Game changer? World Health Organization recognises the global impact of addictive technology
News that the World Health Organization (WHO) has added 'gaming disorder' to its list of known diseases hit the headlines last month. Health expert Anna Glayzer asks what it means for consumers, and how companies might react.
The WHO updates its International Classification of Diseases (ICD) every decade or so, adding new conditions in order to track trends, to increase health professionals awareness and to improve access to treatment and prevention. In 2018, it added ‘gaming disorder’ to its latest revision, ICD-11, defining it as “a loss of control over gaming behaviour; prioritizing gaming over other activities; continuing or even increasing time spent gaming, despite negative consequences”.
The definition will sound familiar to many. Already in the news before the WHO classification has been the addictive popularity of the free online game Fortnite, played by more than 125 million players worldwide. Something of a moral panic has surrounded the game in recent months, with stories of compulsive use of the game, and even the need for children to enter rehab to cure their addiction.
Addiction to technology is nothing new
Concerns about excessive use of technology is nothing new, and can be traced back to the emergence of television as a dominant media. Studies on the social and educational impact of television watching date back to the 1950s and fears about excessive television watching regularly emerged in the following decades. Levels of concern about excessive gaming, along with use of the internet, computers and other devices have been on the rise among health professionals around the globe for years.
Although yet to be classified as a disease by the WHO, excessive use of technology is recognised and treated in some countries. South Korea says internet addiction is the largest health problem experienced among kids. In China there are estimated to be more than 26 million internet addicts. China, Taiwan, India, Singapore and South Korea all have special internet addiction centres, with more than 300 in China alone. In Europe, a study commissioned by the German federal drug agency suggested 28 per cent of children in the country either are addicted to their smartphone, or soon will be.
In 2014, an expert WHO meeting identified a list of potential physical and social consequences of excessive use of the internet, computers, smartphones and other electronic devices. Impacts on physical health include increasingly sedentary lifestyles (linked to increased obesity), damage to vision and hearing, accidents caused by lack of concentration and musculoskeletal problems associated with sitting or lying in the same position too much. Psychosocial health impacts identified included exposure to cyber-bullying, poor social development, sleep deprivation, risky sexual behaviour, aggressive behaviour; plus, a whole range of other social and psychological problems such as poor psychological well-being, poor self‐confidence, family problems, marital breakdown, reduced work and academic performance.
So why has gaming disorder made it onto the WHO’s official list now? The answer lies partly in it being easier to define and measure than other types of tech related ‘behavioural addictions’ such as more general internet or smartphone addiction. It also lies partly in the evidence regarding the number of cases already being treated. National surveys have shown prevalence rates of gaming disorder or addiction of 10%-15% among young people in several Asian countries and of 1%-10% in their counterparts in some Western countries.
What makes gaming so addictive?
Much has been written on what makes gaming so very compelling. Complex and carefully designed reward systems within games help to keep players hooked, as does the creation of strong bonds with fellow players in the community.
For example, in most online first-person shooter games, gamers earn rewards like improved weapons and weapon attachments, based on their in-game performance and total time spent playing. The rewards get higher the longer you play. These rewards enhance gamers’ abilities and improve their public standings. Often, the public and collaborative nature of these games increases pressure on gamers to keep up regular playing.
Perhaps more alarming is that games, apps, platforms and devices themselves are being designed to be addictive; and this affects all of us, not just avid game players. Social media platforms rely on monetising consumers’ data, by capturing their attention which means they are constantly looking for ways to keep people clicking. The Center for Humane Technology represents some of a growing number of former Silicon Valley designers who have had second thoughts about the impact of their work. They describe how they “use increasingly persuasive techniques to keep us glued. They point AI-driven news feeds, content, and notifications at our minds, continually learning how to hook us more deeply—from our own behavior”.
These hooks might be features like autoplaying the next song or video, totaling up the number of days you have engaged with an app, pull-to-refresh feeds and red notification dots are all designed to pull in and hold our attention.
Is there a solution?
Platform providers who don’t rely on attention and data monetization as their core business model can make a difference by redesigning services to shield people from constant distractions. To some extent, Apple and Google have started to incorporate things like screen time reminders and enhanced ‘do not disturb’ functions to enable people to manage their online time better. Third party apps can also help consumers reduce continual usage, as can simple steps like turning the colour settings on your phone to grey to avoid seeing the red dot notifications. Parents concerned about children playing games or being online too long can use apps that set timers for the family, and are advised to turn off the Wi-Fi at night and instill the idea of good “digital hygiene”.
For the small minority to whom the WHO classification is intended to apply however, for whom gaming has completely overtaken their lives, the above is of less relevance. Treatment interventions related to internet use disorders and excessive use of the internet and electronic devices include Cognitive Behavioural Therapy (CBT), group therapy, family therapy, and pharmacotherapy (often targeting comorbid conditions such as ADHD, anxiety and mood disorders).
Some countries have policies in place to try to prevent gaming disorder from developing. Country examples for national information policies and strategies include the regional “Gamer guard” in Thailand, and the “Fatigue system” policy in China, whereby players gain no experience points in the game of choice after 5 hours of playing. Examples of integrated national plans and policies include Belarus’ governmental programme for treatment of internet dependence and South Korea’s 2nd master plan for prevention of internet addiction.
Will the WHO classification make a difference?
The ICD-11 has still to be endorsed by the World Health Assembly in May 2019. The publication in June 2018 was met with objections, unsuprisingly, from the global video games industry, arguing that up to two billion play video games without it becoming problematic, and that there are benefits to playing games.
There has been some debate among experts as to whether the inclusion of gaming disorder on ICD-11 is premature, when so much more research into what is still such a new field is needed. It’s worth keeping the purpose of putting it on the list in mind. According to WHO: “The intention behind including a new condition on the ICD-11 is so that it will result in the increased attention of health professionals to the risks of development of this disorder and, accordingly, to relevant prevention and treatment measures.” It’s also argued that inclusion on the ICD will ultimately lead to more access to treatment.
Despite objections from the gaming industry, and despite the fact that gaming disorder only affects a very small minority, the evidence from around the world suggests people are suffering from this condition and - with gaming on the rise in all regions of the world - more are likely to in the future. More research, more understanding and more access treatment are needed, along with effective, evidence-based policy making. Anything that helps generate this should be welcomed.
As new technologies become a part of consumers’ lives and their impacts begin to become clear, consumers, businesses and policy makers alike need to be willing and able to respond.