Carnegie Mellon University

Steve Downs INTERSECT@CMU Keynote Address

September 20, 2019

Steve Downs: Health Is Not an App

Noelle Wiker

Intersect@CMU keynote address, "It's Time To Build Health Into the OS," highlighted technologies that can sustain wellness-focused behaviors to promote individual health.

For the second annual INTERSECT@CMU, focused on health care innovation, Carnegie Mellon University invited Steve Downs, Chief Technology and Strategy Officer at the Robert Wood Johnson Foundation, to give a keynote address on how emerging technologies will help re-engineer a culture of health. In his role at the foundation, Downs directs its development of health information technology programs, including Project HealthDesign, the Health e-Technologies Initiative, and Connecting for Health. His presentation, titled "It's Time To Build Health Into the OS," highlighted technologies that can sustain wellness-focused behaviors to promote individual health.

"It's hard to be healthy in the United States. It's hard work. And a lot of that has to do with our lifestyles," he said, referencing socioeconomic factors and cultural norms that foster a lifestyle that is indoor and sedentary and a diet saturated with prepared foods. "The human genome doesn't change this fast. What's changed are the circumstances in which we live," he said.

"We've been changing our environment at a rate that is much faster than our species can evolve."

Downs believes that we need to address these deep, systemic issues in order to overcome Americans' declining health. "Part of the problem is that we treat health like an app," he said. "With the app approach, we leave intact all the fundamentals of everyday life: how we eat, how we sleep, how we move from place to place, how we entertain ourselves. We leave these intact, and then we add a thin layer of wellness on top, and expect that to add up to health."

Instead, he said, we need to infuse health consciousness into the design of the services we use. "We can keep on encouraging people to try harder, but it's not working,' he said. "We have to be much bolder and more radical in our thinking."

Innovations That Promote Health

Downs articulated five behaviors that can help to foster better health: cooking real food, moving around, sleeping, building social connection, and spending time outdoors. He introduced several innovations that, while their primary intention is not necessarily to encourage healthy behaviors, nonetheless nurture such behaviors.

For example, meal kit delivery services like HelloFresh and Blue Apron take away some of the steps involved in cooking food at home, which helps to reduce reliance on fast food and unhealthy prepared foods. Mobile games like Pokémon Go require players to go outside to succeed in the game and motivate players to work together to beat challenges. "It's not about health, but it's shaping everyday life in the direction of health," he said.

"We don't yet know how these and other technologies are going to combine to form the new normal of our everyday lives," he said. "We should embrace health as a core value. We should take a health-positive approach to our technology. We should make it an explicit design goal. We should build it deep into our society's OS."

Steve Downs INTERSECT@CMU Q&A

Design a Healthy World

After his address, Rebecca Doerge, the Glen de Vries Dean of the Mellon College of Science, moderated a question-and-answer session with Downs. She began by asking him for examples of industries — such as fast food — that can be reshaped to support healthy behaviors when that is embedded as a core value.

"If you design a world which makes it hard to be healthy, it's really tough to then start blaming people for not overcoming it."

Downs noted that entertainment companies whose business models rely on encouraging as much screen time as possible are facing backlash for negatively impacting users' health. "When most of your users are behaving in a way that you say is not the intention, then I think the designer has some liability," he said. "If you design a world which makes it hard to be healthy, it's really tough to then start blaming people for not overcoming it."

Downs likened the challenge to that a familiar salmon metaphor: "It's almost as if, when we try to be healthy, we're swimming upstream every day against currents that seemingly are getting stronger and stronger, and our response to this is to tell people to swim harder," he said. But he believes that starting with fundamental changes in our values and in the design of new technologies will go a long way to mitigating those challenges. "If we do that, I think we can reverse the direction of the river."