Jonah Berger’s fourth principle of contagious ideas is “public,” making our products and ideas observable. Berger explains that human herd mentality pushes us to adopt the behaviors that we can see. So if you want something to spread, make it visible. Monkey see, monkey do.

And of course, any book on contagious social behavior must include Apple—so here we are! In this chapter, we learn that the logo on Apple computers was once flipped such that nearby observers would see an upside-down version of the company logo when laptops were open an in use. Applying principles of observability, Apple designers decided to flip the logo orientation such that onlookers would see the Apple trademark right-side up. The beauty of Apple’s decision was that the product design itself served as a marketing tool. (Apple’s decision to sell white headphones instead of following the industry standard of black headphones follows similar principles. When you see someone with white headphones, you know that person is an Apple customer (and you are more inclined to mimic their behavior.)

Apple’s clever design decisions created what Berger would call behavioral residue—the physical traces that most activities will leave in their wake. Lululemon understood the power of this concept when they decided to bag customer purchases in reusable shopping bags instead of flimsy plastic or paper bags. The company knew that the customer would feel compelled to save the bag for grocery shopping and running errands, advertising the Lululemon brand while they were out in public. My favorite (non-consumerist) example of behavioral residue are “I Voted” stickers.

In the public health world, we can leverage this concept by making private thoughts and behavior publicly visible and vice versa. Take binge drinking among college students as an example. Most people know binge drinking is terrible for your health, yet 44% of students binge-drink. What’s the underlying psychology here? Students think everyone around them is binge-drinking because they see kegs at the frat house etc., so they partake in the behavior. (Monkey see, monkey do.) There’s social proof that compels students to drink. What students cannot see are their peers who are not at the frat party (instead sleeping and spending time in their rooms), and the fact that everyone around them hates binge-drinking as much as they do because behavior is public, and thoughts are private. Instead of designing public health education initiatives that tell people what they know (binge-drinking is bad), we may be better off trying to tell college students that in fact, their peers share similar mindsets! The stunning reality that in fact, no one likes binge-drinking.

However, if we’re not careful, the concept of publicity can easily backfire. One public-health centric example is Nancy Reagan’s “Just Say No” anti-drug use advertisements. Reagan’s public service announcements showed footage of teenagers smoking and their peers telling them “no.” However, researchers found the PSAs increased marijuana use among young adults. The theory driving this behavior goes back to public vs private behavior. All of a sudden, a once private behavior (marijuana smokers trying to avoid being seen) became wildly public (broadcasted on TV).

Understanding the private/public dichotomy in behavior can help us design products and processes that help to destigmatize certain health-related social behaviors. There are many relevant lessons here for the Help Desk, a GANDHI third year initiative to help connect patients to community-based organizations and support their social determinants of health needs. Think about the WIC debit-style cards which replaced paper food stamps. By turning a former public behavior (paying at a grocery store with pieces of paper) into something more private (swiping a debit card, just as any other customer might), low-income people could feel less stigmatized for partaking in this welfare program.

The Help Desk should consider the observability of its own physical presence with community partners. Increasing our visibility at the health clinic (I hope) would make seeking help on social determinants less stigmatized and allow patients to feel more comfortable in proactively looking for assistance from the Help Desk. Further, having a presence in the local community may remind patients to follow-up with referrals. How should we consider building our initial presence? Marketing visuals (e.g. logo, permanent signage)? Notes on patient take-home files?

As Berger notes in his chapter, if something is made to show, it’s made to grow.

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