrows are synchronized to various song beats and success depends on one’s ability to time and position one’s feet accordingly. Featuring increasing levels of speed and difficulty, this game offers a fun exercise alternative for those whom the monotony of gym routines is a disincentive to working out.
For children forced to live with juvenile diabetes, keeping a constant check on blood sugar levels no longer need be a chore. With Glucoboy, diabetes management morphs from a difficult living condition into a thrilling and educational video game. This glucose meter can be inserted into a Nintendo Gameboy. The product operates independently of the video game system but downloads video game programs that are contained within its circuitry into the Gameboy as a reward for maintaining good blood sugar control. With patients being responsible for their own diabetes management, the Glucoboy carries an essential dual role: providing accurate medical diagnosis for the disease as well as an incentive delivery platform which serves as a key portal for obtaining patient-critical medical data.
Re-Mission, a 3D video game starring a nanobot called Roxie who zooms through the bodies of cancer patients zapping cancer cells, battling infections and managing side effects of cancer and cancer treatments, is aimed at ensuring that teenage victims of cancer understand their condition, internalize the importance of sticking to treatment and adopt behavior designed to improve their health and quality of life. Re-Mission was developed by HopeLabs, US, through a collaborative process that included video game developers, animators, cancer experts, cell biologists, psychologists, and young cancer patients.
UK-based School Food Trust just ramped up its efforts to get children to eat healthy by aggressively distributing Snack Dash. The video game is a race to guide sonic character eBee dBee through the school as fast as possible. Along the way, eBee needs to collect health foods to maximize energy, speed and points, and avoid the unhealthy trap of junk foods that will make him fat and slow.
Sonic Invaders, an arcade game played and navigated entirely in audio, is ideal for those with vision impairments. It requires players to “shoot” down extraterrestrials who are invading earth. Gameplay is heavily based on sound positioning in a stereo field and players control the game exclusively through the keyboard and headphones.
Fatworld, an online game on the politics of nutrition, works through a mix of empathy and ridicule. Players create a character and then live out his/her life in a veritable consumer paradise where they rule over their empire of restaurants and convenience stores, and enjoy food allergies, diabetes, heart disease, and death! Players’ health outcomes are dependent on the choices they make, for example, that between going in for wheatgrass or fried chicken. The game explores the relationship between obesity, nutrition, and the socio-economics of health in contemporary U.S.A. The game is due for release in Fall 2007.
Nintendo’s handheld game Brain Age ensures your mind gets the workout it needs to stay in top form. Inspired by the work of prominent Japanese neuroscientist Dr. Ryuta Kawashima, Brain Age features activities designed to stimulate and exercise different parts of the brain. Solving simple math problems, counting people going in and out of a house simultaneously, drawing pictures on the Nintendo DS touch screen, and playing Sudoku are some of the ways in which the brain is massaged. With its potential for ratcheting up cerebral activities, the game may have a profound impact on staving off and/or arresting the onset of diseases like Alzheimer’s.
ID The Creep is an online game designed to help young girls practice identifying pedophiles online. The game is a part of the “Think Before You Post” campaign from the Department of Justice, the Ad Council, and the National Center for Missing and Exploited Children (NCMEC) and is aimed at making teenage girls aware of the dangers of posting personal information on social networking sites. The game lets players search mock emails, instant messages, and chat rooms and pick out the potential pervert. The game challenges young people who think they would be able to identify a predator to play along and see how they score. It allows players to engage in simulated chat, e-mail, and IM situations and choose from several statements as they reply to others. It serves both as a sobering wake-up call to teens who realize they are not quite as creep-savvy as they think.
Presented as an art installation, visitors to IntroSpection interact with microorganisms and cells derived from their own body in a non-invasive way when they surrender a cell sample from their own mouth onto a microscope slide. The slide is then submitted to Nikon's automated Coolscope which allows telemicroscopy control for the computer orchestrating the multi-media event. Visitors can then engage in a number of games: Exploration demystifies biological research where players undertake a mini-study of their own body; in another game, visitors try to identify what place in their cell sample is the origin of a blown up mystery image. Viewers end up reflecting on the changing nature of identity when so much cultural attention is focused on the microbiological level.
Personal Investigator (PI) is an online 3D detective game designed to help teens overcome mental health problems and engage with traditional mental health care services. It combines the goal-orientation of gaming with the Brief Solution Focused Therapy (BSFT) model of goal-oriented psychological therapy, and serves to reach out to teenagers, a group that therapists often have difficulty getting through to. Players take on the role of Solution Detectives in a Detective Academy. As they move through the academy they are set a series of tasks that are rewarded. The tasks and dialogues implement the therapy model and by achieving the goals set by the game, teenagers learn to understand their problem, convert it to a goal, and identify the resources they have to help them achieve this goal.
Mind Games’ Paint Affects allows you to, quite literally, paint with your emotions. This multi-modal installation gives users creative control over a large virtual canvas and a digital palette that is influenced by their biometric state. The user paints by gesturing with a pressure controlled orb. Simultaneously, the system reads his/her biometric measurements and the resultant swathes of color on the canvas are a direct result of the painter’s emotions as the paint particles adopt characteristics synonymous with his/her biometric state. The game has tremendous potential for application in art therapy, for example, with autistic children.
mtvU, MTV’s 24-hour college TV network is promoting game development around social issues through global online competitions. The channel throws open “challenges” to gamers, activists and students to create innovative video games aimed at making the world a better place by raising awareness and the promotion of personal action. While the competitions offer prize money, the real incentive offered up by mtv is that it helps gamers to develop and market the game. The widely acclaimed Darfur is Dying was one such game that was surfaced through their competition, and then launched by them.
Virtual reality is providing welcome relief to Phantom limb pain or PLP—the discomfort felt by a person in an amputated limb. Drawing on research that prove that when a person's brain is 'tricked' into believing they can see and move a 'phantom limb,' pain can decrease, researchers at UK’s University of Manchester’s Schools of Psychological Sciences and Computer Science are using 3D computer graphics to combat the pain suffered by amputees with remarkable results. By putting on a headset patients enter a life-sized virtual world, where they see themselves with two limbs. They can control the movements of their purely computer-generated limb using their remaining physical one.
Weaving the key concepts of brain structure into the very fabric of game play, Journey into the Brain is an award-winning mystery-adventure game for children ages 7-11. The game’s developer, Morphonix, has come up with a series of video games that make abstract concepts of brain science fun and comprehensible to children and teens. While many software games stimulate children to use their brains, this is the first series of video games that also teaches them the science of their brains including information on neuroscience and a whole slew of brain facts.
Research shows that speed games are a highly effective form of brain exercise with measurable impact on improved cognitive performance years into the future. Focused on helping people of all ages in improving their brainpower and tracking their brain, Cognitive Labs is developing and marketing cognitive testing software that is delivered as a web service on the Internet and through strategic partners. The company’s goal is to provide the widest variety and selection of cognitive games anywhere—both developed by them as well as by independent game developers. The free-of-charge games fit with regular test taking and exercising and with players’ other online activities including searching, reading news, and checking email.
Sponsored by the UN International Strategy for Disaster Reduction, Stop Disasters! is a disaster simulation strategy game that tackles the very real issue of saving lives and reducing the financial impact that natural hazards cause when they turn into disasters. The game aims to raise awareness of how disasters affect people and how even simple measures can save lives. Aimed primarily at secondary level students—a young yet influential audience—the game will soon be translated into the UN's five major languages to broaden its reach.
The need to recruit the next generation of public health professionals has never been greater: Outbreak at Watersedge, an interactive game, introduces players to the domain of public health. Players are challenged to discover the source of the outbreak that has hit the small community of Watersedge and to stop it before more residents fall ill. The learnings from the game include discovering how public health professionals investigate disease outbreaks and their role in promoting health and preventing illness. By introducing players to various professional roles within the field of public health, the game is helpful for those seeking a career in health to identify specific jobs within this field. The game is also available in a CD format.
Squeezed, an online game developed by students and faculty at the University of Denver, is designed to make players empathize with the struggles of migrant farm workers. The common gaming figure of the first-person shooter appears here as first person picker who must pick fruit in order to obtain juice, which is used as currency. Part of the juice gets shipped away. The player must decide how to allocate the little that remains between multiple, competing demands including her family’s needs in her homeland, her own needs, etc. There’s a strong emotional element to the game that reinforces the player’s empathy with migrant workers even as s/he learns about their tough everyday realities.
Darfur is Dying, a free online interactive video game, affords players an insight of what it is like to be a refugee in the genocide-affected Darfur region of Sudan. Players take on the role of refugees searching for water, food, shelter, and safety, while at the same time, hiding from the government-sponsored marauding Janjaweed militia. The third and last “level” of the game makes a conceptual leap in allowing players to together rebuild devastated villages. Created by a team of University of Southern California students lead by Susan Ruiz and Ashley York— staunch believers in multiplayer online game activism—the game hopes to facilitate an immediate call to action as it stirs the conscience of players.
A free online role-playing game developed by teens for teens, Ayiti: The Cost of Life, exposes players to what it is like to live in poverty, struggling to stay healthy, keep out of debt, and get educated. Players take responsibility for a family of five in rural Haiti. The game spans a 4-year time period spread over 16 seasons, in which season-dependent work roles are given to family members, and where players also guide them in community building and in children’s education.
Available in ten languages and with over 3 million players worldwide, Food Force is a free educational video game that serves as a classroom tool for teaching 8-13-year-olds about hunger. The game transports players to the imaginary island of Sheylan where a terrible disaster has struck. Each of the game's six missions or mini-games takes players from an initial crisis assessment of the number of survivors and their needs, through to safe delivery of airdropped food packages and properly planned distribution of food aid. Together, the missions provide an overview of how food aid is used in both emergencies and long-term development projects.
The blended reality aspect of real and virtual worlds can be fascinating. Centers for Disease Control and Prevention is leading trends among Federal agencies by teaming up with Second Life, a 3D online digital world created by its own residents, to disseminate CDC health content via the virtual world. This CDC-Second Life virtual office is focused on merging good health practices in real life with the fun and play of Second Life, making public health a reality, in virtual and actual ways.
Leading healthy lives just got a whole lot more fun for kids with Archimago’s Nanoswarm, a video game. Through the game, players are made to recognize the role that diet and physical activity play in the development of obesity and realize that it’s “cool” to exercise and to eat fruit and veggies. Developed in close collaboration with Children’s Nutrition Research Center of Houston’s Baylor College of Medicine, this action-packed game challenges players to more effectively use information learned during gameplay and incorporate this “virtual experience” into their daily lives through behavior modification designed to prevent diabetes.
Water Alert! is a free online educational game on water, environment and sanitation where young people are engaged in an adventure of strategy and survival. Available also on CD, the game is designed to work within established standards for learning and comes with content linkages that provide contextual support for classroom use. The goal is to ensure that the people in a fictional drought-challenged village, who are facing a flood threat, have safe drinking water and a clean and healthy school environment. Players are informed of the impending emergencies and made to choose between two “challenges” at the River or School and Pump. The first challenge addresses issues of water contamination and emergency planning in a team situation, while the latter encourages local action in school.
SimCity is a game that allows players to create their own cities and to shape their cultures, societal behaviors and environments. It allows players to mix-and-match and combine, connect and rearrange elements of their city depending on the kind of city one wants: a happy and creative one, an aggressive totalitarian one, or one that leaves an environmental footprint. A revolutionary feature allows players to combine buildings that will produce or consume new kinds of resources called “social energies” such as industry, wealth, obedience, knowledge, devotion, or creativity. The social energy of one’s city will determine the quality of life lived in it.
