There are young people on e-bikes or with parents as drivers, but also young people who cannot walk the streets safely. Design scientist Maaike Kleinsmann and communication scientist Moniek Buijzen on solutions for the health of children and young people. 'It shouldn't feel like yet another system.'
What does a child in our time desperately need to become a healthy adult?
Maaike Kleinsmann, Professor of Design for Digital Transformation: 'Knowledge of what is healthy and what is not is not as self-evident as it seems. I also have trouble with it in the supermarket. Sometimes there is more sugar in something than I thought, although the packaging has a healthy look. If you want to eat healthier, you have apps in which you have to enter everything you eat. Quite a hassle, you can't keep that up. I also find the health labels on products complicated. Today's designers are looking at how they can support users in making healthy choices. For example, with apps, but perhaps also with smart shopping baskets that provide information as soon as you pack a product. It should not feel like another system, but be present in the background. It should not be patronizing and should be based on the will of the user.'
Moniek Buijzen, Professor of Communication and Behavioural Change: 'Digital resilience is important, also when it comes to healthy eating and exercise. Young people spend so much time in a digital environment, that has really become part of healthy living. They must be aware of guiding algorithms, cookies and surreptitious advertising. Messages that young people pick up online have an effect – on top of the influence of classmates. In our Movez team, we investigate, among other things, how influential classmates or neighbours can stimulate healthy behaviour and also how this can be done via social media. For the latter, for example, we use algorithms to track who is "talking" to whom on social media.'
Growing up healthy involves so much, a lot goes wrong. How do you tackle that with science?
Kleinsmann: 'In the Healthy Start research initiative in Rotterdam, we are trying to break through the unequal starting position of children and young adults in six important aspects. These are the first thousand days of life, care pathways for young patients, exercise for chronically ill children, mental health, crime and addiction and youth participation.'
'I lead a project to get chronically ill children with a congenital heart defect, for example, to exercise more. Their parents are often very careful with them and they ask the gym teacher to be too. As a result, they sometimes develop new heart problems at the age of forty due to too little exercise. Later in life, they then experience the adverse consequences of lack of exercise in a very unpleasant way. We are working on a system with three parts. Firstly, a chatbot on the parents' phone, which can help and reassure them. Secondly, a fitness tracker that monitors whether the children are moving safely and sufficiently, supplemented with game elements that encourage exercise. Finally, a dashboard for the doctor to look longitudinally at how the child is doing.'
Buijzen: 'Within Healthy Start, I am involved in youth participation. For example, we help young people in Rotterdam neighbourhoods to improve their own living environment, health and well-being. They work together with researchers, policymakers, youth workers and urban designers to create a better environment. Also their digital environment, where they help each other to be more resilient on their favorite social media. With encouraging hashtags such as #beyourownjoy. This should lead to a healthier lifestyle and more social cohesion. This promotes health and well-being and reduces health inequalities.'
It seems cumbersome, improving health with such a complicated project. Why not just promote healthy behavior?
Buijzen: 'We discovered in 2021 that that doesn't work, during the #Influence theatre project in Rotterdam South. In conversation with these young people, it turned out that they have very different things on their minds. There had just been a shooting in Feijenoord, they didn't feel safe on the street. They also did not feel comfortable online. Their self-image was undermined by all those beautiful Instagram photos. So we have to work on that before we can encourage them to eat oranges.'
Kleinsmann: "Even in our remote patient management projects, there are many difficulties to overcome before you can start working on health. Technically, but also with the cooperation between care institutions and families. Everyone should be familiar with the technique and trust it. In the families they have a lot on their minds, and we also have to deal with less literate people. Medicine and nursing programmes should include e-health in their curriculum, and that is happening more and more.'
Can your solutions compete with, for example, the enormous marketing budgets of the food industry?
Kleinsmann: 'Yes, it's difficult. A big annoyance for me are sports canteens where I come with my daughter.' Buijzen: 'A brand like Red Bull is deliberately prominent in the sport. Once a child associates sport with Red Bull, such an association can last for life.'
Buijzen: 'I have long passed the phase of despair. I just keep on stumbling like a turtle. Fortunately, I do notice that the standards have changed in the past twenty years, also in the industry. Although I have become more skeptical about solutions together with the industry. The percentage of overweight people is still growing, but the growth is starting to level off. It is a wicked challenge, all those involved at all levels are needed. Also more laws and regulations at the macro level, such as sugar tax and restrictions on advertising. Just as there are rules for the amount of salt in bread.'
How can you make a difference, give a positive twist to health with interventions?
Buijzen: 'We have noticed that you have to involve your target group from the start of the idea. What are their values and needs? What do they find interesting and important? In our desire to be effective and save money, values such as autonomy and privacy often fall by the wayside. In our old projects with boring questionnaires, it was always very difficult for us to find schools that wanted to participate. Not anymore: we work with a mix of learning and playing.'
'Young people are already using social media, as well as exercise apps such as Strava and Garmin. For convenience, fun and social contacts. We are now joining that. They play with their own avatar in our app, give them a new outfit every day. In conversation with young people, they came up with the name of our Movez lab. We also learn from those who work equality.'
Kleinsmann: 'Co-creation also works best for us. In conversation you find out what the problem behind the problem is. The reason that sports canteens offer little fresh food is that it does not have a long shelf life and a lot has to be thrown away if it is not bought. Then you can come up with a solution for that, for example. We sit at the table with a whole network of actors: patients, doctors, nurses, management teams. Technology itself is also an actor. We as designers can only come up with solutions that really work from that collaboration.'
Moniek Buijzen (1973) is Professor of Communication and Behavioural Change at Erasmus University Rotterdam. She is also Professor of Strategic and Persuasive Communication at Radboud University. She works on positive behavioural change, in which, for example, healthy young people from deprived neighbourhoods are a source of inspiration for others.
Maaike Kleinsmann (1976) is Professor of Design for Digital Transformation at TU Delft. She is also a board member of the National eHealth Living Lab (NeLL) and one of the leaders of the Healthy Start convergence program. She develops co-creation and design methods to help others develop evidence-based e-health solutions. She was recently appointed Medical Delta Professor and scientific leader within the Healthy Society scientific programme.
Text: Rianne Lindhout
This is a publication of the white paper Healthy Society, published by Leiden-Delft-Erasmus Universities and Medical Delta.
