Ben Sawyer is the co-founder of game-consulting firm Digitalmill and one of the pioneers in the field of Games for Health. He founded the Serious Games Initiative a decade ago as part of a U.S. government research effort into how games can accomplish useful ends beyond fun. In 2004, he also co-founded the Games for Health project, which seeks to use games to improve the state of health. The Games for Health project receives major funding from the Pioneer Portfolio of the Robert Wood Johnson Foundation.

His career is built on the notion that video games can achieve good in the world beyond entertainment. Sawyer has worked on games such as the university simulation Virtual U as well as projects for Cisco, DARPA, ONR, Leimandt Foundation, Cadbury, USAID, Lockheed Martin, and several other Fortune 500 organizations. But many games that inspire people to do good or get off the couch and exercise have now gone far beyond government contracts into the mainstream of gaming. It started with the success of the Nintendo Wii in 2006 and has morphed into sensor-based health devices that we carry around with us.

We interviewed Sawyer in advance of this year’s Games for Health conference, which will be held June 12-14 in Boston. Here’s an edited transcript of our conversation.

GamesBeat: So tell us what is the latest in the Games for Health movement?

Ben Sawyer: We’re working on a new strategy for the general Games for Health field that we’ll be working on all summer and then unveiling in the fall. It represents looking at everything we’ve done over the last seven years, especially a lot of the conference material. We’re constantly using the conference as a means of trying to understand where we think things are headed or where we think they should head. So we’ve got a lot going on in terms of various health-game activity.

The conference this year is looking pretty strong. The lead keynote is going to be Microsoft’s director of health [Bill Crounse, a doctor and senior director of worldwide health for Microsoft]. He’s not necessarily working every day on Xbox, Kinect, and stuff like that. But Microsoft is now broadening and looking at Xbox and Kinect as larger ecosystems. People on the health side are hacking and doing things with Kinect.

Microsoft is a player in traditional health information technology, with products like HealthVault and general Windows platform. So it’s going to be interesting to see the perspective of someone who is looking at things from both lenses — the entertainment side as well as the traditional health information technology side. I’ve always said that if anybody was going to really put together that kind of ecosystem, it was probably going to be Microsoft. Unlike the other players in video games, Microsoft has an established enterprise group. It’ll be interesting to see his perspective on where he sees things going.

If you look at Sony’s recent announcement about their restructuring, they’ve really highlighted health as an area that they intend to get involved in. So you may see Sony start to think more about building up its health IT side or what it considers a health products group. That may foreshadow deeper activity. I can’t say much about it because it’s hard to tell, right? Sony’s going through so much. They highlighted health as an area that they see as something that they’re going to move forward more aggressively with.

And then Nintendo, they’ve done quite a bit because of the nature of the Wii system, but they don’t really have that health IT infrastructure, nor would I ever expect Nintendo to do those things. I’m excited about what Microsoft might say. Last year, we had Google’s health strategist with us. We’re starting to see a broader group of industry leaders and health IT start to pay more attention to games.


GamesBeat: I’ve seen a lot of these Silicon Valley startups get into the health picture, with all of their different step counters and armbands.

Sawyer: Last year, we added a sensor day because of that, and this year we’re calling it sensors and gamification because the two seem to be somewhat tied hand in hand. And then I’ve been working on some of this privately myself. I am very, very interested in what’s going on there. What we see happening that I think is interesting is this whole rise of biometric sensors in games. The first biometric sensor that most people probably interacted with the most would be like an accelerometer in a Wii controller, or you could take a visual sensor in terms of what Kinect and Sony’s Move are doing.

But the real, soon-to-be-maybe explosion of things would be wearable mobile sensors. Those include two big groups. One would be the pedometer, gyroscope, GPS that’s on every viable smartphone these days. That would be what I would call a built-in sensor on the most ubiquitous mobile platforms: mobile phones. But then you’re also starting to see these things like Jawbone UP, Nike Fuel, Adidas miCoach, Fitbit, and BodyMedia. There’s a good half-dozen major and then probably another half-dozen smaller players, like Strive and others, coming about.

There’s sort of two distinctions. They’re either offering a high-end sensor capability, like in the case of BodyMedia. The next big thing will be heart rate. But then, on the other side, what they are trying to move toward is this ubiquitous, always-on, totally dedicated accelerometer to track movement and specifically steps. That’s the most common form.

Now the question then is: How do you then hook these things up into applications that offer some level of motivation, framing, or other forms of interaction that rewards someone beyond your own personal interest in counting your steps? Is there something more enticing? That’s where the games side comes in, and you’re seeing everything from simple things we were showing two or three years ago, like Horsepower Challenge from Humana, to more complicated interesting ideas around what Will Wright and others at the Stupid Fun Club call “integrated gaming.”

With this idea, we take all of our data sources and turn them into feeds that can be integrated or turned into some sort of gameplay. It’s got tremendous upside. We’re going to see a lot of false starts: things that seem like they get at it but are dead ends. But I think over time, especially as more game developers get involved, I think you’re going to see what I consider the rise of the human joystick, where you yourself will know that certain physical behaviors are talking passively through these bracelets or watches or things in your pocket to the Internet, and by virtue of doing that, they’re talking to a game or multiple games that you’ve decided to share that input with. A perfect example of it might be: You know that if you manage to walk at least a thousand contiguous steps between, say, 9 a.m. in the morning and 5 p.m. in the evening, then you get a reward.

Then the next question is, well, what does that human controller do? Does it generate a reward or does it generate a move of some sort? Once you get into that sort of element, then it really becomes compatible with a lot of different types of games. Eventually, I think that these two worlds of games that we’re playing now and physical activity will merge in ways that we hadn’t thought about before. But as you can expect, those rewards are a real big deal, not just in games but in health these days. Rewards are going to play a role.GamesBeat: I guess a good thing about these Silicon Valley guys is that there’s real money coming into this market. Lots of venture capital money. It’s not just research grants anymore.

Sawyer: Yeah. I think four or five years ago, I didn’t see a lot of that kind of activity in the games for health space. Now, you’re starting to see more of it, especially along these ways. You’re starting to see entrepreneurs in the games for health space, with the exception of exer-gaming, which they realized was going to be co-opted by the large games publishers, at least as far as the living-room goes.

They didn’t see a lot of broad-based play, especially stuff that potentially didn’t end up in a regulated market as well. Niches are not really enticing investments. But when you look at things as ubiquitous as walking — as ubiquitous as mobile platforms — then you start to enter those broad areas where it’s clear that there’s a decent potential for high returns.

But that being said, I’m starting to see more meaningful types of things made in some of the more niche areas. I’m starting to see things mature in terms of designs and activity. Mobile’s been a big part of that. There’s a company being formed in San Francisco right now that I visited with during the Game Developers Conference that is taking a lot of interesting research from a cognitive health standpoint. They’re going to be putting out at least one if not a couple of mobile games based on a whole host of new neuroscience research around ideas that could be helpful to people in terms of being more productive and being able to concentrate better.

It’s neat to see things that are moving beyond that pure academic standpoint and starting to see things turn into actual products. Especially with the ubiquity of mobile, but also the app stores and the digital download world. I think these niche markets start to become much more addressable in ways that are going to help this space thrive. Much like the indie-game space is thriving: Because it’s easier to get to market, you can price things more aggressively, and the cost of developing some of these titles isn’t as high as it used to be.

GamesBeat: Has somebody tried to measure the size of the market so far?

Sawyer: This is the problem with all serious games, let alone the games for health space. The size of the market is hard to measure because you have to decide where the market actually begins and ends. So for example, if you look at exer-gaming and you look at sales, several years ago you were talking about a market that was a billion-dollar market because Wii Fit was selling so phenomenally well at a high price point. But you also had things like EA Sports Active. You had things like Dance Dance Revolution even if you just took a percentage of DDR sales and assumed that a small percentage of those sales were going to a more fitness-oriented consumer as opposed to just pure entertainment. You were hitting very large numbers. I would say exer-gaming has probably come off those highs, especially as Wii Fit and Wii sales are down, but if you look at sales of things like Just Dance and other things — when is that not an exer-game? Those debates are still open.

GamesBeat: Yeah, like Star Wars Kinect. Does that count?

Sawyer: Well, Star Wars Kinect is probably one of those areas where you start to drift away from exer-gaming. You drift along the spectrum towards more, it’s just a get-up-off-the-couch game like many Kinect games. But I’d say Just Dance would go a little bit more towards a more exer-gaming-oriented title. And then you would go all the way over to things like EA Sports Active, some of the stuff that Ubisoft has done with Your Shape and things like that. And you look at Majesco, with the sales that they’ve had with Zumba Fitness. It’s been huge for Majesco. So that market seems decently healthy, in terms of it’s become I think a staple category.

The question is, can it evolve into having the same level of health impact that we’d like it to have? That’s an open question from the project’s perspective. Great sales for the industry, but we’re not sure whether or not the health impact of those things has been as high as it could be. What’s interesting, and what we think will be one of the first big changes there in terms of health impact, is when services like Xbox Live or PlayStation Network and stuff like that can send that data and store that data in some way where it can share it with your health plan. Maybe that data allows you to get more direct fitness orientation, or share some of that data with a health coach or somebody like that. Or even get credit towards your health plan deductible. That could change things quite interestingly.

The other thing that you could see change is when all of your calorie burn data and other things can be shared across multiple exer-games. You don’t necessarily want to work out one type of way every day for the rest of your life. The question is, when you can start to see that, will you start to see people having a larger, more dedicated set of workouts and things like that? I suspect that you could see something like that emerge in the next couple of years.


GamesBeat: Did you see that Mindbloom Life game get adopted by Aetna?

Sawyer: Mindbloom is more like gamification and a visualization of daily habits. There’s another company called Health Month that’s doing this as well, and there’s sure to be a couple of others that come along. But you could imagine seeing something like that built into Xbox Live, where it becomes a sort of umbrella. It could be like the way your Gamerscore tracks your activity across multiple games — you could have some sort of health score that could track you across multiple exer-games through the lifecycle of you and that service. Which ideally would make it potentially have a chance to have a higher level of health impact.

GamesBeat: Is anybody actually going to build that?

Sawyer: Patents and other things have been filed by various companies. This type of thing is coming.

GamesBeat: That’s where it seems like it’s going to get more interesting when these big health insurers can help the technology spread.

Sawyer: Yeah. There’s lots of last-mile problems. When you look at things like exercise or even disease management or other areas. But what’s interesting is you may start seeing third-party services emerge, and they may talk directly to employers or others. They may be more like these wellness services. They may be startups like ShapeUp. And then eventually, you may see one of those services get bought by a large health care company. The idea of how you’re going to integrate these things into these networks and then get those networks to integrate them into that last-mile problem — that is going to shake out over the next decade.

What’s clearly happened right now is we know from research that we’ve shown at our conference, like the health games research stuff that Robert Wood Johnson funded, we know that games can have very interesting, unique ways of delivering health behavior changes to people. And unique experiences around health. Just like they can offer unique experiences around education and everything.

What we don’t quite have yet but we’re starting to see — much as you’ve talked about — is how that stuff starts to translate into real, viable, sustainable products that can start to scale up to large audiences. But what I’ve taken away from all of it — where I see the shift starting to happen — is both sides are recognizing what it’s going to take to get the scale. And one of the key parts of that is a real sense of interface to the consumer. That what the consumer ultimately wants is an interface that is the kind of experience that they see so well-performed in games. Now, the debate is whether it’s going to be something more gamified and translational, like the way Mindbloom works, or is it going to be something much more like a video game type of story-driven narrative idea that might be more akin to the kinds of things that you see.

There’s a game that some kids at Carnegie Mellon made called Active Adventure, where it’s a real story that you’re involved in as you’re working out and doing these different exercises. My sense is that you’re going to see everything all over the spectrum. The question will be which interfaces become the dominant kind of interactions. I don’t think anybody knows that yet. You’re going to see a lot of lightweight stuff over the next couple of years, and some of it’s going to stick. And then I think you’re going to see things that try to take it up a notch, and that’ll be where the next battle will be.

What’s interesting when you look at exer-gaming or even other things — the battle for video games was the living room — over the last decade. Now, with mobile platforms, the battle is a combination of anywhere in the house and then any time spent outside of the house but on a mobile platform. One of the interesting things from a health perspective — at least from health games — is that when it was still dominated by a living-room experience, it wasn’t types of experiences or the types of ways you would build those experiences [that] seemed different. Now, I think you’re seeing some things start to get a little bit more liberated. At the same time, it’s still interesting to see that at the moment living room, screen-based, large screen-based experiences are still going to be somewhat console-driven. Until we start to see the rise of things like smart TVs or an Apple TV-type console or a tablet, like Wii U or iPad or maybe something Microsoft’s working on.GamesBeat: Does it seem like the bigger opportunity is going to be in mobile?

Sawyer: Yeah. The biggest exception would be, in some respects, exer-gaming. A wide-open space with a large screen in the living room still seems like it has a lot to offer from a user experience standpoint with exercise. But when you think about the types of exercise that likely will become more ubiquitous and could be very broad population-based? It really is something as simple as getting people out and getting them to move five, ten thousand steps in a day. Research is starting to show that it’s not just how much you sit, it’s sitting for long periods of time. So again, looking at how you might deal with things at work and other things, the mobile platform is becoming where people are starting to spend more time. You can’t do experiences like Kinect in a mobile environment (so far). You can’t do big jumping-around types of experiences. You’re still going to have unique experiences, but my sense is you’re going to see Apple TV and other types of things get amplified, for lack of a better word, and that’s going to be interesting because with Apple TV or something like it, you’re talking about a $99 box that easily could drop to $60. If you were to make that work with some sort of 3G so now you don’t even have to worry about whether somebody knows how to hook up their Wi-Fi hub or anything like that? You could start to see much broader adoption.

GamesBeat: Sounds like the momentum is just getting bigger and bigger here for the whole market.

Sawyer: There’s several things going on, right? One is health care costs and their impact on everybody’s bottom line. Personal, for businesses, government, society in general. That still isn’t quite slowing down yet. So there’s a lot of impetus to start to fix these problems, and that impetus is not shrinking by any means. At the same time, I think I’ve always said that serious games — games for health for that matter — we ride on the back of what happens in the games industry. And the games industry has moved — and technology in general has moved — to a lot of exciting new platforms and capabilities that make it easier for this explosion of games to happen. The whole social gaming phenomenon, things like that, and how you can use that to reach people. As long as those things keep making the progress they’re making, we’ll be able to eventually piggyback on a lot of that. It’s where things come together and happen at scale, with that kind of investment that you talked about earlier. I think those are the signs that show that things really are progressing in interesting ways.

GamesBeat: So are there any other highlights that you think will happen at the conference?

Sawyer: Yeah. I was actually just writing up a list of highlighted talks that I’m really interested in seeing, seeing how they turn out. Konami is going to talk about how they’re doing a version of Dance Dance Revolution that they’ve specifically built for group and school type use. There have been lots of smaller companies like iDance and others who’ve tried to go after this group DDR market, and Konami has now decided to do some work in that space themselves.

Another company that I’m looking forward to is Green Goose, which you may be familiar with. Startup, San Francisco-based, doing stuff with sensor-based stickers that can talk to the Internet. So if you rake it knows it, it knows all kinds of different actions, you can turn just a stick into a sword and play games. It takes that gamification of physical activity to a whole new level. That’ll be interesting.

Another set of talks that I’m really looking forward to is one that came from a dating-violence episode. Out of that tragedy came a group called Jennifer Ann’s Group. They’ve been sponsoring a small contest for people to propose games and build games around the topic of dating violence. So their leader is going to come and talk about that project and the story behind it, and then he’s going to be joined by another project that’s been doing some work on dating violence with games and do a sort of super session on that topic. What’s very interesting and touching to me in the games for health space is just how many different areas people are trying to address with games.

GamesBeat: Sounds pretty good. What’s your outlook?

Sawyer: Yeah. It continues to go. I’m really, myself, personally hoping to see this year further broadening. Some things around the centers, some things around ideas like walking and nutrition, everyday things that can be turned into those kinds of broad-based products that have a chance to not only become investable but by virtue of being investable it’s probably because they have a chance to have a very high impact across a large population of people. Move beyond these lab-based confines that some of this more academic work tends to be stuck with. I think that’s what we have to continue to see and talk about in these broad terms than we may have been two or three years ago.

GamesBeat: Fitbit has launched its Wi-Fi scale. The gamification of bathroom scales seems to be in full force here.

Sawyer: The term “gamification” is one I have lots of issues with, much like many of my compatriots. The term that I like is what I was saying earlier about this notion of integrated games. You’ve generated inputs elsewhere in your life. What can we turn those into? That seems to be what Will Wright’s working on with that “personal gaming” project. I have no idea how they’re doing it or what they’re doing or what they’re thinking in terms of an actual product. But that term of integrated gaming seems more respectful of the player than what many designers have felt “gamification” is, let alone what that became. It’s interesting, I think.

Also, it seems like every time you can find new ways to generate input into a game, that has brought about some form of expansion if not actual market explosion. If there’s been a more consistent way to create new territory and new business in games than generating new means of game input, I don’t know what it’s been. With the exception of maybe social networks. It’s really been that kind of thing. Now, whether or not bathroom scales represent the next big thing, it’s clear that there’s some sort of tie between creating novel forms of input and new games that run on top of that in some sort of blue ocean strategy. It seems, with the sensors, it’s going to be this sort of multi-sensor input from what you carry in your pocket to the bathroom scale to other things. The challenge is going to be creating really interesting experiences. Somebody will do it. That much seems inevitable to me. I wish it could be me, but I have a feeling it’s going to be someone who we don’t even know about yet.


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[Photo credit: ePatient]