Three organizations offering creative and inventive nudges—those innovative pushes that lead people to make better decisions—have won “Designing for Better Health,” a unique online competition co-sponsored by the Robert Wood Johnson Foundation (RWJF) and Ashoka’s Changemakers. Descriptions of the winners and all of the finalist appear below.
Just A Cloth Piece? GOONJ
New Dehli, India
A piece of cloth can provide an important nudge to open up a taboo subject and reduce infections and diseases that plague millions of women in India. Because sanitary pads are largely unavailable, poor women in India turn to old rags, newspapers or even plastic bags to use during their menstrual cycle. GOONJ collects donated cloth and creates clean sanitary pads that it then distributes to women, while at the same time bringing out in the open the taboo subject of menstrual hygiene. The movement is working in 21 states of India through a network of more than 150 grassroots groups, including units of the Indian army, nongovernmental organizations and community-based organizations.
This unique waste management program nudges people to change their traditional habits to improve their health by producing compost for family gardens. Previously, people burned their waste and threw garbage in the street. Now 95 percent of community members participate in the waste management program. In addition, Healthy Amazon encourages people in the community who are already involved in agriculture to devote some of their land to growing food that their kids need to grow and stay healthy. They demonstrate the healthy benefits for their kids and provide an incentive—free compost from their waste for their land.
Child Promoters on Oral Health: An Alternative to Achieve Wellbeing
Children are nudged to better oral health because they receive training to act as scholar/promoters who share what they have learned about proper oral hygiene and care with other children, parents and other relatives. Children become closer to health professionals because they lose their fear of dentists. Because children are now teaching others, they are more invested in their own oral health and parents and relatives accept the oral health education more readily from their offspring. Dentists are also nudged to understand that their profession has a significant social element and that part of their mission is to teach and work with people to overcome their difficulties. To date, 55,000 people have improved their oral health through this effort. Seven-hundred Venezuelan children have been trained as oral health promoters, who manage and carry out educational and preventive dentistry programs in their own education centers. Some 600 Venezuelan people have served as scholar promoters on oral health, providing the scholar population with education on tooth brushing techniques, oral hygiene and oral diseases prevention. More than 500 dental students became aware of the social change impact that they may have.
Room Makeover Award, Creative Strokes Network
The Creative Strokes Network Room Makeover Award provides the necessary nudge to help people with mental health challenges to develop the life skills to create and maintain living spaces that evoke personal pride and self worth. People in recovery, often living on fixed incomes and dealing with disabilities, volunteer to paint and decorate each other’s apartments. The mental health system focuses on providing housing—the Creative Strokes peer volunteers focus on helping people create homes that they are proud to live in and make them feel good. Self-esteem increases with the pride and gratification of helping others and oneself.
Inspired by Kiva.org, Lend4Health takes online, collective microlending to a new area to provide a unique funding option for health-related pursuits. Unlike other peer-to-peer lending Web sites that typically charge interest rates and could be used to fund health-related needs, Lend4health loans are interest-free. Currently Lend4Health is facilitating loans for the “biomedical” treatment of adults and children with autism spectrum and related disorders, which is not usually covered by insurance. The objective is to increase the number of people who can seek treatment, the speed with which treatment can be obtained, and awareness and support of health issues. To date, 40 loans have been funded and disbursed with no defaults.
Just an Idea: A Nudge for Breast Self Examination
Sometimes the simplest things can have the biggest impact. A symbol put in birth control pill packages on the optimal day to conduct their monthly breast self-examination (BSE) may nudge more women to catch cancers in their earlier stages when they are most treatable. Drug manufacturers would need to make small cosmetic changes to their packaging and include explanations about BSE in package inserts. The barriers to this are not financial. The American Cancer Society has dropped its recommendation for women to conduct breast self-examinations because too many forget to do so and research has failed to show a direct link between BSE and saving lives. A simple reminder about BSE, in a package that millions of women look at every single day, could help prevent some of those cancers from being killers.
Depression screening test scores recorded as lab values in an electronic health record (EHR) are helping to nudge primary care providers to prioritize depression care. The use of the EHR has made it possible for a network of 16 health centers in high-need medically underserved areas in New York City to make depression screening and treatment a routine part of primary care. By recording the depression screening score as an abnormal lab value, primary care providers, who are accustomed to responding quickly to abnormal lab values, better see depression as an actionable, treatable condition like any other, and one that can be managed in the primary care setting. People who would have fallen through the cracks and not received treatment for depression are now getting it.
Freiker (FREquent bIKER) nudges children to regularly bike/walk by employing an inventive combination of advanced technology and incentives. With the aid of an RFID tag on their backpack or helmet, children record their efforts through the Freikometer, a solar-powered radio frequency ID reader, which scans their tag and counts the number of days they ride or walk. Children log on to the Freiker web site to see the number of rides they have accumulated and, at the end of the year, receive prizes and rewards. The program is operated through schools with the efforts of volunteers and support from Freiker. There are 12 systems operating in the US and Canada.
The Veggie Mobile
The Veggie Mobile nudges inner city and seniors citizens to adopt better nutrition and health habits by making it possible for them to have easier access to affordable fresh produce. The Veggie Mobile drives into targeted neighborhoods and sets up shop at pre-determined locations for weekly stops, selling high-quality produce at half the price of most grocery stores. The mobile green grocers concentrates its work in neighborhoods where the nearest grocery store is more than four miles away and where residents lack easy transportation and thus limiting access to affordable produce.
WalkBoston is nudging more people to walk for good health by including walking times on their maps, specifically highlighting community destinations linked via five-minute increments. By showing what a five-minute walk looks like, readers better understand how easy it is to choose a variety of interesting, fun and useful routes. The big picture benefits of walking are adding physical activity as a more constant element of peoples' routines, reducing greenhouse gas emissions and car trips, and creating more vibrant communities.