Life lessons

Virtual 3-D communities such as Second Life present health care educators a chance to experiment with new ways of interacting with the public

The Centers for Disease Control and Prevention (CDC) spent nearly $40 million on marketing last year to educate people about its work and encourage them to lead healthier lives. So a $73 expenditure wouldn’t normally catch anyone’s attention, much less create a buzz — except that the money was used to buy a parcel of land in a virtual world known as Second Life.

Today, CDC’s small presence in Second Life is sparking ideas for ways to use this immersive social networking site to improve health care.

For CDC, the Second Life investment is part of a larger effort to take advantage of as many technologies and media as feasible to get its health message out to as many people as possible.

“We want to make CDC’s science and research more engaging and more interactive and to use the new channels that changing technology is providing us,” said John Anderton, acting associate director of communications science at CDC’s National Center for Public Health Informatics.

Although it is only one of 26 virtual worlds that have been created in the past several years, Second Life has become the most visible and fastest growing. Created in 2003 by Linden Lab, a San Francisco-based software firm, the site is a virtual community with a real economy (underwritten by Linden dollars), property ownership and avatars (powered by real people) that drive, fly and walk around, engaging in many real-life interactions and activities.

Since February 2006, the site has grown from 175,000 users to more than 6 million, and major corporations, nonprofit organizations and government agencies are starting to pay attention. Coca-Cola, IBM, Mercedes-Benz, W Hotels, the National Science Foundation, the National Oceanic and Atmospheric Administration, and Live2Give all have a presence there.

The next big thing?
David Ellis, corporate director of planning and future studies at the Detroit Medical Center, said he believes virtual worlds could be the next big thing in the Web’s evolution, despite the fact that Second Life and other virtual communities aren’t yet close to delivering major results.

Furthermore, the sites often freeze and crash, primarily because the underlying computing environment can’t provide the needed power and bandwidth.

After those issues are resolved, though, such virtual worlds will provide the simulated experience of 3-D or holographic systems. They will also incorporate haptic technology, which simulates the sense of touch.

“This is coming, and I think it’s going to make a huge difference in how people relate through technology,” Ellis said. “It’s basically [the equivalent of] going from reading an e-mail from someone and being in the same room with that person. People are able to communicate on a much, much more intimate level.”

Ellis said virtual worlds could have major ramifications for the health care industry. For example, they could add another dimension to telemedicine by enabling physicians to have face-to-face conversations with patients. Haptic technologies and sensor-laden bodysuits could create ways for physicians to perform physical exams remotely. They will also be able to consult with one another on a patient’s care, sit in on a cutting-edge surgery or attend medical conferences without leaving their offices.

Randal Moss, manager of futuring and innovation-based strategies for the American Cancer Society, said virtual worlds offer more than supercharged vehicles for delivering health care services. They also have the potential to increase the quality of life for patients with physical and mental disabilities and those with socially challenging conditions such as autism, agoraphobia and Tourette’s syndrome.

“You can have rich, healthy social interaction in this space,” he said. “So this can be an acclimator, something that can help people who struggle with real-world relationships incubate an understanding of social context. And when you talk about people with physical handicaps and physical limitations, it almost provides a sense of normalcy. It’s a very powerful medium, and there will be new and productive uses of it as time goes on.”

Testing the virtual waters
Of course, that vision is far in the future. But that hasn’t stopped health care organizations from dipping a toe in the virtual waters. For example, the National Institutes of Health has a small site on Second Life’s HealthInfo Island, and the March of Dimes is in the process of setting up a virtual neonatal unit.

The American Cancer Society, which has a virtual office in Second Life, hosted a virtual Relay for Life last year and raised $41,000 for cancer research. Moss expects the event to top $75,000 this year and involve at least 2,500 participants.

And the Detroit Medical Center will set up a site in Second Life in the next three months that will feature health information and doctor referrals. “We’re taking baby steps,” Ellis said. “The good news is you’re not asking your organization to take a chance on something that involves millions of dollars. By technology standards, this is really inexpensive.”

Nevertheless, no one is ready to plunge in headfirst. CDC’s Second Life site is quite small, akin to an informational booth in the atrium of a large hotel, Anderton said. But it’s enough to offer basic information about CDC programs and grab the attention of passersby.

Visitors can walk through a virtual gallery of public health posters and take a poster with them, or they can watch a short video about CDC’s National Center for Health Marketing. By clicking on a link, they can go to CDC’s Web site, where they can view the Morbidity and Mortality Weekly Report and learn about health topics, such as seasonal flu.

The site even has a part-time tour guide, an avatar named Hygeia Philo, Greek for “lover of health,” who can answer questions and show visitors what resources are available on the site. Anderton paid an extra $1 to provide her with a professionally appropriate outfit, but because the site attracts only 100 to 150 visitors a month, he said he doesn’t think it warrants the employee resources required to keep the avatar on-site around the clock.

CDC also takes advantage of Second Life’s social and entertainment events. The agency held a virtual health fair in October 2006 and attracted 80 people seeking information on specific diseases. It also participated in a virtual trade show that drew another 240 people.

“People like the social congregation aspect,” Anderton said. “They like to go where other people are, and if that’s where they are, we want to try and interject some health content into some of those places.”

CDC has also extended its health marketing to the virtual community of Whyville, a slightly older site that requires less computing power and bandwidth and is targeted to a younger demographic. Elementary and middle schools, in particular, use Whyville to augment their curricula.

Last fall, CDC partnered with Whyville officials as part of a campaign to teach students about the seasonal flu and the importance of getting vaccinated. The program, which ran for six weeks and cost CDC $2,400, involved an avatar giving flu shots to children at a clinic.

Children who participated were given the opportunity to have their avatars vaccinated. Avatars of children who didn’t opt for the shot eventually got the virtual flu, sporting red spots on their faces and sneezing whenever they tried to talk. The condition lasted five days.

Ultimately, 20,000 children were vaccinated, but more than 170,000 visited the area during a six-week period. Erin Edgerton, content lead for interactive and new media at CDC’s Division of E-Health Marketing, said the medium’s qualities of immersion and social networking add to the educational experience in a way that makes knowledge stick with students longer.

“This activity had some impact on their virtual avatar, how they interacted with people and their experience in the world, and so really they had a vested interest in this activity and learning more about it,” she said.

Edgerton said CDC wants to expand its presence in virtual worlds, create content that capitalizes on the unique aspects of the medium, and help people learn about disease prevention and health care.

To virtual infinity and beyond
Second Life and other worlds have the challenge of overcoming the perception that the sites are little more than entertainment and game-playing venues. And that challenge will be especially great when it comes to getting overworked physicians and other health care providers to take the medium seriously.

Determining whether the medium is truly advantageous to medical care and collaboration will require a lot of research and testing.

“The whole thing is still a bit experimental,” Anderton said. “But the best part of it is that it’s a learning space, so as people come up with applications for it, we can examine them and ask: How would that work? Is it safe and secure? Does it advance the doctor/patient relationship? The fact is these are just new ways to reach people and generate new attitudes and new ways of learning. We’d be remiss not to try them and see what their potential is.”

Whether it is good for society to have people spend a large part of their lives in virtual worlds relating to one another via digitized images is something the philosophers, sociologists, politicians and economists will need to debate, Ellis said.

However, for someone looking for ways to use technology to advance health care, immersive technology has no negative ramifications, he said.

“If you think of medicine as the ability to improve the health and lives of people, I see only upsides to the application of Second Life and similar environments to medicine,” he added.

A sense of (virtual) communityThe number of virtual worlds in cyberspace is growing. Although they all offer immersive 3-D experiences, they differ in their targeted audiences, atmosphere and activities.

Here is a sampling of some of them.
  • Second Life. Created and owned by its residents, this virtual world allows its participants to do anything they can do in the real world, including attend events, play games, buy and sell items, and open businesses. It has more than 6 million users (average age: 32) and an international flavor, with users hailing from more than 100 countries.
  • Whyville. A leading virtual world for boys and girls ages 8 to 15, the site encourages its citizens to learn and play, with an emphasis on activities that require a team-based approach to solving problems. It has 1.7 million users, with girls outnumbering boys 2-to-1.
  • Activeworlds. This site hosts a universe of more than 1,000 virtual reality worlds. Participants can play games, shop, make friends with people from all over the world and even build a virtual home.
  • Cybertown. The cyberpunk genre of literature and film has influenced this virtual world’s futuristic science-fiction theme. More than half a million cybercitizens build homes, hold jobs and participate in the community’s elaborate political system.


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