This is a post about nudges. And optimism.
There’s a story I read a long time ago by David Brin. It’s called “The Giving Plague,” and the protagonist is a virologist and epidemiologist who describes his life working on viruses and vectors. The Plague of the title is a virus that has evolved the ability to make infected people enjoy donating blood. Recipients keep giving blood, leading to an exponentially expanding network of people who find themselves giving blood regularly and even circumventing age and other restrictions to make sure they can give their pint every eight weeks.
The central twist of the story is that the protagonist’s mentor, who discovers this virus, realizes people who donate blood also perform other altruistic acts–that the act of giving blood changes their own self image. Makes them behave as better people. And so he suppresses the discovery, for the greater good of society. The protagonist, a rampant careerist, begins plotting murder to allow him to take credit. But before he can act, more diseases strike, the Giving Plague moves through the population, and the protagonist forgets about it in his efforts to cure newer diseases.
And if anyone thinks something like this is too outlandish, I encourage you to read this piece about Toxoplasma gondii and how it makes infected mice charge at cats, the better to be eaten so that T. gondii can spread. Yeah.
But what does this story have to do with the future of wellness and health?
One of the biggest problems in health today is figuring out how we can get people to do the things they really should for their health. Eat fruits and vegetables. Minimize the fast food meals we eat. Exercise. Get regular dental checkups.
We know all that.
And it’s hard for many people to do these things anyway.
So how do we get people to change? Because obviously the answer isn’t simple and it isn’t easy, or I wouldn’t be writing this post. I mean, look at this map (courtesy of the Centers for Disease Control, http://www.cdc.gov/obesity/data/prevalence-maps.html)
This is an obesity prevalence map for 2013, and a pretty sobering map too where even in the states with the lowest percentages, the prevalence of obesity hovers around 20-25%.
So, getting back to the story:
In David Brin’s optimistic view, what people need is a nudge, and even a small nudge like feeling the urge to give blood every eight weeks might be enough to motivate them to do other altruistic things. To create a greater good much stronger than the initial small act of giving blood. Kind of the butterfly wing phenomenon applied to human behavior.
Could this work in real life?
Brief, related digression: I’ve been working my way through Cass Sunstein’s book “Simpler.” It’s a fun and interesting book and one that my brain is still processing. One of the things he relates is how, while he headed the Office of Information and Regulatory Affairs (OIRA) during the first Obama term, OIRA worked to implement principles of behavioral economics into how the government creates regulation.
One of the things behavioral economics has to teach us about human behavior is that people are in many ways influenced by subtle elements in their environment. By knowing the ways in which the environment can alter behavior, we can speculate on how shifts in a person’s environment can lead to behavioral change. Change that can snowball, and maybe lead to a self-sustaining process of improved and improving health.
Okay, again more optimism.
But let me provide the example of Opower and what it’s doing to help people save energy as an example of what could be really powerful in health. Opower is a consulting company that provides solutions to energy companies that want to improve customer engagement and energy efficiency. Their value proposition is that customers want information, want to save money, want to save energy, and are just looking for the right method to making energy efficiency easy, transparent and personalized. Also easy. Did I mention easy? Key takeaway: to make a change, figuring out how to make it easy for people is 87.3%* of the battle. Opower helps energy companies make communicating information easier and makes acting on that information easier for the consumer, too.
One example of what Opower does is help utilities utilize text messaging to nudge people when they are likely to be facing a high power bill. By giving people real-time estimates of spikes in energy usage, and, I suspect, usable, relevant information (“if you continue using power at this rate, you will likely see a 50% increase in your energy bill this month, which equates to 45 hot fudge sundaes) and easy links to more information (embedded links: how much easier does it get?), Opower helps change behavior.
Could we do this with health? I don’t see why not. This seems like a direction a lot of the health apps are going–using real-time feedback, competition and gamification, easily visualized data and rapid rewards to try and modify behavior. To smoke less, eat more mindfully, walk those five blocks. Maybe that’s where Google and Apple and Microsoft and the other big players in mobile health are hoping to get to with their platforms for data storage and portability. Use their data and tools and the connectivity and immediacy of the internet to nudge people a little, with the hope that a little becomes a lot. There are a lot worse things to do with the power of omnipresent computing and Big Data than make a Giving Plague of changing attitudes and behaviors about health.
*This is a totally made up number. But the principle is real.