Building H Index:
Inaugural Report
Introduction
This report represents a first effort to develop a prototype tool for understanding the influence of popular consumer products and services on consumer behavior and, through that, consumer health. It is a part of a broader effort to catalyze work on tools for assessing company impacts on public health.
The report is based on the application of a framework anchored on five health-related behaviors to the products and services of 10 companies in the food, entertainment and transportation industries. For each product or service profiled, we examined its likely impacts on each of the five behaviors. It is a purposely narrow view and as such it does not attempt to make any judgments about the societal value of the products/services or the social impacts of the companies as a whole. Ironically, it does not even include a company’s specific efforts related to health care (e.g. Lyft and Uber offer subsidized rides to medical appointments). It’s exclusively focused on behavioral impacts.
The exercise revealed a number of opportunities for answering these questions in greater depth. Most importantly, there is a need for more in-depth data on users and usage patterns, such as time spent using the product, how often certain features are activated or different modes are selected, or what activities people do concurrently with the given service. We expect to offer updated profiles based on additional data in the near future. Other possibilities for future enhancement include:
an understanding of how the products are used across different demographic groups, enabling an assessment of the equity impacts of the products;
exploring the community impacts of the products -- recognizing that many have influence on people beyond the users (e.g. rideshare and delivery drivers); and
the emotional impacts of the products, recognizing that emotional responses, such as stress, can both influence health directly, or through behaviors that result from (or are suppressed by) the resulting emotion.
The Covid-19 pandemic has also created something of a complication. Some behaviors that are normally healthy (e.g. socializing with friends) are suddenly not and some, such as ordering grocery or meal deliveries, have become essential. We have based the analyses on a pre-COVID context, which we hope will be representative of the post-COVID context.
Methodology
Health impacts of company products and services are assessed by analyzing two sets of relationships: 1) between those products/services and the activities (e.g., watching a movie, riding a bicycle) they promote or inhibit; 2) and between those activities and a set of five human behaviors that have been shown to influence multiple health outcomes -- eating, physical activity, sleeping, engaging socially and getting outdoors. Our methodology focuses on these five fundamental behaviors of everyday life, which have all been shown to influence both physical and mental health.
Companies’ products and services are assessed qualitatively, based on what is known about how those products/services are designed and how consumers use them. Multiple raters subjectively evaluate the direction and general magnitude of the effects of each of the company’s products/services on their users’ participation in each of the five behaviors discussed above. Considering effects across products/services, the raters score the effects on a seven-point scale ranging from -3 to +3, coming to consensus about the appropriate score through discussion and review of evidence. An overall score is calculated by summing the scores associated with each behavior and translating the numerical scores into letter grades. Opportunities, given the product impacts, are also described.
Ratings: Food Industry
Company
Products profiled
Overall Rating
Ratings: Entertainment Industry
Products profiled
Company
Overall Rating
Ratings: Transportation Industry
COMPANY
PRODUCTS PROFILED
OVERALL RATING
Key Points
The selected companies have broad health influence. First, it is clear that all of these companies, each of which has its own specific industry and is organized to meet somewhat narrow, specific needs of its customers, has influence across a broad range of health-related behaviors. With only rare exceptions, each of the products and services profiled had at least some effect on all five behaviors -- eating, physical activity, sleeping, engaging socially and getting outdoors.
Measuring these health impacts is new. The companies profiled in this report are not considered “health companies;” most do not claim health benefits for their customers; nor are they commonly considered responsible for their health. Rating them in this way is a bit like giving them a pop quiz on a subject they didn’t know they were supposed to be studying. Thus this report has to be seen as a baseline and it is less important how a company scores in this report than how it responds. Will it begin to look at its products and services through this lens? Will it measure user behavior to gain a better understanding of it? Will it introduce new features that seek to have more positive influences on user behavior?
Company context is important. Although the companies are grouped by industry, this report mixes apples and oranges. The companies offer different services, with different objectives. Television watching is unlikely to become a healthier entertainment activity than mobile gaming. Using public transportation, bikes and scooters is generally going to be healthier than being driven in a car. So the focus of the company makes a difference, even independent of how the company designs its offerings within that focus.
There is always a healthier version of the core product/service. Despite the limitations inherent in the type of product or service being offered, the report clearly shows that there are opportunities to deliver it in a way that has more positive influences on health behavior.
Key opportunities include better filtering of menu items and food outlets and establishing “bedtime modes.” A number of products could be enhanced if they were able to make it more likely that consumers would identify and purchase healthier foods. Doing so might require better information or standards that could enable search filters or ranking algorithms to surface healthy opportunities. To facilitate better sleep, a number of services could follow the leads of Apple and Google, who have established bedtime as a user-defined time of day that is treated differently than the rest of the day. By doing so, they enable the user to minimize distractions or other sleep impediments.
Team
A team effort produced this report: Thomas Goetz and Steve Downs conceived and directed the project; Steve Downs was the principal author; company health impact profiles were developed and written by Steve Downs and Carlo Martinez; Sara Singer, Matthew Trowbridge and Brittany Sigler provided valuable feedback and helped guide the project throughout the process; and Abby King of the Stanford Prevention Research Center reviewed the methodology and the profiles.