The new face of public health interventions?

By Sarah Hill

The benefits of an active life to physical and mental wellbeing and the problems associated with a lack of physical activity are well known[i],[ii]. Yet, the average Brit still fails to meet recommended levels of physical activity on a regular basis. One of the main concerns with the lack of engagement in exercise is its association with obesity, in particular, the rise in childhood obesity. This is a growing concern and the target of many public health interventions[iii],[iv] since the associated costs (to both individuals and the NHS) are considerable. Whilst nutrition plays a large role in this recent trend of young and growing waistlines, physical activity (or lack of) also plays a part. Children and adolescents simply don’t move enough anymore (less than 20% of older children met recommended physical activity levels in 2012[v]). Developments in technology over the past few decades have made entertainment available at the click of a button; we can be occupied for hours without having to exercise more than our thumbs. However, it could be this very same culprit that holds the key to resolving this situation. Could gaming be the new way to get fit, not fat?

Enter, Pokémon GO. This is the new augmented reality*  game that has hit the world by storm. Having been released in the UK for just over a week it is already proving to be the most popular thing since sliced bread. As a ‘90s child who grew up playing Pokémon*, I of course had to jump on the bandwagon and I don’t seem to be the only one. The game is already attracting greater user time than social media giants Facebook[vi] and Twitter[vii]. Since the game’s UK release on July 13th I haven’t walked down a street without seeing at least one person following their phone in the giveaway “Pokémon hunting” stance. Witnessing the sheer numbers of people wandering, and at times running, around my local park at the weekend trying to catch a Pikachu* hiding in a bush made me think: this game is a fantastic public health intervention, whether intentional or not.

IMG_1690For those unfamiliar with the game, the reason for my excitement over its relevance to public health is that players are forced to physically move around in order to play. The game uses GPS to map itself onto real-life, making players walk around to visit real life places of interest (a monument or library for instance) to collect items and attempt to capture Pokémon. Other physical activity incentives exist in the game such as hatching a Pokémon egg which requires the player to walk a certain distance, anywhere between 2km and 10km, before their baby Pokémon will come to life. The question is, could this game be getting people to actually walk more?

Whilst it is too early to have any solid data on which to confirm a hypothesis, some preliminary data has shown an increase in activity post-Pokémon Go release[viii] and if anecdotal evidence is anything to go by I certainly know of friends who have gone on an evening “Pokémon hunt” over their usual trip to the pub or night in front of the TV. Another positive of the game is that it likely to be attractive to young people, and may just engage those who fail to respond to standard physical activity interventions.

This is of course not the first attempt to use technology to encourage us to walk more and get more exercise, but whilst other fitness trackers and health apps try to turn healthy behaviours into a game, Pokémon Go turns a game into exercise. So could augmented reality games be the new face of public health interventions?

We cannot really do anything but speculate at this point and there are a few points that should be considered first:

  1. When the novelty wears off, will it continue to have an impact? How long the game continues to hold people’s attention is anybody’s guess and whether the increased levels of physical activity continue beyond the life of the game is debatable.
  1. Will people just start to cheat? There have already been videos online showing you how to “hatch an egg without walking”; will people continue to play fair and rack up their steps or just start strapping their phones to their pets instead?
  1. What about the negative aspects of the game? There are several that I alone can think of:
    1. Accidents and injuries. There have already been many reports of minor injuries caused by people bumping into things whilst nose-to-screen rather than watching where they are walking. Most of these will be minor, however a number of more severe accidents have made headlines such as people walking off cliffs and crashing cars whilst playing the game.
    2. Safety concerns. Criminals have got wise to the game and have been targeting victims at hotspots for players. Also there are safety concerns for children wandering off on their own hunting for Pokémon and potentially finding themselves in dangerous situations. In addition, there have been a number of complaints by homeowners who have found players trespassing in their gardens whilst hunting for Pokémon.
    3. Potential lost productivity from excessive game-play detracting from work/studying.

Do the above drawbacks outweigh the potential benefits? Assuming they do not and the game does prove to have positive health benefits, this could be a very cost-effective intervention as it is free for the individual to download (providing they already have a compatible smart-phone and are not lured by the in-game purchases) and poses no cost to local authorities who currently oversee public health in England. The largest cost is borne by the producers of the game who will surely recover that in revenue obtained from the game directly and indirectly (Nintendo’s share price shot through the roof since the launch of the game). Whilst the novelty of Pokémon Go will surely wane eventually, this is just a glimpse of what augmented reality can do. If technology can be harnessed to effectively incentivise healthy behaviours could we be looking at the new face of public health interventions? Watch this space as I guarantee there will be analyses conducted to attempt to answer this question once substantial data become available. In the meantime, I’ve got some Pokémon to go catch…


Augmented Reality (AR): The integration of digital information onto a real life environment. In the case of AR in Pokémon GO the player can see their surroundings on their phone screen (through use of the phone’s camera) whilst digital images of Pokémon pop up on the screen, so it looks like there is a creature on the path in front of you.

Augmented reality in action

PikachuPokémon: Little monster-like creatures that can be captured by “trainers” and trained to battle against each other. Each different Pokémon has a name, type, evolutionary path and special fighting moves that can be used to battle against other Pokémon. The franchise has existed since the 1990s where it started as a game for Nintendo’s Game Boy (a handheld video games device); since then expanded into a card game, TV shows and even several movies.

Pikachu: A small, yellow, lightening-type Pokémon that can shoot lightening blots from its cheeks. Pikachu is probably the most recognised of all the Pokémon.