Measuring the Health Impact of Consumer Products and Services

Which companies have the biggest impact on Americans’ health? Drug companies? Hospital systems? What about restaurant chains like McDonald’s or Chick-fil-A? Or how about Netflix? Or Facebook? The epidemic of chronic diseases, such as diabetes, heart disease, obesity, and depression, has been linked to health behaviors such as our diets, our physical activity, our sleep patterns, and even our social behavior. And these behaviors are influenced by the products and services in our lives. But which products have positive effects, which have negative effects, and where are the opportunities for improvement? We at Building H, a project of the nonprofit Public Health Institute, looked at all these questions in the 2024 Building H Index, a rating and ranking of more than 75 popular products and services across four industries, and offer a few thoughts below on ways state policymakers can use this information. 

The products and services of everyday life — in industries such as food, entertainment, and transportation — shape our daily behaviors: how we eat, sleep, move our bodies, and socialize. Fast food high in calories, sodium, fats, and added sugars can lead to diet-related illnesses; binge-watching television can lead to physical inactivity, lost sleep and even unhealthy snacking; the new wave of online order and delivery services can contribute to social isolation and feelings of loneliness. All of these industries have health impacts on their customers and those impacts can result, over time, in chronic diseases whose treatment costs hundreds of billions per year.  

Currently, companies do not have strong incentives to design their products to generate positive impacts on health. Consumer product regulation is anchored in a safety paradigm: if it is too dangerous to use or too toxic to consume, its use can be banned or otherwise limited. This paradigm is not helpful in preventing chronic diseases that result not from individual uses of individual products but rather from the aggregate impact of the use of many similar products, accumulated over time. No one develops diabetes after eating a single meal at a fast food restaurant; people can, however get sick from eating 25% of their calories from fast food restaurants for 10 years. To create stronger incentives for companies to offer products with positive health impacts — or at least mitigate their negative impacts — we need public policies that will create accountability for any company’s contribution to the collective impact on the public’s health. 

The Building H Index 

The 2024 Building H Index rates and ranks products and services across the entertainment, food, housing, and transportation industries based on their impacts on five health behaviors: eating, physical activity, sleep, social engagement and spending time outdoors. It covers products from companies like Apple, DoorDash, TikTok, GM, Uber, Burger King, and Nintendo. We researched each product, examined the scientific literature for studies linking use of certain types of products with any of the five behaviors, and conducted original consumer survey research on product use, health behaviors, and how they are connected.  

We generated analyses of how each product affects each of the five behaviors and then engaged nearly 200 volunteers form the public health, health care, and health policy communities to score the impacts. Each product got an overall score between 0 (strong negative impact on all five behaviors) to 100 (strong positive impact on all five), with 50 representing a neutral impact. The top scorer was Culdesac (82), a real estate developer that has created a car-free community in Arizona that emphasizes outdoor social spaces and recreation. At the bottom was Netflix (18), which scored negatively on all five behaviors. Overall, we found that the impacts are real and are widespread: most products affected most of the five behaviors. The effects were not all negative: many companies scored positively, and within each industry, we found outliers that had positive impacts on several behaviors.  

Some findings — that many fast food chains and food delivery services had many negative impacts, for example — were not surprising, yet still troubling. Entertainment services — including video streaming, social media, and video game consoles — were a major concern, with all but one of 20 services scoring negatively. Of most urgent concern was our finding on the role of technology generally and of AI specifically. Too often they are being used to make unhealthy behaviors easier or to push greater consumption. The most cutting-edge technology in the world is being applied to get people to eat more fast food, watch more television, and avoid interacting with other people. These new technologies will shape everyday life in profound ways and if they are not harnessed to support healthy behaviors, we could further engrain unhealthy lifestyles in our society. 

Policy Opportunities 

We’re at an early stage in understanding the impact of everyday products and services on the health of their users. At this time, the most important activities states can undertake are to: 1)  shed light on the issue, 2) encourage or require greater transparency for consumers and 3) create incentives and greater accountability for these impacts. Policymakers can: 

• Undertake fact-finding efforts to better characterize — and even quantify — the impacts that different industries and types of products have at the societal level – in terms of costs, lives lost, and the burdens of illness. Policymaker attention would create greater urgency to address the issue, and quantifying impacts in terms such as economic costs or lives lost would give policymakers vital information about the scale and importance of the problem. 
• Press companies on the need for them to track and ultimately disclose usage patterns and associated user health behaviors. Companies capture a vast amount of data on how their users interact with their products and services, much of which are relevant to the products’ impact on health but are not disclosed. And some impacts, such as how a product affects a user’s sleep, might not currently be captured but would be important to know. Signaling to companies that they should, at a minimum, understand these impacts would be a first step toward establishing greater accountability for health impacts.  
• Focus attention on the company practices and design techniques that encourage unhealthy behavior or unhealthy consumption and likewise spotlight practices that lead to healthier behaviors. Chain restaurants often prompt users to add additional food items after they complete their orders and video streaming services autoplay next episodes to encourage binge-watching, but on the positive side, smartphone operating systems offer users the ability to set a regular bedtime to promote better sleep. By calling attention to these practices, their purposes and their impacts, policymakers can help to shift norms about their acceptance. 
• Support research to understand better the links between use of certain types of products and services and resulting health behaviors. The links between some products and health behaviors, such as fast food and consumption of unhealthy ingredients or television and a lack of physical activity, are generally understood, but in many cases, there is a need for additional research that can provide a deeper understanding of the degree of influence, any mitigating factors, and how the impacts vary across the population.  

The products and services of everyday life have a strong influence on the health behaviors of their users, as the Building H Index demonstrates, and those health behaviors can in turn lead to chronic illnesses that we treat and manage at great societal cost — both in terms of money and in human suffering. As new technologies such as AI emerge and are integrated into new products, they will transform everyday life and thus transform health. Whether they will build a future that makes it easier for people live healthy lives depends on leadership at all levels. It depends on leaders actively prioritizing health and ultimately adopting policies that encourage development of products and services that support people to live healthy lives.