Designing treatments to help someone function well used to be a space reserved for epidemiologists and physicians, trained in (and sworn to uphold the ethical use of) methods and tools to improve human health. The International Classification of Functioning, Disability and Health—known more commonly as ICF—was first published by the World Health Organization in 1980. It’s the international standard and reference document that healthcare professionals use to describe, diagnose and measure individual and population wellness, based on categories of ability, function, and behavior in life’s activities.
In 2002, the ICF was significantly revised with language that classified healthy function in life in using ability, rather than treating dysfunction, or disability. It also broadened definitions of functioning well to include the physiological, psychological, and social factors that determine whether we can fully participate in our real worlds. Healthcare professionals began designing treatments that were tailored to an individual’s unique physical abilities, emotional states, and social, behavioral experiences in their physical contexts.
This shift towards a broad, biopsychosocial framework of categorizing human flourishing radically expanded the tools and practices that could make our lives go well. The “problem space” of well-being got exponentially bigger as more of our daily being and doing went online. Suddenly, it’s more than healthcare professionals exploring, understanding and designing tools and interventions to help us feel good and function well. More practitioners are influencing how we build and sustain physical and digital habits that support our flourishing. And more questions arise about how (and whether) designs that optimize our well-being are serving us—and our planet—well.
Colours of persuasion and participation
The ethical implications of using persuasion as behavioral treatment or medical interventions to improve functional health is not new, nor are the ethical questions black and white. And while ongoing research connects some deleterious dots between living our lives online and less-healthy physical and psychological function, it’s complicated (Alcott et al, 2019). Similarly, the ethics of persuasive patterns are not as dark or as light as some critics might suggest. There is a range of color in the spectrum of designs allowed into our digital lives that influence, prompt, or otherwise persuade our offline behavior. The particular hue and saturation of the design often depends on how much it enables our full participation in the very daily activity of being persuaded online.
Behavior design in digital and analog spaces that nudge us to live, be, and do well have been around for more than a decade now, and we often welcome these subtle nudges and reminders. They reflect the accepted definitions and valorized behaviours of our continuous journey towards individual, social and planetary thriving—bike instead of drive, take the stairs, remember to recycle. Apple’s Screen Time feature is a primary example of how colourful the spectrum can be between dark and light patterns of behaviour design. In this case, an opt-in, fairly forceful user experience that steers us to unplug and behave in ways deemed “more healthy” by healthcare professionals is hailed as progress. But what happens when we haven’t opted in, don’t know what behaviours are being influenced, by whom, or by what?
Enormous language models are rapidly advancing and make it possible for machines to influence both our online and offline behaviours, across a range of social interactions and behaviours that will impact our well-being. OpenAI’s GPT-4 apparently “actively deceived” a human in a test to complete a task,1 and a recent Stanford study from the Institute for Human-centred Artificial Intelligence (2023) noted that persuasive AI “could be used for mass-scale campaigns based on suspect information and used to lobby, generate online comments, write peer-to-peer text messages, or even produce letters to editors of influential print media.”
Since there’s no ICF or Hippocratic Oath for behaviour designers (yet), individuals and groups need help staying aware of who, how, and what new designs and actors are persuading us to behave “well” across our rapidly shifting contexts. And our participation in those design activities will remain critical.
Patterns of light
Even when we aren’t using our eyes, they are active. Phosphenes are the little light show of stars and patterns that seeing folks have when we close our eyes. We see patterns as our brain digests and our body processes what we’ve seen. Our eyes can also see the tiny particles of light produced by our own body—they’re the electrical charges emitted by our resting retinas. Physical pressure can also generate phosphenes and light. Even without external stimuli or information to process, our active eyes and processing brain can produce patterns in the dark.
So, too, with becoming active participants in behaviour design for well-being. The external stimuli of behaviour—the physical environments and our digital choice architecture—will shapeshift and change dramatically in the next 5, 10, and 50 years. So will the number and different types of intelligences who are trained to prompt, persuade or otherwise influence our choices in everyday social interactions and habits in health, mobility and sustainability spaces.
But the internal, drivers of human ability—our human agency—remains at the centre of our possible, potential and preferable future well-being. To feel good, function well, to develop our potential with purpose and positivity, we need to be able to see and create our own light patterns. The story of human lives going well on a flourishing planet depends on it.
