The modern world, and the products we use everyday, are making us sick. But what if we could shift this trend and start to build health into everyday life? That’s exactly what Steve Downs and Thomas Goetz, co-founders of Building H, are working on. Steve, the former CTO of the Robert Wood Johnson Foundation, joins us to discuss how Building H is helping companies and designers re-engineer products and “product environments” so they improve rather than harm health.  

We discuss:

• Shocking trends in American health: 48% of Americans are lonely, 35% dont get six hours a night of sleep and 60% of adult calories come from ultra-processed food.
• The mistake of thinking of our daily choices as “individual” decisions, when these decisions are profoundly shaped by our environments and the products we use.
• The Building H Index, which evaluates everyday products against five metrics of health: eating, physical activity, sleep, social connection, and spending time outdoors.
• Culdesac - A real-estate developer that is building “cities for people without cars”.

Steve asks how we could broaden consumer product regulation to focus on broad health impacts, not just safety:

"McDonald's is not responsible for all the food related chronic illnesses in America. But you might argue that they are, I don't know, 1.7%, responsible or 3.8% responsible …  I think we ultimately need to get to a place where if your product is leading to unhealthy behaviors, which is leading to illness and disease and cost, there may need to be some accountability for that." 

Relevant Links

Building H website

Building H Index

AJHP paper on the product environment

Daniel Lieberman’s book on the history of the human body (no affiliate fee taken)

Culdesac website

HBS Impact-weighted accounts

International Foundation for Valuing Impact

ANNOUNCEMENT: Building H is seeking volunteers with a background in public health, healthcare or health policy to help build the Building H Index by rating products and services on their health impacts. If you’re interested in participating in a short scoring exercise, please go to this site for details and sign up https://www.buildingh.org/index/volunteer-signup 

About Our Guest

Steve Downs works at Building H as a co-founder. Prior to his role at Building H, Steve was the chief technology and strategy officer at Robert Wood Johnson Foundation (RWJF) where he led a transformation of the Foundation’s practice of program strategy, putting in place an approach that is highly flexible and adaptive. Over his career at RWJF, Steve held a variety of management roles — including chief technology and information officer, assistant vice president of the health group, and founding leader of the foundation’s innovation portfolio — while also funding and working directly with a broad portfolio of innovators at the intersection of tech and health. Downs is a lecturer at the Hasso Plattner Institute of Design (d.school) at Stanford University and adjunct faculty at the Interactive Telecommunications Program at NYU.

Connect With Us

For more information on The Other 80 please visit our website - www.theother80.com. To connect with our team, please email [email protected] and follow us on twitter @claudiawilliams and LinkedIn.

Summary

Steve Downs discusses his work as CTO and Chief Strategy Officer at the Robert Wood Johnson Foundation. (02:00)

• Claudia Williams and Steve talk about his work at the Robert Wood Johnson Foundation where he helped develop their strategy and grantmaking approach around building a “culture of health”..

Trying to be healthy in the modern world is like swimming upstream against strong currents. (05:58)

• Humans, who evolved as hunter-gatherers, are not well-suited for modern and sedentary life, leading to the rapid recent uptick in chronic diseases.
• We highlight the gradual erosion of healthy behaviors (diet, physical activity, sleep, social interaction) in parallel with the rise of chronic conditions.

The Building H Index measures the health impact of everyday products and services. (10:36)

• Steve and a team of experts developed a project – the Building H index – to assess the health impact of everyday products and services, starting with 37 major products and services and expanding to 75 in a new iteration.
• The team aims to use a Health Impact Assessment framework to evaluate the potential health effects of the products and services we use everyday.

Products can have negative (or positive) impact on a surprisingly broad range of health behaviors. (12:40)

• For instance, consuming fast food has a negative impact on nutrition but also on sleep, social interaction, physical activity and time spent outdoors.
• The Building H team aims to get companies to recognize their influence on health behaviors and work towards creating healthier products and experiences.

Laying the groundwork for different approaches to product regulation. (14:08)

• Steve discusses how consumer product regulation could consider the aggregate of product influences, rather than just safety.
• He argues that companies should be held accountable for the externalities of their products on people's health, such as obesity and related illnesses.
• Steve suggests that measuring and internalizing these externalities could lead to different forms of regulation.
• Researchers at Harvard Business School are developing a framework for corporate financial statements that quantify a company's social impact in dollars and cents.

How have companies reacted to the Building H index? (19:55)

• Some companies are eager to engage in conversations about product changes they could make to make them healthier. But that reaction is not universal.
• Some companies are curious, engaged, and want to improve, while others are indifferent or unresponsive.
• Steve highlights the constructive nature of the assessment, which is akin to a free product consultancy with actionable suggestions for product changes that could lead to a more positive impact on health.

Could this lead to voluntary agreements across companies? (23:34)

• Companies could work collaboratively to avoid harmful practices like autoplay in video streaming services.

Culdesac – a company building a car-free community in Arizona – won the top score on the 2022 Building H index. (25:41)

• Culdesac is building a car-free community in Tempe, Arizona, with shared bikes and scooters, lots of social spaces, and a grocery store. Many people want to live in an environment that supports and promotes healthier and more green choices.

Moving beyond a model of behavior change based on individual choice. (27:38)

• We discuss how individual agency and choice is not always a useful way to think about health behaviors given the enormous influence from how the products we use and the environments we live in are designed.
• Steve: "If you tilt the playing field in a certain direction, the balls are gonna roll to one side."
• Steve suggests reimagining entertainment beyond screens and couches, envisioning a future where it's more physical, social, and outdoors.
• Building H is collaborating with the University of Washington's Department of Human Centered Design and Engineering to explore speculative design projects.

How can universities and schools of public health be more impactful in creating the conditions of health in America? (33:30)

• Steve urges schools of public health to jump on this issue of the "product environment" since it is an underexplored topic for research and action. We need more research and measurement around the impact of product features on health behaviors. We also need more people to do research that is an input for an action, application or policy change that will influence health.