Stanford professor Sara Singer and I have a new paper out in the American Journal of Health Promotion that makes the case for treating the “product environment,” meaning the products and services that people interact with regularly, as an important driver of health because of its collective influence on people’s health behaviors. The ‘Product Environment’ is an Important Driver of Health. It’s Time to Measure It discusses how the long history of technology, from electric lights and automobiles to social media and smartphones, has created an environment that has changed everyday behaviors and norms.
To shift the product environment in a more health-positive direction, we need to be able to measure the influences of specific products and services on user behavior. In the paper, we introduce the Building H Index. We developed the Index at my organization, Building H, as an early example of an approach that demonstrates the possibility of such measurement.
What is Building H?
Thomas Goetz, a journalist and entrepreneur, and I co-founded Building H, now a project of the Public Health Institute, to focus on this issue of the product environment. Our thesis is that the products and services of everyday life – in industries such as entertainment, food, housing, and transportation – have collectively made it hard to be healthy. Unless we can shift this environment in a more health-positive direction, the chronic disease epidemic will continue. Bringing about such a shift – where companies prioritize the development of products and services that encourage and facilitate healthy eating, physical activity, good sleep and other healthy behaviors – is a massive undertaking. We wanted to start with something very immediate and concrete. The Building H Index rates and ranks many of the popular products and services that form the product environment on the influences they have on five health behaviors (including physical activity) of their users. The 2022 Index rated and ranked 37 products/services from companies like Apple, Google, Amazon, Netflix, Uber, DoorDash and McDonald’s.
Why is this approach useful?
In the paper, Sara and I offer two key ideas. The first is to see the constellation of products and services across several industries holistically as an overall environment that can be addressed as a whole. The second is that products should be accountable, not just for crossing a line that represents extreme harm, but also for their contribution to an overall influence on behavior. The first point reflects the reality that the causes of a population shift in health behavior, such as increasing levels of sedentary behavior, are widely distributed. It is not the fault of a single company but the aggregate of their interacting influences and associated public policies (e.g. around parking and land use) that create environments, culture and norms. Nor are the impacts of those companies’ products restricted to one behavior such as physical activity. The second point – to make the contributions of individual products count – starts to address the issue of aggregate impact. Importantly, it also roots accountability with specific companies for specific products.
Our work at Building H aims at both a high, conceptual level and at a more granular level. We seek a reimagination of how companies across industries can be held accountable for the health influences of their products. We also seek to engage companies in the specifics of how their products affect the health of their users. And we’re seeing impact at that level: a number of the companies we profiled for the 2022 Index have adopted some of the feature changes we recommended.
How does this tie to physical activity policy research?
We see the Building H Index, along with work that builds off of it, as an opportunity to apply research findings and generate new research questions. The Index relies on research findings to develop its assessments. For example, how shared scooter trips displace both automobile trips and walking trips factors into how we assess the influence of micro-mobility services. It offers additional opportunities to put that research into practice. And by focusing on specific products (e.g. Netflix) or product categories (e.g. video entertainment) or even design features (e.g. auto-playing the next episode), we raise questions about what we don’t yet know and what research is needed to inform these assessments. Beyond the current Building H Index, we’re looking into how to estimate the societal costs associated with influences of selected products. This work raises interesting research questions about calculating the marginal benefits and costs of more (or less) physical activity.
How can I get involved?
Building H is working on the next edition of the Building H Index, which will expand to more than 75 products and include new analyses of social media, video and computer games, and automobiles and bicycles. A key part of the methodology is a crowd-rating process. Volunteers with health backgrounds review the analyses of the influences products have on each of the behaviors and then score those influences on a numerical scale. Building H is recruiting 200 volunteers to participate in this process. The task takes approximately 20-30 minutes and will take place in October and November. It’s quick, it’s fun, and it’s an interesting opportunity to see the methodology and explore the connections between everyday products and health behavior. It might even inspire some new research questions!
More details and the signup form are here.
Steve Downs presented about the Building H Index on the October 2022 PAPREN Network call. You can access the presentation here.
