The Development of a Gamified System for Health Activism as a Graduate Student Project

Introduction

Health activism is action on behalf of health-related causes that goes above and beyond the norm (Martin, 2007), often challenging those perceived as responsible for social injustice or health inequality in the process. Obstacles that health activists face include individualism, unsupportive political environments, and commercial and corporate interests (Laverack, 2012). The need for health activism today is obvious. Structural strains such as food deserts (Walker, Keane, & Burke, 2010) and long work hours (Virtanen et al., 2012) intersect with personal health behaviors such as lack of exercise to act against healthy lifestyle choices and outcomes, leading to escalating rates of chronic diseases and conditions, including heart disease, obesity, and diabetes (Centers for Disease Control and Prevention [CDC], 2015). Additionally, these factors intersect with other social structures. For example, governments play a key role in protecting public health and safety (Frieden, 2013) through programs like implementing city-wide nutrition standards (Lederer, Curtis, Silver, & Angell, 2014) and mandating that fast food menus show calorie information (Dumanovsky, Huang, Bassett, & Silver, 2010). Such top-down approaches to health promotion aim to uniformly benefit large numbers of people, although the national data highlighting significant health disparities and inequalities among race, class, and other groups indicate that many are left out (CDC, 2013). Other people object to top-down approaches on philosophical grounds by arguing against perceived government intrusion in their lives and liberties (Harsayani, 2007). Purveyors of unhealthy food products employ flavorists to maximize consumers’ favorable responses to artificial tastes and smells (Schlosser, 2001), and fast food advertising all but ensures that people, especially kids, develop a relationship to the food and the companies selling it. Fast food restaurants spent $4.6 billion on advertising in 2012, almost half of that specifically targeting children, while in the same year McDonald’s demonstrated its market dominance by spending 2.7 times as much to advertise its products than all bottled water, milk, fruit, and vegetable advertisers combined (Yale Rudd Center, 2013). It is no wonder that changing people’s health behaviors is hard; they experience structural inequalities, exhibit individual resistance, and face the challenge of shrugging off corporate socialization efforts, not to mention the fact that, to many, unhealthy food tastes good and routine is easy, even preferable to change. The point: top-down approaches to health promotion are confronted with opposition due to various factors and face the difficulties inherent in employing blanket solutions. Top-down approaches are typically divorced from everyday health activism.

Bottom-up approaches to attitudinal and behavioral health change are more closely intertwined with health activism in forms similar to grassroots environmentalism (see Bullard, 1993, 2000). These “people-centered” (Biehl & Petryna, 2013) approaches are positioned to avoid top-down pitfalls and can subvert the interests of oppositional corporate and political voices on local levels (Zoller, 2005). Additionally, innovative approaches to effecting health change are likely to be developed from the bottom up because bottom-up innovation is often apart from or in direct opposition to the dominant healthcare culture. To the extent that innovative ideas are perceived as threats by the dominant health, political, financial, or other institutional culture, they are unlikely to receive funding or attention, pushing them further away from the mainstream and toward the local level (Bergman, Markusson, Connor, Middlemiss, & Ricci, 2010), where they are more likely to become embedded in people’s everyday lives.