Literacies

Hey you, WHO, CDC, OECD: go stuff your endless texts!

There are many kinds of literacy. One that we all recognize is the ability to read and write in a native language. The average adult literacy, of that kind, in the United States, is utterly abysmal.

So bad, in fact, that health information should be written at no higher than an eighth-grade reading level (13-14 years old). That’s according to the American Medical Association, the National Institutes of Health, and the Centers for Disease Control and Prevention, as reported by Wylie Communications.

You might say: it is what it is, we do the best we can. But publishing health information, at the level of younger adolescents, is bound to reinforce health inequities. The reason for that? Even when information is dumbed-down thus, about half of all adults still won’t understand it. Not because they’re morons, of course, but because they lack reading skills.

This is a problem for anybody who produces health information, health education, or health promotion. Those are three pillars of self-determination, for controlling and improving health. They are meant to empower people. Problem is, most of what gets published under those headings is text. It must be read rather than watched, heard or experienced.

Ergo: no read, no learn; no learn, no improve.

There’s an additional problem for those who have proficient reading skills. Shown text that is written for juvenile eyes, they are more than likely to be bored. People tend to check out when boredom occurs. They don’t pay attention. They don’t engage. They don’t learn.

If we add the 50% of the adult population, who can’t understand the basic text of health information, with the 15% of the adult population that gets bored reading Golden Books, that leaves only 35% in the crosshairs of epitomic health information, health education and health promotion. No wonder the pillars are wobbly!

(Literate persons reading this may have noticed that health care is not listed as a pillar — for obvious reasons, to anybody who has received health care on a regular basis. It doesn’t empower through self-determination. Just the opposite, with rare exceptions. For better or worse, usually for worse, health care is a system of command and control.

However, I digress.)

The ability to read and write is a foundational literacy. It must be present in order for other literacies to flourish. Two others that are particularly important to Humaginarium are health literacy and scientific literacy.

According to the World Health Organization (WHO), health literacy is the ability of individuals to access, understand and use information in ways which promote and maintain good health.

According to the Organisation for Economic Co-operation and Development (OECD), scientific literacy is the ability of individuals to engage with science-related issues (including medicine), and with the ideas of science.

Each of these definitions, in their contexts, requires proficient foundational literacy to understand. The language is tortured. But for me they refer, somewhat allusively but inevitably, to reading skills: in one case, reading the rhetoric of medicine, in the other, reading the rhetoric of science.

Professionals spend decades in school and training, acquiring health or scientific literacy. And the 85% of adults in the United States, who have less than proficient reading skills? They don’t have a clue or a chance. They are sitting quietly, in the last row, waiting for the bell to ring.

That’s a problem that feels like an opportunity, at least to me.

Humaginarium has an opportunity to solve that problem. After noticing that the literatures of health information, health education and health promotion are banal and ridiculous for adults who are not morons (i.e. almost everybody), we cut a new path to empowerment. We obviously can’t develop the reading skills of folks with chronic illness, so instead we made reading optional. In fact, we made reading unnecessary. To be clear, people who come to our brand read nothing.

Instead of reading, they do what comes more naturally, no matter what level or kind of literacy they have attained. They get to:

  • Look at beautiful pictures
  • Play with amusing things
  • Crush thorny brain-teasers

In other words, they play video games. Our novel video games are health promotion in disguise.

Nobody will recognize the health promotion, because there’s no command-and-control text on the screen telling them what to think or do. Instead there are persuasive voices asking them to explore and act according to their own self-interest, their intimate wants and desires.

And for what? To win the game. To control the illness. To increase their share of well-being.

So hey, you, WHO, CDC, OECD: go stuff your scrolling pages of text already! Read my lips. The work needs to be about much more than information. It needs to be about empowerment!

Nurse Nancy, a Little Golden Book, now available from Amazon, and others since the 1950s

Arcade Redux

The overarching purpose of Arcade is to ignite the desire to learn and use health science.

In his magisterial medical history entitled The Great Influenza (2004), John Barry evokes the heroism of brilliant, bewildered and ambitious pathologists trying to identify an emerging crisis in public health that would soon kill around 50 million people worldwide:

And the excitement! Each time a student fixed a specimen on a slide and looked through a microscope, an entire universe opened to him! To some, discovering that universe, entering into it, beginning to manipulate it, was akin to creating it; they must have felt almost godlike.

Humaginarium isn’t a microscope; neither is it for clinicians (though some may choose to use it). Even so, that historic experience of hunting flu virus and its collaterals in 1918 is somewhat comparable to the living experience of trouncing disease in Humaginarium.

Our users are adults who have or risk developing chronic illness and coincidentally enjoy challenging video games. Our prototype application is for consumers who are affected by – or have reasons to be concerned about – metabolic disorder (even if they don’t know what that is and are oblivious to the risks it poses).

It’s important to state clearly and emphatically that users stand to benefit mightily from Humaginarium – but that’s not why they use it. They use it because it’s fun and beautiful and enriching and self-actualizing. “That’s entertainment!” Health and educational affordances are consequential and valuable aftereffects.

Our users stream Humaginarium to large and small screens. They may be in classrooms or clinics when they play, but probably not. More likely they’re at home or work or traveling – just hanging out. They’re keen to play rather than learn per se. However their learning experience is so surprising and engaging and useful that they really won’t dismiss it (as they tend to diss traditional health information and education); instead they’ll relish and likely share and build on it.

Our typical users take their first look (through a digital lens) at a biological universe that beggars the imagination; one riddled with fantastic menace like some seething terrorist underground; one they can safely explore and manipulate and maybe even master if they’re clever and fast and keep trying. Like those antique pathologists striving to rescue humanity from gruesome pain and suffering and sudden death, our users may experience the thrill of victory, the agony of defeat when saving themselves (or their family and community, or their generation) from Morgoth-like powers of organic malevolence. Moreover if I do what I intend with Humaginarium, players may indeed feel “almost godlike” because they themselves are creating the meaning of health and life inside a miracle known as “my body.”

Thanks to historian Barry, I know how pathologists discovered the one pestilential ring that ruled them all back in 1918. They did hard, frustrating, relentless science in labs, clinics and the field. How will users destroy a ring of their own in Humaginarium? They’ll start by getting situated in our Arcade.

The overarching purpose of Arcade is to ignite the desire to learn and use health science (to gain the power of health literacy). That’s the unrivaled albeit unconscious goal of all users from the moment they land on our home page. Without a desire to learn, users will experience our game simulations the way inert marbles experience a pinball machine. We don’t want that; it feels too much like industrial health care.

Imagine then an Arcade that dramatically opens on the first of many self-assembling choice architectures we have prepared: a prelude to the quest for wellness. The Arcade interface is desirable, intriguing, tempting and threatening; shimmering, sparkling, promising and ominous; spatial and fluid like gripping and evanescent dreams. Users gaze on this animated tableau for a few seconds and most likely utter “WTF?”

Their eyes are drawn to a stony portal they can see through to observe wonders, but can’t seem to pass. The portal is a metaphorical cut in a border wall between the real world (where we must live) and a hyperreal world (that we long to live for): a world full of promise and pleasure and despair.

To penetrate the portal each individual must make a magic key that becomes a private and powerful identity and credit card in Humaginarium. Like DNA, that key is unique to each player. It cannot be shared or exchanged though it can be edited. The key is a personal credential for playing and learning in Humaginarium. It works forever and grows in power over time, but it may be forfeited under penalty for unworthy behavior. The key is endowed with tangible and symbolic assets that are useful in play and beyond, on both sides of the border wall.

To make a key, each user dips into three wholesome mini games about biological birth, growth and death. These are visual puzzles that users manipulate in order to become deeply situated and immersed in Humaginarium while generating clues to unlocking the portal. All three pose the question “how”: how is the ideal body born; how does it grow; and how does it die. Content is presented in elementary symbolic rhetorics, not in words. Together the solutions inform a mental model of homeostasis (physiological wellness) that is important for future struggles in Humaginarium. For now the mental model is a grail; it triggers an urgent desire to learn.

Once through the portal, users leave the Arcade behind and enter an agonizing labyrinth – a framework for quest. In the first instance of Humaginarium (our MVP), there is one modular and multilevel game named Diabetes Agonistes. Eventually there will be hundreds. Before proceeding though, users must discover a little about the problems that lie ahead, as they provision for adventure.

I’ll describe that provisioning in my next post.

Scientific entertainment. Variation on Les Deux Baigneuses (1884), by William-Adolphe Bouguereau. Pictured with a micrograph of menstrual hormones.