Health in design

People think design is just about aesthetics but it is also about problem solving. Architects solve problems of occupancy, environment, lighting and more in a building; graphic designers are expected to resolve a problem of communication; and furniture designers often design for a person’s comfort and health, for example ergonomic chairs.

Speaking to Business Day, Vessel Health Communications' systems designer, Ayodhya Ouditt, explained that, in a similar way, his company worked on behaviour change design in healthcare systems to help people make better health choices, thereby saving lives and money.

The company, a behavioural change think tank, was started by Ouditt and his uncle, Vessel’s creative strategist, Steve Ouditt, in 2016.

Steve is an artist with a long career of functional design. He studied the works of designer and former professor of cognitive science, Donald “Don” Norman, after reading the works of Hungarian-born artist György Kepes. His interest in the topic showed in his 2013 exhibition, Proceeds to Mental Health.

“Kepes and others researched the way human society worked and came to the conclusion that non-communicable diseases (NCD) were basically a result of poor design of our technological environment... What we are doing at Vessel is just an evolution of that.”

Among other things, Ayodhya Ouditt studied design for social change at the Rhode Island School of Design. “Design for social change dovetails very closely with design for behaviour change because you can’t have social change without understanding how to change human behaviour.”

The project, which became his thesis, dealt with designing new medical systems to address hand hygiene in hospitals. It was very successful and it launched his interest in behaviour change in the medical field.

“Design is inextricably linked to psychology. It is executed based on an understanding of what people like, what they find attractive, and how people work... Designs for behaviour change takes the principles of behavioural economics, a field in psychology which deals with how people make decisions, and we apply that to the design process.”

BEHAVIOURAL ECONOMICS

There are several aspects of behavioural economics that advertising agencies, businesses, and others use to their benefit. These things, he said, could be applied to our health system.

One such aspect was the power of default. “People will always default to what is easily accessible or readily available around them. It’s a very fancy way of saying that humans’ brains are quite lazy because we are built to save energy. That’s why opt out systems work really well for keeping people in.”

Ouditt gave the example of subscription websites. He said these websites were usually built in such a way that it was easy to sign up but finding how to stop the subscription was more difficult. Since people were generally lazy and preferred to just leave things as they are, at the end of the subscription period it automatically rolls over to the next time period and takes your money.

Cognitive load and heuristics were other relevant factors in behavioural economics.

He said cognitive load relates to the amount of information that working memory could hold at any one time. Unnecessary stresses may prevent people from keeping important things in mind so they did not have the mental space to think rationally.

This could be applied to busy parents, or individuals tired after a hard day at work. Even though they know it is healthier, at that point they may not want to go home to cook so they buy fast foods.

Then there were heuristics. He explained that humans usually made decisions and formed judgements on inherent rules and guidelines in the brain. This basically means when people do not have the time to consider all the details of a decision, they use shortcuts, or heuristics, to skip the hard thinking and come to a decision.

“Understanding that our context and our environment is what drives our health decisions, is the fundamental principle behind Vessel. Some of that is an individual’s education level but most of it is where we are, what we are doing, who is around us, the influences in our life, they type of job we have, the hours we are working, how tired we are, the crime level in society... all these and other factors influences a person’s decisions.”

He said each individual had to take responsibility for their own health but as a population, if most people were making the same mistakes, then there was a common underlying problem. He said it was not enough to tell someone they should do something. Instead, a more empathetic understanding of how people made decisions needed to be developed. Behavioural designers studied such things and apply it to their work.

HEALTH APPLICATION

Ouditt noted that some Scandinavian countries, made organ donations an “opt out” system that was linked to individuals drivers licences. On receiving a driver’s license, the person was notified that they were automatically signed up to be an organ donor. They would also receive a form that would allow the driver to opt out of being an organ donor.

“But most people, just because we don’t like filling out forms, won’t opt out of it. They don’t really care because they will be dead anyway, but when they used to ask people to sign up to be organ donors, they had much much lower rates of compliance.”

In TT, he said, the Heath Ministry was using the informational model to address rising obesity rates. He said it was hanging posters encouraging students to eat healthy, or using jingles followed by a narrator giving advice.

He said Vessel did not believe the ministry was taking the right approach to dealing with lifestyle diseases as that traditional method assumed people were rational and based decisions on information. “There is no comparison between a bunch of words telling me what I should eat, and a burger, roti, or chocolate in front of the average child.”

He believed redesigning the school cafeteria would help. He suggested placing the healthier foods to the front of the display and making them attractive. He said simply because the healthy food was in front of people and it looked good, many would pick it.

“This isn’t going to eliminate people’s consumption of junk food in one go. It is going to make the healthy food a lot more inviting to people, a lot more immediately available in their mind, and once it is already in their mind, a lot more people will pick the healthy food.”

He pointed out that groceries did that all the time. They placed snack items by the cashiers because they know that while people were waiting in line they would pick up what was in front of them.

Vessel, he said, worked primarily in public health, specifically on NCDs and lifestyle diseases. “What we follow is the ecological model of health which says individual and population health is the result of everything around in their environment.”

For example, if someone lived near a farm there was a high risk of water and soil contamination; those living in a city with bad air quality had a high probability of developing lung cancer; and people living below the poverty line or in areas with a lack of mental health facilities were prone to substance abuse.

“What people don’t recognise is that the majority of an individual’s health problems in the western world right now are driven by population factors. There is a generally accepted diet that most people follow. That means almost everywhere that food is readily available it’s going to be too high in fat, too high in salt, too meaty, etc. Those are population factors and they drive individual health.”

He added that there was no way to deal with the individual unless someone like a fitness trainer, doctor, or lifestyle coach spoke to someone personally.