disease. This trend is partially influenced by neighborhood-level factors: In the U.S., low-income neighborhoods have far fewer grocery stores than affluent ones. And in the stores that do exist, fresh fruits and vegetables are hard to come by. In this setting, technology such as a personal electronic food journal may be less effective, because the problem is not simply a lack of awareness of one’s habits, but also that making healthy choices is fundamentally more challenging. Examining health issues in this way moves us beyond a focus on how behaviors can be improved, to how ICTs might help users make healthy choices despite a food environment that makes such choices difficult.

Coping with the Ramifications
of Inequality
Activist tools can take many forms.
One approach is to create systems
that help users cope with the rami-
fications of inequality. Much of my
work has focused on helping resi-
dents of low-income, predominantly
African American communities
overcome the disproportionately
high barriers to healthy eating
in this context. For example, I
designed OrderUP!, a cellphone
game in which players learn to
make healthier decisions when
visiting local eateries (see Figure
1). Rather than tell users not to eat
at fast-food restaurants, the game
acknowledged that fast-food-laden
streets are the reality for many peo-
ple. As such, OrderUP! attempted to
help users deal with this environ-
mental context. Players assumed
the role of a restaurant server; their
goal was to quickly make healthy
recommendations to customers by
choosing the healthiest item from
a rotating menu. The menu items
were commonly available at res-
taurants in the neighborhoods that
my study participants frequented:
fast-food and soul food dishes (i.e.,
traditional African American cui-
sine). As players saw their reality
reflected in the game, they began
to think about their own day-to-day
eating habits. Furthermore, because
the game showed how healthy each
dish was in comparison to other
commonly available dishes, players
got practical ideas for how to eat
more healthfully.

tool lets people use their cellphone to record and share audio stories describing how they have tried to make healthy eating choices in their neighborhoods. Through this system, community members help one another eat more nutritiously by sharing their experiential knowledge. Eat Well users valued hearing the emotion and personality in the voices of individuals from their community. These stories inspired hope, showing people who were up against the same barriers to making nutritious choices.

In addition to helping residents advocate change to one another, ICTs can also help residents change their environments. Prominent organizations such as the Robert Wood Johnson Foundation consistently advocate research and interventions that facilitate environmental change, whereby the physical and social environments

• Figure 1. OrderUP! challenges players to make healthier eating choices when visiting local eateries.

 

Facilitating Change In addition to helping users cope with inequality, we can imagine tools that empower them to fight back against it. Designing systems that support health advocacy is one promising direction in this space. Take, for example, another application I created called Eat Well. This

March + April 2013