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Transcript for eGames for Health

Part II
I want to talk a little bit about future ideas, other directions that we might go in, that people are thinking about going in, that I’m personally going in. So, most of the discussions in games for health have to do with two domains: personal treatment and professional practice. The things that I do, just as an individual, for my own health care, and how we train and recruit professional practice. And these are some of the areas – and I mentioned two of them already because they are particularly important – that come up often. High-level simulations: scenario planning, how do we deal with first response of situations. And there are a lot of these games out there in general, usually having to do with chemical agents and things like that. This is a common type of topic to be talking about, not surprisingly, given the present geopolitical circumstances.

Training, and here I mean training for specific medical, or nursing, or health-related fields – not necessarily training for the average person – but the use of games for training in specific contexts, in which case this sort of competition from commercial games doesn’t really matter. Increasing interest: there was a game produced by the U.N. World Food Program recently called Food Force which, essentially, the point of the game was “Hey, you can be a humanitarian. . . . That’s a career option.” Hey, who’d know it? The idea that you could do that with health care. We have really no idea what it means to be a health care professional or a health professional in the broader sense, and that’s something of interest. And then this idea of health messaging: working with commercial publishers and developers to try to take advantage of the audience. And I just want to give you a couple of examples of places where this hasn’t necessarily taken place, but you might not expect it. There’s a game called Fabled, for Xbox, which – it’s a role-playing game, and you play this character from a young age, and they have to make decisions, and there’s this sort of very rudimentary morals system, but there’s weight effects in this game, and when you eat an apple pie it has like 100 points of weight effects versus eating a carrot, and your character changes, and things like that. One of the examples I always like to give because nobody speaks well of it, is Grand Theft Auto, which is the game at the bottom. And you can say what you want about the violence in Grand Theft Auto, but you have to run around. And when you run around, you get tired, and you can’t run for very long, and if you run more you get more endurance and you can run longer which is useful if you’re a criminal. [Laughter] In later versions of the game, you can even work out, and what you eat sort of matters in a very rudimentary sense. So this stuff is not . . . it’s already being done in games in a very interesting way – or at least a rudimentarily interesting way – without any of us talking through it: they’re just doing this on their own because it’s interesting stuff.

The next one I wanted to do because, again, because I have the floor is tell you a little bit about what I’m interested in and what I’ve been doing: My studio is called Persuasive Games, and I take a slightly different tack when I’m thinking about games in general

And I’m not necessarily interested in education and measurement in the traditional sense; rather, I’m interested in persuasion. I’m interested in rhetoric. I’m interested in making arguments with games just like I would make an argument with a book I would write. And essentially, my contention is that, what games are: they’re models. They’re representations of how systems work. We have all of these really complicated, interacting parts and systems like the human body or the public policy world or whatever. And we can model how they do work Which is normally what we think videogames do or simulations do. Simulations are usually thought to model accurately how things work, but I just don’t believe that that’s possible. Or we can model how they might work, how they could work – how they’re broken, how we would change them, and we can sort of start to make arguments about how the world could be different. And in this sense, game play isn’t producing clinical outcomes, or kind of has a learning goal, or would we want to measure that learning transfer, but rather, we’re trying to argue a position that’s usually a position about the way that a system works or the way that it could work. We can do this to expose ideology, for one thing. “Hey, this is how people conceive of the world,” and we may not think about it as ideological. “Let’s maybe expose this in a game so we can start thinking about the things that we don’t think about.” And for me, this means that persuasive games – my kind of games – are fundamentally political; they’re fundamentally social. We can’t sort of separate something like health and wellness from the realm of the political. So really what I’m interested in is in this intersection of health and public policy. There are some examples we already saw: I mentioned this game Sim Health which was a simulation of the 93 debates about the health care system. This was a tremendously unsuccessful game as a commercial game but an interesting specimen. And when I started the studio, the first thing that we did, was we made this game for the Howard Dean campaign that they had commissioned, and this was interesting on the surface of it, but what we were doing, was we were kind using games an entry point into public policy. I actually didn’t put it in the slides here, but later we did a game about medical malpractice and tort reform, which is probably the only videogame about tort reform [laughter] in the world. And what I’ve been working on now that I wanted to share with you, is a game called Fat World, which has been funded by ITBS and PBS. This is the first time they’ve done this, and what we’re trying to do is make a game about, not surprisingly, about obesity and nutrition.

But trying to upset this sentiment, the sentiment that what obesity and nutrition has to do with is education and personal responsibility, which strikes me as a . . . it’s a position that’s framed in a particular political belief. And rather we’re trying to introduce a whole set of other issues into this debate, such as class and income and food incentives and the food lobby and the actual way that the world works and the way that that intersects with the choices that we really have. And a lot of this is based on work like Mary Nestlé’s, a book called Food Politics, which some of you are probably familiar with. Then we have these sort of situations like corn, where corn gets subsidized, and we can have cheap corn syrup and so we can sweeten things with corn syrup very profitably and sell them. We really wouldn’t want to get rid of corn syrup because then all of the industry lobbies would come and kind of try to upset our profit margins. And what we’re doing is we’re trying to model this in games. This is a game where you make decisions and there’s politics and there’s economies, and yeah, you can choose what you eat, but you’re constrained and you may have an income, and you live within a certain means. And essentially, you’re just making decisions – I’m using some concept art from the game: I apologize for the nudity – but the idea is we wanted to give people the opportunity to sort of decide what kinds of choices they are making and to give them an opportunity to make bad ones really: this is something we tend not to do in these educational games but, like when you have a game in which there’s a weight model and you can eat and it’s pretty sophisticated, and it’s based on like 500 core grocery ingredients that you can build into recipes and all these sorts of things, what’s the first thing you want to do? Well, you want to make yourself as rotund as possible – that’s the edge case: this is what people do with games. And there’s actually a tremendous amount of learning you can do there.