Why build seriously fun games for health?

The last transition post gathered a lot of interest. I had the joy of responding to friends - old and new, having calls with well-wishers and family, and speaking to mentors and experts in my research interest in Chronic non-communicable diseases. Few did pick up the hint and were curious about the puzzle hidden in the post. Again, thanks for playing along!

 Common themes that emerged during the conversation with multiple people over the past 4 weeks and flowed into research:

One thing that the pandemic did good is - Everyone is purposeful and willed about their health:

Insurance coverage and subscriptions rose, and the market continues to grow, currently at 8.6%, albeit a minor correction but emerging markets especially in Asia led by India continue to grow. The rise in non-standard risks is leading to higher Premiums. Overall, access and coverage with insurance has improved.

The Pandemic fuelled democratization of spoke networks around Pathology lab hubs and VC fuelled growth of App ordered tests has lead to increased overall testing beyond requisitioned testing. Chronic condition testing is improving as well due to an increase in the number of annual preventive exams. Higher testing rates should translate to higher diagnoses and higher rates of people seeking care. That plus the continued growth of Telemedicine should be helping. Not quite - I’ll get to that in a minute.

The rise and rise of wearable sensors led by consumer tech. Smartwatches go way back - 1975 to be precise. For naysayers saying “No way!” Check out the ‘Calcron’ - a wrist-worn calculator which defined the precedent later followed by Seiko and Casio. Arthur C Clarke’s adage comes to mind, now popularly known as his third law - ‘Any sufficiently advanced technology is indistinguishable from magic’. And magic became commonplace beyond hobbyists’ interests post 2014. Computers have moved from the desk - to the lap - to the palm and now resting on wrists. Some have even moved to the finger. In the healthcare context, today’s smartwatches and bands let you record a 2 lead ECG, wirelessly transmit a stream of SpO2, pulse rate, respiratory rate, and with the most divine sensor that MEMS research gave us - accelerometers, track all forms of physical activity. All in all - a classic case of industry-changing pivots where even traditionally analog watchmakers have moved to the digital realm. Take a moment to reflect on how medical-grade sensors have made it to consumer tech.

Forget infections - everyone close to us has some pain or metabolic disease. 

An infallible truth about NCD incidence came from an individual I was interviewing, “I did everything by the book, watched what I eat, stayed active - and there’s no history of this condition in my family, but my diagnosis shook me to my core” Everyone, I re-iterate everyone, has an immediate family member impacted. And everyone has to deal with the diagnosis and sentencing of a chronic condition. Most consults end with the patient’s mindset not gaining acceptance of the humbling fact - “I have the disease, I need to manage it for life.” And it’s not just Mendelian genetics at play, our lifestyle choices are to blame too.

Incidence rates are scary for NCDs, why isn’t the world waking up to act?

In a study across 6 countries evaluating 6 conditions - Angina, arthritis, asthma, chronic lung disease, and hypertension, besides being the single highest risk factor for Ischaemic heart disease, hypertension left the other 5 far behind in comparison when evaluated for undiagnosed prevalence. People walk around ignoring the headaches, the vision changes, and the occasional buzzing in the ear, ignoring these subtle signs. Another study based on the NCD-RisC Collaboration notes a dearth of evidence reported in Africa but reports a startling incidence delta from 1990 to 2019. We have gone from aneroid and mercury sphygmomanometers to digital automated measurements in which patients or individuals suspected of high blood pressure can test themselves, yet as per WHO estimates, 46% of adults with hypertension are still unaware of their condition - almost 1 out of 2 individuals! The same number for Diabetes is 44.7%! One could write lengths about Diabetes, but this article does a fabulous job to explain the statistics and predicted trends. Obesity and chronic pain bear no differences either. For the Stats geeks, the University of Washington maintains a beautiful visual tool called GBD Compare to explore this data with multiple indicators, etiologies and results.

I downloaded a healthcare app, got bored and deleted it. Almost everyone dropped out of a regimen they adopted.

For most of us from the SaaS universe, churn is something we are abundantly familiar with. And digital approaches to healthcare are not spared from the human characteristic of getting bored. Or not finding continuous value. Acceptable SaaS churn rates lie within 4-7%. Most companies are successful in maintaining these rates below 10%. In healthcare, this gets a bit tricky. A systematic review estimated a pooled dropout rate of 43% for clinical trials of digital interventions employed for chronic conditions. Market research estimates of the same arrive at 74% of users dropping out by the 10th use. In Pharmacology and Medicine, we study compliance to drug regimens. But the space of digital interventions for chronic care management and compliance still has room to grow and stabilise.  It is still marred with chaos. The kind of chaos approaching the edge of order which sparks evolution. The kind of opportunity that attracts the eye of an entrepreneur, a capitalist, researchers and policy makers. 

Building in the confines of these constraints

The NCD problem lies not in diagnosis alone, but monitoring and treatment too. Stickiness in healthcare products has always been a sketchy subject. Having worked with brilliant designers in the past, inspired by Karl Kapp’s research and Nir Eyal’s books, my personal thesis on the topic has been to build habit-forming products that stick, giving joy beyond the intended use.

There’s a child in all of us. Can we appeal to that child to leverage hooks that engage users to stay on the regimen? To see the game through and win the boss fight at the end. And in the process deliver better outcomes that supplement drug based regimens to reverse morbidity in chronic conditions. Which is why games! 

Till then, if you are a wearable enthusiast or you’d like to discuss NCDs, would appreciate the conversation, do reach out!

If you’re short on time, and would prefer filling a short survey instead, you could head here: https://forms.gle/7ZBhLjFqAY9FUrgK7