5 Questions

Health Axioms and Designing for Behavior Change

May 31, 2014          

Episode Summary

In this episode of the Digital Life, we discuss the Health Axioms card deck and designing for behavior change, with Involution Studios Creative Director, Juhan Sonin.

The Health Axioms are 32 recommendations that put you in touch with habits to improve your health, life, and well-being. The sometimes surprising, always practical axioms nudge you toward the healthiest life possible. These are one small part of a global movement to shift the health care system to one of: non-invasive personal diagnostics, highly specialized clinicians that work closely with patients and their families, and self-monitoring, self-empowered patients. Getting there is equal parts smart technology, healthcare reform, and everyday common sense.

Jon:
Welcome to Five Questions. I’m Jon, and today our guest is Juhan Sonin, Creative Director of Involution Studios. He’s going to be talking with us about his Health Axioms card deck and behavior change in health. Welcome Juhan.

Juhan:
Thanks for having me.

Jon:
Tell us, how did you get interested in healthcare design?

Juhan:
Over 10 years ago, I was lucky enough to go to one of these micro-clinics that bigger companies have that you can walk through after lunch. There’s a nurse practitioner and there’s a doctor there, where it’s almost like a Ford factory line — staffers walking through getting their blood drawn. The doctor clinician has their stethoscope and they’re doing these micro little visits with you. I was in my early 30s and I was convinced that my health was spectacular, that I was invincible. And I noticed, coming crashing down back to planet earth, I noticed that my cholesterol was in the stratosphere.

It got me that one variable, getting me more interested in what was happening to me. Because I had no idea what my body was doing and I didn’t have an easy way to look into it to see the trends, to see what was happening with me and several of my colleagues were in the same boat. That was one big variable in getting into the design of health, because it was a moment that I will not forget of just being completely unaware of what my body was doing and then how do you actually see and tell really fascinating stories about it.

Jon:
How did the Health Axioms fit into that scenario?

Juhan:
Since then, I’ve been really involved in design and technology, with the technical components of healthcare design, with building software, designing software. But health usually, believe it or not, is not always about technology. We think it’s about the latest little gadget that you’re wearing, that’s in your pocket, whether it’s the iWatch or whatever. But really, it’s about old fashioned behavior.

When you think about, when you’re sitting down at the dinner table on Sunday nights — hopefully many more nights than just that — but you’re eating your green peas, your kale chips or whatever, fish, maybe tofu, instead of the red meat. It’s like your mother or what your grandmother used to say about “Saying please and thank you”, “Going outside to play”. And I tell my kids that, “Go the hell out of the house. Do something outside. Wear your sun block. Eat your veggies, and then maybe grab a few fresh herbs from the garden.”

I think that’s where the Health Axioms fit it. It’s a deck of cards that help people cut through the BS and focus on clear actionable advice that will hopefully have impact on how we interact with the healthcare system and our bodies. That’s the one liner of what they are. Each card has a single idea on it. One specific behavior that we should concentrate on like “Move more“, or “Get more sleep”, “Take baby steps”, “Exercise is medicine”, “Food is medicine”.

These are fairly easy to grok ideas and on the back are these easy to follow highlights. And they are outlined in practical actions, which will hopefully increase the quality of your life and your health. On the front, the design of these card I think are really quite elegant. They’re these graphical examples, trying to use a visual story to communicate something about your well being. And that’s what I’m really proud of, is how elegant and beautiful they are and I think they’re really resonating with people.

Jon:
What’s the reaction been when people, or clinicians, or nurses when they first take a look at this deck? How are they using them and what’s their reaction?

Juhan:
The initial reaction when you open up the deck is that they’re really beautifully illustrated concepts. They should be easy to understand and easy to learn and some are easier to share than others because of the content maybe a little bit dicey. Talking about death, for instance is not something that’s an easy thing for people to do. The reaction in general has been “Wow, these are beautiful.” When I’m looking through them, people looking through them. Again you need to do more of that. I need to walk a little bit more. Exercise is medicine. I should be eating a little more green than I do now.

I should be more involved in understanding my body and understanding the metrics in which … I should be more involved in understanding my body and the particular readings of what’s happening with my biology and me. What I think is interesting, from the clinical side, is what clinicians and doctors now are using. We only have three clinicians who are prototyping them in their hospital settings with real patients, with real humans using them. There are natural subpacks that are forming, several packs — One for pre-type 2 diabetics that have a handful of cards, just four, or five, or six cards. I think that’s easier for people to lock onto as well. Thirty-two or forty cards is a lot for me even to handle and I’m the one who’s part of the crew here making these things.

Just having a few key concepts to follow that I can remember, that I can put on my wall of my house or like I do with my kids. I put two of them, “Wash your hands” and “Don’t rush the brush”, in my bathroom mirror so that my two boys at home can always see those when they’re going to the bathroom and brushing their teeth. It’s these graphic reminders that are integrated into their lives, not just on a screen somewhere that you can hide in your pocket.

Getting back to the clinician’s part, is they’re handing out maybe four or five of them or two of them, almost as prescriptions. Here, remember to do these three things. So that when you leave the office, it’s not just this “Oh yeah, let me remember what my doctor told me to do, or what the nutritionist told me to concentrate on.” It’s now I have these physical micro flash cards that I can put in my purse. I can put in my wallet wherever I want to put my card at home to really help me get that slight change in my life going. This is not going to be the only thing that’s going to modify your behavior. That takes a lot of different things. I think this is a really good reminder system in order to get your brain and life and body in the right place.

Jon:
Designing for behavior change is the holy grail of healthcare design. If you can encourage people to change, how they are interacting with their food, their meds, their exercise, health as an ecosystem in which they are living as part of their life, that’s what accountable care organizations want to do. That’s what on a broad scale the US Health and Human Services, that’s what they want to do. This is an amazing goal that we’re trying to achieve. I see in these Health Axioms the germination of an idea around behavior change for health in more systemic way for people and I just wanted to understand better how you saw people changing their behavior while using these cards.

Juhan:
Roni Zeiger who’s a medical doctor and he’s the former chief health strategist at Google and is also the cofounder of Smart Patients. He said something about the cards which I think may get to part of answering that, which is he said, “We need to prescribe these simple beautiful recipes for health through our patients and our loved ones.” What I like about that a lot is that he’s in essence talking about changing your health habits. How do we start to change those?

One mechanism is for clinicians to help you through that in your care team. Whether it’s your dietician, whether it’s your nutritionist, whether it’s your nurse that you go and get your BP done at Target or at the Minute Clinic or whatever it is. Whether it’s your clinician, your OB or my GP and I go in for my yearly or every 6 months visits with them my encounter with them that they give me a prescription as part of this as what things do I need to change in my behavior and then I take them home and the Health Axioms themselves I think you can use in a very tangible way because they are ink in papyrus on pulp where you can have them on your body and have them littered in your house potentially or where you work and have on my laptop get more sleep because it’s easy to fall into that trap.

There are lots of different mechanisms not just the Health Axioms in order to change behavior. You need to do lots of small things in order to change how you eat. For instance, it’s easy to think, in theory about, I should eat less sugar. I should put down that muffin. That is very easy to think about in the abstract but doing it when you’re hungry is a hell of a lot harder. Health axioms are just 1 thing of many solutions in order to help you steer you towards a healthier habit. You need your spouse, your kids to be involved in this and also as a support group to help you through this. I know it sounds clunky but I think with other people in the network around you pushing and pulling you to change your habits, you’re not going to do it.

Think about what we’ve done at the studio in trying to change everyone’s eating habits. We had someone work with us for 8 months on what is a healthier lunch. Taking out all the soda and Coke and Diet Cokes and sugar snacks that we had in the kitchen and replacing them with more green things. While we had a physical card says “Eat less”, “Eat things that are more green”. It also takes other kind of crowbars in your life to change your behavior.

Jon:
I like that. I also like the cultural component that I’m seeing in these cards, that this is, in addition to being mom’s recommendation from our childhood made into a card deck, there’s also this culture jam based on some best health practices with scientific basis that had bubbled into these cards. Now the cultural aspect of it fascinates me because as a culture Americans have a lot of things that are unhealthy for us. We all know what those are being sedentary, maybe eating lots of fatty foods, etc. etc. but there is a cultural element here that I very much enjoy and I don’t know what your thoughts are on that or if that was an active piece that you took into consideration during the design process if you can tell us about that.

Juhan:
I’m trying to think of a short succinct answer for that. Look at the culture of losing weight in this country. We all are obsessed with how we … Look at the attention that losing weight has in this country. I think we obsess sometimes about it. Hell, I think United States spends $50 billion on it every year just on that function alone. How do I lose another pound, another 5 pounds and yet we get heavier every year. It’s diminishing our insurance business. I think that when you consider all the money that we spend on behavior change, it’s probably closer to $300 billion. It could be probably a lot more depending on how you create that equation.

That tells you how much attention we put to it, that we spend on changing our behavior every year and we probably don’t do a very good job in executing against it. I don’t know what the particular golden bullet is. I think this is 1 out of many. I think the Health Axioms are really these beautifully simple way to remind us to make smart choices and choose healthy habits. That ultimately is what the Health Axioms are starting to do.

Jon:
Tell me a little bit about where the project is going. What is the future of it? I know that you’ve sent out packs to lots of people and I know that we’ve got interest from medicine acts for instance and that new cards will be coming but why don’t you tell us a little bit about that.

Juhan:
I’ve been rather promiscuous in who and how many I’ve sent out partially because you need to spread the word organically to people who you think may be able to spread for you and pass out decks to their friends. Where’s it going next? We’re only in beginning of week 13 of their existence. We’ve already identified from clinician feedback, from patient feedback about a handful of new cards from “Meet you eats”, who’s the person farming and growing the food that you are eating, to “Avoid sunburns”, pretty straightforward advice to get your shots on time when you’re a child, hopefully. “Donate your data to science” that in particular was for the Personal Genome Project and American Gut Project and all these fantastic research projects that are trying to get people to donate their health data whether it’s their genome, their biome, and other about them to science or the Resilience Project at Mt. Sinai. All these projects really are relying on humans to donate data about themselves in order to find interesting things back. And then “Food is medicine”.

We have about a handful of new cards coming out in the fall and then we’re also working with clinicians and their micro clinics and clinics on how can we integrate these Health Axioms and the artwork into the actual, physical clinic itself. Are these 2 x lifetime on a wall when you walk in and they’re 15 feet tall and there are three axioms like a mural there, that people can really walk on to and they’re also beautiful. There’s also even another play that we’re investigating with MIT’s environmental health department, where there are probably the same number of core axioms for what’s happening on the planet and in climate change and how we can affect that and that’s something they’re also considering right now is that maybe a next deck as well.

Jon:
We’re really excited to see where the Health Axioms go and thank you so much for coming on the show to talk about it.

Juhan:
It’s been a blast.

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