Market

Healthcare treats health literacy as noise on its uneconomical fringes.

The mission of Humaginarium is health promotion. Yet strangely, there’s no market for health promotion. People aren’t buying it.

According to the World Health Organization (WHO), “Health promotion enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.”

The emphasis here is on “individual people,” meaning consumers or patients – those I call regular folks. They are the targets and beneficiaries of health promotion.

The emphasis is also on “control,” meaning medical self-efficacy among those selfsame individuals. Health promotion is not supposed to benefit the healthcare or wellness industries that sell services to consumers. It benefits the people who have or risk illness.

The specific pillar of health promotion that concerns Humaginarium is health literacy. WHO says that health literacy enables people to “acquire the knowledge, skills and information to make healthy choices, for example about the food they eat and healthcare services that they need. They need to have opportunities to make those choices.”

Thus health literacy is not knowledge or skill or behavior, and certainly not health outcomes. It’s merely the ability of regular folks to learn, in order to make sense and use of their own choices.

In effect health literacy is a competence rather than an outcome, and it’s one that never comes naturally. It must be learned, and there’s the rub. Most folks may be educated, but few have even the most basic health literacy. They didn’t learn it in school. They didn’t learn it in clinic. They didn’t learn it from friends and family. They didn’t learn it by surfing the Internet. Why is that?

Well, I know of two reasons. One is biology as a second language. We must dismiss the advertising we’ve seen and remember that healthy choices are not consumer packaged goods in the supermarket. They are expressions and perceptions that employ the semantics of science. Healthy choices are really hard! The second reason is the information itself: the intelligibility and utility and consequences of choices even after you know what the words mean.

For example, you probably know the word bacteria, but what good is that without knowing how certain pathogenic bacteria got into your mouth and throat and lungs; and how they managed to thrive; and what they’re doing there; and how your body is coping with them? You cannot gain health literacy – you cannot become an individual who exercises control – without some level of scientific acumen that makes you aware of things like this going on in your body.

Mundane health promotion doesn’t make you aware in that way. It typically doesn’t increase your ability to understand and use scientific information. That privilege is reserved for denizens of the laboratory and clinic. Consumers get to pay the salaries of those professionals, with taxes and co-pays and health insurance. That’s mostly where their role ends, for now.

Taking a new approach, Humaginarium promotes health literacy by helping folks experience and play with science of the human body, so they can discover their own truth and make meaning personal. Few health promoters have inspired regular folks to believe they can do that. Maybe Humaginarium has found a way.

However there’s a problem. Remember what I said about the market for health promotion: there isn’t one. Humaginarium can’t go selling health literacy where nobody is buying it. We’ll have to sell it where customers are likely to show up and pay.

That isn’t in the healthcare industry, which treats health literacy as noise on its fringes. Healthcare rarely addresses or prevents the root causes of ill health, but focuses on treatment and cure. That’s understandable; it’s how companies create shareholder value. As a healthcare executive once said to me: “We’re not interested in wellness; we make money from illness.”

Thus the fringes of healthcare are littered with low-budget crap like self-help books and infomercials. Humaginarium doesn’t like fringes; we want to be the center of attention. So we turn to entertainment, where there is a huge market of individuals seeking to exercise control: the market for commercial video games.

In the video game market we know we can render scientific health information visually and dramatically, without bewildering language. Not to teach but to inspire many individuals with the experience of discovering and controlling healthy choices. First in enjoyable, escapist fantasy chock full of risky adventure; then with the real and persistent challenges of their own body and life.

Scientific entertainment. Male Nude, with Arms Up-Stretched (1828-1830), by William Etty. Pictured with small polymorphic bacteria which cause pneumonia, genital and urinary infections in stressful situations like this one.

Psychoneuroimmunology

Producing outcomes without being a healthcare company.

Humaginarium is not a healthcare company. We’re unlike startups whose therapies heal or cure; also unlike those who manage medical service delivery. Nothing we do for patients requires access to medical records or histories; nothing we deliver to patients requires prescription, clinical control or reimbursement. In fact we rarely think of users as patients at all, but as regular folks.

Likewise Humaginarium doesn’t cater to providers, payers or suppliers of the healthcare industry. We don’t make things for them to buy or ask them to finance what we make for consumers. True, we are working to earn their versions of the Good Housekeeping Seal of approval, but not because it has monetary value. The effort to gain healthcare industry blessing will simply make us a better company.

All of the foregoing seems rather odd and uneconomical positioning for a health tech startup, but hopefully it’s rational. I’ll try to explain.

Humaginarium is an entertainment company. We develop video games and ancillary apps that amuse and inform. We use our programs to educate and empower people; not about everything, of course, but about their bodies and health; in particular about chronic illness they have or risk getting. Why? So they themselves can actually do something about it!

The foregoing category description rests on four functional pillars known as health promotion, health literacy, health education, and health equity. With a difference. Most programming within those pillars is behaviorist. It’s about conditioning: what, how and when to do things in order to become healthier. It’s rarely about learning: why something is and why it can be different.

Humaginarium is all about that why. As artists and educators we know there is only a dotted line between understanding and making a difference in real life. Our project turns those dots into a solid line with an arrow pointing to personal empowerment.

Yet as a high-tech artist and educator, am I certain that Humaginarium won’t heal or cure? I’m really not sure of that, so I don’t claim that it will; but I think it’s possible. Moreover likely.

I say this because I believe, from study and experience, in causal connections between mind and body; between mental and physical. The clinical term for such connections is psychoneuroimmunology (PNI). Everybody experiences PNI throughout their lives, practically every day and certainly when enjoying great entertainment, but science is only beginning to recognize and explain it. Clinicians by and large don’t have a clue. But it’s real.

A palpable example of PNI is the placebo effect, by which perceptions and beliefs improve health outcomes. Peer-reviewed research has proven (beyond any reasonable doubt) that the way people think and feel about themselves and their environment alters the biochemistry of their bodies. In plain English, our state of mind can actually make us well or sick. Everybody knows that, but why is it?

“Theorists propose that stressful events trigger cognitive and affective responses which, in turn, induce sympathetic nervous system and endocrine changes, and these ultimately impair immune function.” Did you get that? So for example, job insecurity or marital difficulty can, and often does, make people literally frail, vulnerable and symptomatic.

But what are job insecurity and marital difficulty? They are types of stress produced by the same thing: a lack of control. The same kind of stress that occurs with chronic illness. You have it, you don’t understand it, you can’t predict it, you can’t avoid it. It feels like a bewildering constant threat, like an asteroid heading towards your personal planet.

As such chronic illness is a self-perpetuating condition. The more fearful and anxious and angry the patient gets, the worse the disease may become. That’s fact, not fiction.

Humaginarium answers that fact with fiction. Literally, with fantasy in which users can face and understand and oppose and overcome illness in their minds. Fantasy of this kind is not merely an escape from reality, it’s an engine for belief in oneself; belief that “I am the master of my fate.”

When discussing PNI in the context of his long medical career, Sherwin Nuland wrote, “The question that remains is how these three major networks – the nervous system, the endocrine system, and the immunologic system – interact and, how, by understanding these interactions in precise quantitative terms, we can learn to predict and control them.”

That question is for scientists including positive psychologists, but not for artists and educators like me. We already know PNI works, though we can’t yet explain the molecular and cellular dynamics. If it works, we want to use it right now, not after decades of clinical trials, for the benefit of folks who have or risk getting a miserable chronic illness.

That is what Humaginarium is doing, and that is why I expect to produce meaningful outcomes without being a healthcare company.