This White paper is intended to stimulate discussion and understanding of the role of gamification strategies and enabling technologies as they can be applied to healthcare and public health policies. It argues that society is on the cusp of a revolution in public health strategies brought about by the combination of serious resource constraints, demographic health time-bombs, artificial intelligence developments, wearable sensor devices and unprecedented access to knowledge acquisition and publishing. It illustrates how knowledge professionals in every sector of society have been impacted by Web 2.0 and the emergence of the “Prosumer” phenomenon and explains some of the challenges to be faced now and in the future by health specialists and policy makers. The paper offers some solutions and enabling technologies that can support the development of gamification skills and strategies to the benefit of future public health policies and outlines the benefits of adopting best practice ethical gamification strategies for the individual and the organisation.

1. GAMIFICATION FOR HEALTH
WHITE PAPER
Addressing Global Health Challenges
by Gamification and Enabling
Technologies
Gamification is a process designed to shape the world (achieve
goals/objectives) by influencing the actions, behaviours,
characteristics and state of entities within the world (through
the use of games strategies and/or enabling technologies)
3/5/2014

2. GAMIFICATION FOR HEALTH WHITE PAPER
Addressing Global Health Challenges by Gamification and Enabling Technologies
Gamification is a process designed to shape the world (achieve goals/objectives) by influencing the
actions, behaviours, characteristics and state of entities within the world (through the use of games
strategies and/or enabling technologies)
Executive Overview
This White paper is intended to stimulate discussion and understanding of the role of gamification
strategies and enabling technologies as they can be applied to healthcare and public health policies. It
argues that society is on the cusp of a revolution in public health strategies brought about by the
combination of serious resource constraints, demographic health time-bombs, artificial intelligence
developments, wearable sensor devices and unprecedented access to knowledge acquisition and
publishing. It illustrates how knowledge professionals in every sector of society have been impacted by
Web 2.0 and the emergence of the “Prosumer” phenomenon and explains some of the challenges to be
faced now and in the future by health specialists and policy makers.
The paper offers some solutions and enabling technologies that can support the development of
gamification skills and strategies to the benefit of future public health policies and outlines the benefits of
adopting best practice ethical gamification strategies for the individual and the organisation.
Introduction and Background
The last half century has seen unprecedented technological advances that have impacted daily life that
would have been difficult to imagine in the aftermath of World War II. The baby boomer generation
entered a world where society was based around hierarchical structures in which “Knowledge was Power”
and knowledge, skills and experience were critical factors in both public and private sectors, forming the
bedrock of our relationships and dependencies. In the health sector, we relied on the years of training and
specialist skills of GPs, Consultants and Surgeons to diagnose and treat our conditions and their status in
society and remuneration was a reflection of our dependence on and respect for this expertise.
This situation is rapidly changing, not just in healthcare but also in every aspect of society where the role
and value of the knowledge professional is undergoing a massive revolution. The consequences of these
changes are rippling through society in commerce where strong brands like Virgin can transfer their values
and expertise from Record Sales to Airlines and Banks where they had no previous presence or expertise
and in education where teachers are no longer the subject matter experts delivering existing knowledge
but are rapidly becoming coaches, mentors and facilitators, brokering relationships between individual
students, their peers and sources of knowledge.
The same phenomenon is happening in healthcare where not only is it impossible for health professionals
to keep track of rapidly changing healthcare options but these professionals also face growing competition
from alternative sources of healthcare and treatment outside traditional practices (See Figure 1). At the
same time, especially in the developed world, we are facing serious global health challenges that arise from
greater life expectancy and modern lifestyles.

3. As a global society, we have the expectation that
because we have contributed at least a portion of
our income towards financing healthcare provision
either in taxes or insurance payments, we can
expect any health problems we might have to be
taken care of, regardless of whether our lifestyle
choices have contributed to those health
problems.
What is Gamification ?
The words "Game" and "Player" are embedded
into our everyday vocabulary with meanings that
go far beyond the context of sports or
entertainment. We speak of people being in "the
Insurance game", people playing "mind games"
and use the descriptive noun to describe someone
as a "Major Player". The use of the words in these
contexts is an implicit assumption that being a
player means having some influence or control.
Sadly, the perception of being a "player" or playing
"mind games" is all too often seen as being a
negative influence, using manipulation of
behaviour for selfish or unethical purposes, but
the fact is that success in achieving any objective
necessitates influencing the actions, behaviours,
opinions, attitudes and motivation of other human
beings. Whether consciously or unconsciously,
everyone uses games strategies to manage their
lives. Parents use game strategies to persuade children to eat food or be quiet, husbands, wives and lovers
use games strategies to attract and bond with their partners and politicians use games strategies to get
support etc.
“Reality – The Worst Game Ever”
In fact, our whole lives and our existence can be regarded as a massive multiplayer complex online game in
which we constantly use Gamification and games strategies to manage our world on a daily basis.
Therefore the ability to consciously or unconsciously use games strategies to achieve goals and objectives is
an essential part of everyday life.
Figure 1 Tesco Healthcare

4. Gamification is related to but different from games and simulations. Games and gameplay have always had
an impact on health but Gamification is more based on the psychologies that motivate people to play
games.
Why is Gamification Important and Relevant to Healthcare?
Many of the health problems we face today are a consequence of modern lifestyles. The ageing society
brought about by higher standards of living and better healthcare is shifting the demographics of society to
a situation where the sector with the highest probable demand on healthcare needs is growing rapidly and,
as a result of slowing birth-rates, the working population is declining.
At the same time, in the developed world, sedentary lifestyles and eating habits are creating higher
incidence of obesity which will be reflected in cardiovascular conditions and diabetes problems. Despite the
concurrence of this “pincer movement” of higher life expectancy and lifestyle related medical conditions,
the public expect treatment and support when and where it is needed without any extra cost burden or any
enforced changes to their lifestyles.
For these reasons, it is absolutely essential that policies and strategies are adopted that are effective in
influencing behaviours and lifestyles in the general population and to establish some personal responsibility
for health management. Gamification of health and the creation of “win-win” relationships between those
partners who have the motivation and mandate to improve personal health offers a cost effective solution
which could address these serious global challenges in a commercially sustainable way without adding any
cost burden to national health services.
Changing the Role of the Healthcare Professional
One of the most dramatic impacts of technology on society is the shift from hierarchical organisational
structures to networked structures. As the dependency on our knowledge professionals declined,
traditional relationships that sustained society for thousands of years have been fractured. This process is
often referred to as disintermediation or the removal of intermediaries who are no longer needed when we
have the power to be able to deal direct. Our dependence on those above us has diminished.The result of
this is a decline in leadership and an increase in individual power without the associated responsibility for
the consequences of that power.

5. This process of disintermediation has stripped out the middle layers in traditional relationships and
changed the role of knowledge professionals from “experts” to brokers, coaches and mentors. In this new
structure, it is important for healthcare professionals to take the lead in facilitating critical partnerships
with other parties who can support the necessary changes in personal health management. Gamification
processes and strategies can develop leadership and influencing skills within a culture that encourages
partnership building and responsible citizenship.The development of these skills and cultures is vital to the
sustainability of healthcare provision.
“Dramatic Shift from a Hierarchical structure in society and business to a network structure”
There are already some examples in healthcare provision and strategies in which medical professionals
have formed relationships with other bodies to “co-produce” solutions. The CLAHRC (Collaboration for
Leadership in Applied Health Research and Care) networks are an example of how medical professionals
are working with patient groups to promote healthy living practices. Other examples include Tesco working
with Diabetes Research to engage their shoppers as part of Corporate Social Responsibility and
experiments involving shifting the health management of obese patients from GPs to gymns and personal
coaches.
All these examples are steps in the right direction but they are only scratching the surface and far too often
there is a “silo mentality” amongst knowledge professionals either through a lack of awareness of
alternatives or because of a fear of unwanted competition. Adoption of a strategic gamification approach
has the potential to create multiple “win-win” partnerships that could achieve results far beyond the
capability of any one partner.
What are Gamification Strategies and How might they Work for Healthcare?
How does Gamification work and how can we develop Gamification Strategies to address global health
issues? Gamification strategies influence the actions and motivation of both others and ourselves and
consequently help us to better manage our lives. Every human being needs to achieve objectives in their
daily lives whether they involve trivial daily tasks or longer term strategic goals. Our ability to achieve an
objective that involves other people is heavily influenced by a number of factors which I call the “A Team”
The "A Team" Gamification Factors

6. “Develop your own A Team for Success”
The A Team is a set of attributes that can determine how well we can affect the actions, behaviours,
opinions and motivation of others :-
Authority
“Our Authority is a reflection of the relationship we have with those we seek to influence”
Building our actual (or perceived) Authority or status makes it more likely that people will be influenced by
us. Authority can be represented or influenced by many factors such as a uniform, job title, age, or
appearance. Within the health sector, doctors, consultants and other professional have traditionally been
seen as the voice of authority but as with other knowledge professionals, technology has empowered
citizens with access to knowledge and eroded traditional sources of authority.
Aptitude
“Aptitude is a real or perceived level of ability or competence”

7. Aptitude can influence our perceived authority and/or relationship with others, especially when there is a
real or perceived high level of difficulty or risk of failure. Developing or strengthening our actual or
perceived Aptitude for gamification makes us a better “player” in the game of life
Ambition
“Ambition is what drives us to achieve goals and objectives”
Strengthening our own Ambition gives us the will to succeed and overcome barriers. Strengthening and
developing the ambitions of others brings support for our objectives.
Alignment
“Alignment is a measure of how “in tune” we are with those we seek to influence”
Creating an Alignment with the motivation and aspirations of others helps to build support for our
objectives and creates more effective “win-win” relationships
Adjacency
“Adjacency refers to our physical or emotional closeness to those we need to influence”

8. Getting physically or emotionally close to those we seek to influence increases the chances of success. It
builds and strengthens relationships and trust.
Associates
“Associates are entities that can align with our objectives and become part of “win-win” collaborations”
Developing a network or community of Associates who share the same vision is key to building win-win
relationships especially if those Associates have power and influence.
Awareness
“Awareness reflects our level of sensitivity to the world around us and situations we can influence”
Strengthening our Awareness of situations and building Awareness of a need for action in others is
important
Affectedness
“Affectedness is a reflection of the relevance of a situation to those we need to influence”

9. High levels of physical and/or emotional Affectedness are major drivers for action in ourselves and others
Activation
“Activation is the level of motivation and commitment to a goal”
Change can only take place with the Activation of the key influencers of outcome. If there is no motivation
or determination to succeed, objectives are more difficult to accomplish
Attractiveness
“The Attractiveness of a proposition can act as either a positive or negative incentive for action”
Focusing on the Attractiveness of our objectives and our proposition drives motivation. The opportunity to
realise an attractive goal can build our interest and the prospect of being damaged by an unattractive
outcome is equally powerful.
Accessibility
“Accessibility is a reflection of the level of difficulty or complexity and the barriers to success”
Improving the Accessibility of critical tools and resources makes success easier to achieve and can also
influence motivation
Affordability

10. “Affordability is a measure of the commitment of individual resources such as time and money compared to
the availability of those resources”
The level of Affordability both in time and money will have a big influence the actions of others
Within the healthcare sector we need to reflect on how to develop strategies which not only provide the
necessary incentives to influence positive actions from all the potential stakeholders but we need also to
develop a culture of “Self-empowerment with Collective responsibility”
Today there are rapid developments in wearable consumer sensor technologies that are becoming
embedded in our daily lives and give citizens access to information that reflects their health status. This
data will be critical not only for motivating changes in lifestyle but also creating valuable “big data” that can
improve our understanding of best practices and better inform public and private health policy.
Gamification Enabling Technologies for Health
Gamification Enabling Technologies are those technologies which support the process of gamification by
developing, enhancing, amplifying and/or augmenting those factors which help facilitate changes in
actions, behaviours, characteristics or states - the so-called “A Team”. It is the emerging measurement and
feedback technologies which hold the key to Gamification Strategies which reconnect society and combine
empowerment with personal responsibility. Measurement and Feedback technologies based on the
“Internet of Things” and increasingly powerful immersive technologies that engage our senses and
emotions can help shift our locus of control from External to Internal, give us more responsible control over
our lifestyles and transform us from spectators into fans, players and even games masters.
“Enabling Technologies and Gamification can have a major impact on our personal health”

11. My own personal experience of using Gamification strategies to take control of my health provided me with
an insight of the potential of the latest emerging technologies to have a major impact on important societal
challenges. The use of a lifestyle monitoring device with its iPad applications empowered me to
dramatically improve my wellbeing by adopting a Gamification strategy that influenced my actions,
behaviours, characteristics and state.
As an individual, the shift in my own lifestyle behaviour required a combination of circumstances, a
gamification strategy, enabling technologies and a “win-win” relationship with a technology partner. My
results could have been improved still further with the involvement of other partners such as
nutritionalists, physical exercise specialists and medical specialists collaborating to not only personalise my
lifestyle practices but also to contribute to their sustainable development.
Conclusion
The ability to take control of our future and continue to develop throughout the whole of our lives depends
on how successfully we can influence those entities which shape our world. Gamification strategies which
are ethical and are based on genuine win-win relationships supported by enabling technologies can
contribute to significant improvements in personal health management and help to address global health
challenges. My own view is that the best way to impact healthcare is to begin with “personal gamification”
strategies focused on developing our internal self-management competencies. If we are to be successful in
developing the skills to influence others, we must first hone those skills within our own lives by using
technology to influence our own actions and behaviours.
Health is one of the most important areas for the sustainability of our planet. If we do not address these
imminent global health challenges, we will not only face serious resource problems but we will create a
very divided and unstable society. The only way to address these challenges is .effective collaboration
between those stakeholders who are best placed to influence lifestyles and to shift responsibility for
healthcare management in the direction of individual citizens enabled by technology, supported by domain
professionals and motivated by gamification.
About GAITSS
GAITSS is committed to the use of ethical Gamification practices to shape the future of business and society
and we offer a variety of services to clients and partners wanting to adopt or develop Gamification
strategies including consultancy, workshops and networking.
See www.gaitss.net or contact us at info@gaitss.net
Copyright GAITSS (David Wortley)
March 2014