Building H #87: Mindset Games

Back in April, our commentary focused on the Commercial Determinants of Health, a new way of understanding the roles that businesses in different industries play in influencing a population’s health. The commentary was triggered by a series of papers from The Lancet that lay out the conceptual frameworks for the idea. More recently, we were struck by a new commentary in JAMA that looks at the US health care industry through the lens of commercial determinants. In Understanding the US Health Care Industry as a Commercial Determinant of Health, Sandro Galea and May van Schalkwyk outline four health care industry practices that undermine public health goals: political practices (i.e. lobbying); preference shaping; legal and extralegal environment (e.g. resisting certain payment systems, mergers and acquisitions); and product generation and promotion (e.g. generating demand for pharmaceuticals).

The discussion of “preference shaping” was most interesting because it works at the level of societal mindset. Galea and van Schalkwyk note how the health care industry promotes a “medicalized view of health” that frames health as an individual issue that revolves around the consumption of health care treatments:

“Even though modern health care brings unprecedented benefits, the promotion of pharmacological and other individualized interventions entrenches a medicalized view of health that can undermine efforts to promote public health and equity. This perspective favors many industries, such as the tobacco, alcohol, firearm, and automobile industries, which benefit from framing health as a matter of personal responsibility. It also serves the interests of the health care industry, which profits from providing care to individuals for preventable health problems created by harmful products.”

It’s an important critique and it captures the systemic effects of often unspoken, implicit values or mental models of how health is achieved and who it’s for. And a reminder that those mental models have been built over time in part because of the business interests that they serve.

We’d love to hear your thoughts on this issue. Comments are open.

Help us build the next Building H Index!

Our own contribution to the illumination of the Commercial Determinants of Health is the Building H Index, which rates and ranks the influences of popular products and services on the health behaviors of their users. The 2022 Index got terrific coverage from Fast Company and some companies are already changing. Instacart, a company we engaged with as part of our process, announced a big commitment to health last fall. In our report, we made a big deal about the negative effects of autoplay in video streaming services like Netflix and Hulu. At that time, only Hulu allowed users to turn autoplay off in settings – now virtually all services include that capability.

We’re in full swing on our effort to produce the next edition of the Building H Index. We have ambitious goals: we’re doubling the number of products and services analyzed to 75 and we’re adding new product categories, including social media platforms and video games. We’ve got a team of terrific MPH students from USC hard at work on product analyses. And, with some funding from Einhorn Collaborative, we’ll gather insights from consumer surveys about use of social media, games, cars and bikes that will inform our analyses.

To get all this done, we will need up to 200 volunteers – who have backgrounds in public health, health care or health policy – to review profiles of services like YouTube, Netflix, DoorDash and Uber and score them on the size of their influences on different health behaviors. It’s a light lift – people that volunteered on the last Index reported that it took between 20 and 30 minutes. Based on our current schedule, we’ll send out profiles for review in October and November. Please sign up here and please help us recruit by forwarding this email to at least two other people. Thank you!

Threads!

Finally, we’re not sure how good Threads, the new Twitter competitor (clone?) from Instagram, will ultimately be for people’s health, but in the meantime, we’ve established a presence there and we’re finding a lot of good public health, design and tech accounts to follow. Also a reminder that you can still find us on Twitter, Instagram and LinkedIn.

Read the full newsletter.