Public Health Games

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Welcome to PublicHealthGames.com, a new community site for discussion of games, simulations, and virtual worlds for public health applications and related topics. This site is sponsored by the Center for the Advancement of Distance Education (CADE) at the University of Illinois at Chicago. Please register for our blog and join in on the discussion. Thanks!

Virtual Reality is a game-changer that has already proven itself and is changing the communications and education landscape faster than almost any technology before it.  Why?  Because it was an obvious next step that science fiction writers and technologists have been imagining for decades.

CADE has built virtual locations and resources to offer any of the following scenarios:

* Emergency Dispensing/Mass Prophylaxis (POD)
* Emergency Treatment Facility
* Emergency Housing Facility
* Pandemic flu
* Small pox outbreak
* Anthrax attack
* Dirty Bomb
* Incendiary Device
* Flood Control and Response
* Natural Disaster ­ hurricane/tornado
* Large Scale Fire
* HAZMAT Spill with Multiple Jurisdictions
* POD Operations with ICS reinforcement
* CBRNE Response Planning
* Hospital Evacuation
* Surge Capacity Response
* Non-traditional Space for Surge Expansion
* Anti-viral Distribution
* Isolation and Quarantine
* Cordon Enforcement
* University or High School conflict resolution and armed assault
* Collaboration: law enforcement, public health, and hospitals
* Jurisdictional Politics and Joint Operations
* SNS Staging Breakdown and Shipping
* SNS Secure Transport
* Handicapped access evaluations using first personalization
* Mass Casualty Procedures

Visit http://www.virtualpublichealth.com or contact cade@uic.edu for more information.

Yesterday, the Robert Wood Johnson Foundation Health Games Research initiative announced their first round grantees (PDF), numbering twelve in all. It looks like a great group of research projects, including evaluating the results from a fascinating sounding blended game called BloomingLife that incorporates both video game and physical world challenges to promote physical fitness at the University of Indiana.

While this entertaining and insightful talk by Daniel Floyd was given in reference  to entertainment games, I think his points about society’s skittishness about sex in video games absolutely has implications for serious games, and especially, serious games related to public health.

While not a public health game per se, I was impressed with Budget Hero, an online game about the challenges of balancing the U.S. federal budget, produced by Marketplace and American Public Media. While keeping game play fairly simple, it does a good job of explaining the complex interplay between budget cuts, spending initiatives, and taxes. What’s more, it allows the player to try and shape a budget to match his or her personal priorities (e.g. health and wellness). Via BoingBoing.

Worlds continue colliding. Just as games have taken their place as advertising delivery mechanisms, public health-themed games have come to the party. And I really do mean “party.” In Frankfort, Germany, men standing at bar urinals have the opportunity for an interactive gaming experience to judge whether or not they may be too drunk to drive. Brilliant. (You can try a web version, even if you aren’t properly, er, equipped.)

For better or worse, though, this experiment came into being because of a need to advertse taxi services, and as such, has been evaluated by the ad industry, but not really examined in a scholarly way. (Or at least, not yet.) The industry rewarded the game with a Clio. But it would be nice to know if the game’s creators have collected any statistics about its success in reducing drunk driving.

(On the other hand, in a University environment, the fact that the game has a certain gender bias might have raised an eyebrow or two.)

(Via MeFi.)

Last weeks New Yorker contained a terrific article about using immersive VR experiences to treat soldiers suffering from Post-Traumatic Stress Disorder (PTSD). Given estimates that 300,000 or more returning vets may suffer from PTSD or major depression, it’s hard not to look upon these combat-related disorders (and related suicide rates) as a major public health concern.

One of my favorite public health blogs, Effect Measure, mostly covers policy and epidemiology topics. But Revere (the nom de blog used by all contributors) has given a fair amount of attention to Second Life in the last couple of years. Today, Revere comments on Spain’s efforts to use Second Life as a youth outreach tool as documented in this Guardian article. This touches on a topic I work on quite a bit, namely the notion that one of public health’s great challenges is to redefine “outreach” to respond to the techical and cultural shifts in media consumption (not to mention media creation). As Revere points out, it’s too soon to say if the Spanish experiment will prove successful, but it’s precisely these kinds of experiments that public health needs to conduct.

The ModSim 2008 conference is coming up in September and presenting sessions on “decision making in complex enviornments using modeling and simulation.” The conference features two tracks relevant to public health issues, Health & Medicine, and Homeland Security, as well as a general Serious Games track. Call for papers here.

Scores of big brains converged April 15 for a glimpse into the future of online social media and virtual reality networks at the MIT Enterprise Forum in Chicago April 15, 2008. Presenters included Kevin Harvey, Assistant Director, CADE; Colleen Monahan, Director CADE (as his trusty sidekick); Scott Stephens, Playboy Online; and Marc Goodman, Marketing Director, Alcatel-Lucentand. Kevin was the only public health speaker in the bunch and had some wise words.  With Virtual Worlds, we may be on the verge of a new paradigm as powerful as the World Wide Web has proven to be. Simulation is a simplified model of reality and is judged by how close it comes to reality. Virtual Worlds is a simulation of persistent space with proxy avatars. Virtual Worlds provide game-like immersion, social functionality, and game-like goals. Virtual Worlds provide a sense of presence with others at the same time and place. Virtual Worlds have jumped the gap from entertainment to military, government, science, education, health and energy industries. New levels of computing capacity, speed, and affordability allow more people to participate in more complex “worlds”, and allow simulation of reality at a new level.

Kevin Harvey talked about the “metaverse,” and showed a video created for BP that describes the concept of the emerging metaverse - linking Virtual Worlds and three-dimensional repositories of data. Using “machinema,” one can create films in the virtual worlds. Games and other simulations create new ways of interacting with 3D “spaces,” e.g. 3D representations of information.

Second Life is setting the standards in technology and terminology for interacting with the “metaverse”.  3D visualization is the new paradigm for digital interaction. The computer moves from being a tool used to manage information to being a “gateway to experience”.

Games for Health has posted a preliminary schedule for their 2008 conference which will be held May 7-9 in Baltimore Maryland. Register here. (Sadly, no tour of locations for The Wire seems to be included.)

A few months ago when we were still deciding whether or not to start this blogging project, I made note of an article about an epidemic simulation recently accomplished using the World of Warcraft virtual world. Like so many of the tiny, yellow sticky notes littering my desk, that one seems to have disappeared somewhere into the ether. Fortunately, Laura Kahn, writing in last month’s Bulletin of the Atomic Scientists, summarizes the experiment neatly.

(As a side note, I’m a long time reader of the Bulletin for reasons too convoluted to recount here. They’ve always covered some public health related subjects, but thanks to Kahn’s column, seem to be placing more emphasis in this area than ever before.)

Here at CADE, we’re using virtual worlds technology like Second Life for a variety of applications: training, exercises, and planning. And in addition to real time Second Life experiences, we’ve also started exploring ways to use Second Life “machinimas” to animate scenarios. Machinimas are essentially movies of things that happen in Second Life.

So, when some of my colleagues heard that the 48-Hour Film Project was sponsoring a machinima-based competition, they jumped at the chance to see what they could do. The result? Zombie Attack, and several awards, including Best Film, Best Special Effects, Best Directing, and quite a few others.

(Think this is a stretch for a public health games blog? Well… )

And it’s not just adolescents who are the subject of groundbreaking Wii-related research. A study conducted at the Banner Good Samaritan Medical Center finds that certain types of Wii games provide an excellent warm-up for surgeons. (Specifically, the credit Marble Mania for improving tool control and overall performance among subjects.)

Also of note, the researchers will present their work at the upcoming Medicine Meets Virtual Reality conference, a meeting that we in this community should probably keep an eye on.

Every year, the British Medical Journal publishes a terrific Christmas issue covering slightly more offbeat topics. Among the treasures in this year’s issue was a study by Graves, et. al. comparing energy expenditure among adolescents playing Wii compared with adolescents playing XBOX 360. Not surprisingly, Wii won out, although of course, the article goes on to note that real exercise is even better.

(I was reminded of this today by a post at The World’s Fair, who adds the comment: “Who funds this kind of stuff, I don’t know.” I might suggest they look at the whole issue to see the spirit in which the study is intended.)

I checked their website this week and was pleased to see that Persuasive Games has released their much anticipated obesity awareness game, Fatworld (one of the winners of the Why Games Matter competition). Windows only at this point, although they claim a Mac version is in the works.

(On a related note, Media Bistro recently published a brief interview with Persuasive’s art director, Nicolas Massi.)

On a whim, after reading the Economist article referred to below, I Googled “augmented reality” and “public health,” and not surprisingly, didn’t score too many relevant hits. But I did run across Outbreak @ MIT, a handheld based AR application from way back in 2004. It’s not an example of the types of sophisticated imaging systems written about in that article, but it definitely tantalizes with possibilities.

This past week, The Economist featured two terrific articles in their Technology Quarterly. First, “Getting Serious” covers virtual worlds like Second Life for training generally, while also giving a nod to some health-relevant applications like a triage simulation. Second, back in first life, “Reality, Only Better” covers augmented reality (AR) solutions, mostly related to practical applications like assistive systems for pilots and surgeons, but also with regard to military and other training applications.

Earlier this month, Changemakers.net and Robert Wood Johnson Foundation announced the winners to their Why Games Matter competition showcasing games related to heath and healthcare. Lots of great examples and ideas, including this one from one of the winners:

Just released in Japan and coming soon to the US and Europe, Nintendo’s Wii Fit takes a soft, games-based approach to health and fitness. But what may be the more interesting development is the bundled ‘balance board’ a new Wii accessory that detects foot movement, weight, and balance. Suddenly a whole bunch of new options for Wii-based simulations open up.

(A few people are starting to use Wii remotes for custom educational simulations, although not with the Wii console itself. For example, this buckyball bowling game requires a Cray XT3; not something most of us have laying around.)

A few short weeks before launching this blog, CADE proudly announced the national availability of The POD Game, a Dispensing and Vaccination Center (DVC) simulation. Players assume various roles and work to answer challenges from the public while keeping the flow of people moving as quickly as possible.

The national rollout of The POD Game is made possible through the generous cooperation of the Chicago Department of Public Health, for whom the game was initially created. If you’re interested in deploying The POD Game in your organization, please visit the game’s web site for more details.

In the future, we’ll write in more detail about projects that CADE and others are doing with Second Life and other virtual worlds platforms. But to give you a taste, here are links to two general sites related to public health applications for virtual world platforms:

Here at CADE, we’ve launched VirtualPublicHealth.com, a site about CADE’s Public Health Preparedness Island in Second Life where you can get information about various projects we’ve undertaken for the Chicago Department of Public Health, the Chicago Project for Violence Prevention, and others.

Meanwhile, the Idaho Bioterrorism Awareness and Preparedness Program has lauched Play2Train, a virtual training space and open content alliance in Second Life specifically supporting Strategic National Stockpile (SNS), Simple Triage Rapid Transportation (START), risk communication, and Incident Command System (ICS) training. (Much more here.)

In a similar vein to some of the earliest examples of public health games, Disaster in Franklin County, built by the Center for Public Health Preparedness (CPHP) at University of Minnesota, takes players through the 30 days immediately following a severe storm. The simulation offers numerous public health roles, and covers issues as diverse as disaster mental health and food safety.

What is especially interesting about this simulation is that the University also uses data from this simulation in its work to evaluate how individuals respond in emergency situations.

Successful participants also qualify for CEUs.

It seems fitting to begin by talking about some of the public health games work CADE and others have done in the past. Three of the earliest examples of public health games are Envirorisk, BioterrorRisk, and Outbreak at Watersedge.

CADE developed EnviroRisk in conjunction with CDC and ASPH. EnviroRisk is a case-based problem-solving simulation in environmental risk assessment and risk communication. Players assume the role of a public health professional going through an assessment process and working with colleagues and the public. Successful participants also qualify for CEUs.

In BioterrorRisk, also developed by CADE, players assume one of three roles, clinician, lab professional, or public health official. Under these roles, players go through a bioterrorism scenario covering aspects of hazard recognition, interagency communication, risk assessment, and risk communication.

Finally, Outbreak at Watersedge, created at the University of Minnesota, offers a terrific early example of an epidemiology simulation. Players investigate an illness in a small town and take steps to stem the epidemic.

With virtual worlds, mobile technologies, and sophisticated game engines, we’ve come a long way in just a few short years. But all of these examples have held up well over time, and all of them are still actively used in public health training and education today.