Go directly to jail, skip 1 turn, and do not pass go



You can read the original Dutch essay here.

Poverty manifests itself in many forms and starts with an unfair distribution of opportunities in life. It touches me that certain groups always start 2-0 behind. As a healthcare designer, I am particularly concerned with health inequality.

Health inequality is a deep-rooted phenomenon that disproportionately affects people in poverty, including in our country. It is not an isolated problem, but a complex interplay of various factors that maintain and reinforce each other. 

The solution therefore transcends the need for new Chance cards for a game that is not played fairly. It requires a more structural approach. 

How can we as designers contribute to understanding and addressing the factors that perpetuate health inequalities, to shape a structurally fairer playing field? That, if possible, also looks good.


People in poverty live in unhealthy living conditions. They have less access to healthy products. Due to long-term financial worries, they are more likely to suffer from chronic stress. This also puts them at greater risk of mental complaints and chronic diseases, such as cardiovascular disease or diabetes [1]. The cancer atlas of Dutch cancer research center IKN shows how cancer is more common in the poorest neighbourhoods of the country. This makes it painfully clear that health inequality is linked to poverty, lower education and poor living conditions [2].

The biggest risk factors for preventable death are, in order: smoking, lack of exercise and low socio-economic status. The first two now occur much more often in the last group [3]. After all, people who live in poverty more often have an unhealthy lifestyle: they are more likely to be overweight, less likely to meet the exercise guidelines and drink more [1].

Health inequality is a persistent fact and is maintained by several overlapping phenomena. 

First and foremost, health inequality arises from an accumulation of problems that hinder attention to health  [2]. The theory of scarcity describes how people in poverty have less mental bandwidth to make healthy choices [4]. For example, healthy shopping within a budget requires time and mental space. 

You don’t have that when you have to make ends meet every month. In this situation, people must always respond to immediate problems and can rarely think ahead. People in poverty also avoid the risk of additional costs [5]. A preventive check-up at the dentist is postponed for financial reasons. Ultimately, this will only be achieved when the damage and therefore the costs are really great [6]. 

In addition, people in poverty are in many cases dependent on authorities and have little control over how processes operate. This causes passivity towards achieving goals [5].

The social and physical environment in neighborhoods with a low socio-economic status also offers fewer opportunities for healthy behavior. The neighborhoods are less green, there is more visible marketing for unhealthy products, there are more fast food restaurants and more tobacco sales points [7]. The fact that people in the immediate social environment live unhealthily does not help [2].

Moreover, preventive or health-promoting measures often appear not to suit people in socially vulnerable situations. People are mainly reached who can easily be persuaded to take prevention measures. Consider, for example, participation in population screening for certain types of cancer. In fact, communication campaigns around healthy behavior can even be perceived as stigmatizing by the target group that engages in unhealthy behavior. People are then even less inclined to seek help, which means that the measures even reinforce health inequality: the Matthew effect [8].

Finally, a number of different schemes have  accumulated over the years. These schemes have been created for specific needs. From the perspective of fairness, specific requirements are attached to each scheme. There is therefore a very logical explanation for each regulation in itself. However, if you look from the citizen’s perspective, all logic is lost. After all, a family is not divided into different arrangements [9] [10]. 

People in poverty already have an uneven start because developing and maintaining a healthy lifestyle is more difficult. Moreover, the preventive or health-promoting measures offered as opportunity cards appear to insufficiently reach the target group. Finally, the rules of the game are too complex to understand.

It is an illusion to think that as designers we will eliminate inequality from the world with our “design skills”. Yet I believe that we can make an important contribution. 


Behavioural science teaches us that people can live healthier lives if this is made as easy as possible. By working together with behavioural scientists, we as designers can, for example, shape environments that encourage movement.

With design research we can identify which factors play a role in unhealthy food choices. We could develop communication that motivates people to participate in population research. Or we could come up with completely new concepts to help people make healthier choices. 

The following example illustrates how design can have a positive impact on children’s eating habits at school. The designers of Greater Good Studio investigated why children in the school canteen did not empty their plates. They observed the canteen and captured the perspective of the children themselves by having them wear Go-Pros on their heads. The waiting line at the food counter turned out to be the problem. The children stood in line for a long time, but then had to choose what they would eat in just a few seconds. Even though they could barely see over the bar. Concepts were devised, prototyped and tried out with the children, their parents and the canteen employees. Ultimately, a new model was implemented. From now on, each course was brought to the tables on a kind of elongated plateau. This gave children time to choose and they could take a bowl from the platter themselves. Children ate better and started eating a more balanced diet. It was also found that they ate up to 13% more vegetables [11]. The example shows how the way a service is designed has an effect on behavior.

In addition, we can help shape tools that experts in the neighborhoods can use to help people develop and maintain a healthy lifestyle. 

An example of this comes from our own design studio: “De Beweegkring”. This arose from the ambition of the Kenniscentrum Sport en Bewegen (Sports and Exercise Knowledge Center) to ensure that more people would comply with the exercise guidelines. Together with behavioral scientists and in co-creation, the core message “Bring movement into your day, it’s easier than you think!” was devised. With the exercise circle, professionals can help people map out what they already do in a day. Together they look for opportunities to do more. Instead of prescribing what someone should do, the concept starts from what someone already does. For someone who never plays sports, participating in the annual street run may be a bridge too far. But someone can exercise more by taking the children to school by bike, taking the stairs more often or going for a walk during the lunch break [12].

Finally, drawing on behavioral science, anthropology or sociology, we can look at completely new ways to make it easier for people in poverty to make healthy choices. 

The following example of the way food aid is offered in Belgium and the Netherlands inspires us to think about new concepts for aid. Since the creation of food banks in the 1980s, food aid has taken the form of food parcels. These can be picked up. Shame and stigma often form a barrier to queuing at the food bank. Location or pick-up time can also form a barrier. In addition, the packages are not tailored to a balanced weekly menu for the family. The Rotterdam project “Better Eating” wants to make healthy food accessible to everyone. The households receive a normal debit card with a weekly budget. 

They can use this budget in a regular store for healthy (or better, “not extremely unhealthy”) food. They scan the receipt with the app. When the products meet the conditions, the amount spent will be replenished. In a pilot, participants experienced less shame because they no longer had to wait in line. The payment interaction at the cash register also went unnoticed. There was flexibility in where, when and which groceries they can get. The certainty of a weekly budget for healthy food also caused less stress. After all, parents felt they were taking better care of their children. They were grateful that they could now buy healthier products. After all, they experience that these are often more expensive [13] [14].

By working together with behavioral scientists, among others, we as designers could help shape environments that stimulate healthy behavior. We could work on tools that help care providers use behavior-changing principles. And we can think about completely new concepts to make the healthy choice the obvious choice. 


The best way to ensure that a solution meets the living environment and needs of end users is to involve them  in the design process. “The people closest to the problem are the closest to the solution.” [15].

We may rely on behavioral science, anecdotes or experience, but we will not really understand what it is like to live in poverty. Co-creation or investigative design is one of the most powerful tools designers use to ensure that people feel heard and involved. Questioning the target group is one thing. But working together on the solution, testing it together and implementing it together creates ownership

In a design study, we worked with young adults with acquired brain injury to look for solutions to the challenges they experience on a daily basis. We noticed that the young people also started sending emails with ideas between sessions. They created a WhatsApp group among themselves and after the sessions they stuck around to exchange ideas with each other.

The success of the Groningen Active Aging Strategy (GAAS) also inspires to think about how different target groups can best be involved. It was found that elderly people in deprived neighborhoods exercise less and become lonely. Moreover, there were difficulties in reaching the target group with preventive measures. The elderly themselves felt that they were not so bad off. They were proud that they managed to make it with their modest financial resources. To reach them, they wanted to connect with this experience. People therefore went door to door to recruit participants for an exercise group. They were asked who else could be invited in the area. This turned out to be an initial success factor. They then focused on creating a group culture by making the participants themselves responsible. They felt ownership of the program and they managed to transfer project responsibilities to the groups themselves. The elderly started exercising more and had more leg strength and endurance. Four years after the start, all seven exercise groups still existed. The participants themselves covered the modest costs for an instructor and space. Moreover, it was seen that the healthcare costs of the participants decreased, while those of the control group increased [16].

Furthermore, how we identify ourselves and whether something fits in with our daily reality largely determines whether we feel addressed. Through user research, designers test whether the message, tone of voice and visual appearance of a design are understood and accepted. 

In the design process of an app for COPD patients, we tested various concepts with the target group. We wanted to ensure that the app was also accessible to older, more tired or less digitally skilled patients. Ultimately, a conversational interface was chosen. By shaping the interaction with the app as a conversation, it became more accessible for patients [17].

When designing information or interfaces, you can take a B1 language level, clear step-by-step instructions and simple drawings into account. However, you can only be sure whether information is understood when you test the design with the end user. 

I believe that designers can play a role in the accessibility of preventive or health-promoting measures through co-creation and user research. Involving the target group is the way to ensure that the solution actually meets their living environment and needs. Working together on the solution creates ownership.


Service designers shape the most streamlined customer experiences for airlines, fast food chains or coffee houses. We could also use that power to shape access to help, care and health. We could lower barriers by simplifying procedures. We could literally and figuratively bring help closer [5].

 “Don’t make me think ”, based on the book of the same name by Steve Krug, has been a well-known principle in UX design for years. The author wanted to indicate that user-friendly software helps its users to achieve a goal quickly and intuitively [18]. In the same way we can also look at the stacking of governmental schemes and their desks. 

Designers can draw out a service step by step and literally put it on the table. This creates an overview [19]. Visually representing a service or process helps to quickly involve everyone. I learned this in various design processes for hospitals. In this way, teams can get a grip on the process together. It opens the conversation to identify where and how things could be improved. How do people get to the right place? What administrative hurdles are there? Can we eliminate unnecessary steps? What information is already available earlier in the process and therefore does not need to be supplied again?

Furthermore, those involved become aware of each other’s roles and dependencies, allowing collaboration to be better streamlined. 

Finally, the way we visualize and frame the process can also inspire new ideas. For example, when designing an improved admission process for a psychiatric hospital, we saw that “Waiting time” is a very passive way of looking at the time between the decision to admit and the moment of admission. We framed this as  “pre-recording”. That  opened the conversation about what help could be provided in the meantime.

Designers could therefore help to map the steps that make up a service or scheme. This helps to identify, together with policy makers, care providers and other stakeholders, where and how things can be improved. Finally, procedures can be simplified and made easier to understand.   


Health inequality is a deep-rooted, persistent problem that disproportionately affects people in poverty. I see a role for designers as creative problem solvers in removing the barriers to healthy behavior and care. We can’t do that alone. We must do it together with behavioral scientists, policy makers, care providers, and the target group itself.

This way we can make healthy behavior easier. We can ensure that measures, which are offered as Chance cards, help the right target group. Finally, we can contribute to simpler rules that are easier to understand. Because health inequality is maintained by an interplay of factors, each of these issues will have to be addressed. This way we can arrive at more structural solutions.  

Without pretending that designers will sweep health inequality off the table with one stroke of the pen, I believe that we can make a valuable contribution to a structurally fairer game.  

With special thanks to 
the designers of Panton 
Alexander Van Hoof 
Thirza Andriessen 
Tine Claes


[1] RIVM, “Cijfers en feiten over de relatie tussen armoede en gezondheid,” nd. [Online]. Available: https://www.loketgezondleven.nl/gezondheidsthema/armoede-schulden-en-gezondheid/latie-armoede-en-gezondheid . [Accessed August 25, 2023]. 
[2] W. de Kanter, “AD,” January 24, 2023. [Online]. Available: https://www.ad.nl/home/in-armere-ongezondere-wijken-voel-je-in-elk-geval-even-geen-stress-als-je-rookt~ae3350c3/ . [Accessed October 1, 2023]. 
[3] L. Stalpers, “Effectieve preventie pakt allereerst roken, weinig bewegen en armoede aan,” Tabeknee, May 2, 2022. [Online]. Available: https://www.tabakne e.nl/nieuws/item/2559-eeffective-prevention-pakt-allereerst-roken-weinig-bewegen-en-armoede-aan . [Accessed September 20, 2023]. 
[4] vzw Vlaams Instituut Gezond Leven, „gezondleven,” 2023. [Online]. Available: https://www.gezondleven.be/themas/voeding/voedingongelijkheid/wat-is-voedingongelijkheid . [Accessed September 1, 2023]. 
[5] j. Laan, M. MSc. Dr. van Doorn, W. Goede and R. MSc. Dr.van Geuns, “Een gedragsgericht benadering van armoede,” October 2017. [Online]. Available: https://www.hva.nl/binaries/content/assets/subsites/kc-mr/publicaties/armoede-stromen/een_duursgericht_Approach_van_armoede.pdf . [Accessed September 1, 2023]. 
[6] J. Gordijn, “Lagere inkomens hebben slechtste mondgezondheid en gaan het minst naar de tandarts,” November 24, 2022. [Online]. Available: https://www.ad.nl/gezond/lagere-incomes-geven-worst-mondgezondheid-en-gaan-het-minst-naar-de-tandarts~a24190ba/ . [Accessed September 2, 2023]. 
[7] L. Wilderink, I. Bakker, A. Schuit, JJC Seidell and CM Renders, “Negen kernelementen die volgens betrokken professionals bijdragen aan het succes van Zwolle Gezonde Stad,” TSG – Tijdschrift voor gezondheidswetenschappen, no. 99, p. 61–69, 2021. 
[8] vzw Vlaams Instituut Gezond Leven, “Kunnen preventie en gezondheidsbevordering gezondheidsongelijkheid vergroten of verkleinen?,” 2023. [Online]. Available: https://www.gezondleven.be/gezondheidsongelijkheid/kunnen-Prevention-en-gezondheidsbelanging-gezondheidsongelijkheid-vergroten-of-verkleinen . [Accessed September 12, 2023]. 
[9] M. Wielaert, Composer, Nacht van … Stijgende armoede in Nederland. [Sound recording]. NPO Radio 1 / KRO-NCRV / NTR / EO / BNNVARA. 2023. 
[10] T. Claes, Interviewee, staff member of the Netwerk tegen armoede. [Interview]. September 16, 2023. 
[11] Greater Good Studio, “Designing a cafeteria experience where kids eat more and waste less,” sa. [Online]. Available: https://greatergoodstudio.com/projects/academy-for-global-citizenship/. [Accessed October 16, 2023]. 
[12] Panton, “De beweegcirkel. Tools om meer te bewegen,” 2023. [Online]. Available: https://www.panton.nl/project/de-beweegkring/ . [Accessed September 1, 2023]. 
[13] T. Andriessen, “Richting een waardige vorm van voedselhulp? Een studie naar de impact van ‘Beter Eten’ op de waardigheid van deelnemers,” Wageningen University, Wageningen, 2022. 
[14] T. Andriessen, Interviewee, Researcher Wageningen University. [Interview]. September 29, 2023. 
[15] E. Martin Glen, “JLUSA,” nd. [Online]. Available: https://jlusa.org/about/ . [Accessed October 3, 2023]. 
[16] L. Preller, “All over sport,” December 2, 2019. [Online]. Available: https://www.allesoversport.nl/thema/beweegstimulering/beweegstimulering-kwetsbare-ouderen-achterstandswijken-een-nieuwe-spraak/ . [Accessed 2023 Oct 10]. 
[17] Panton, “Copilot app voor COPD. Krijg grip op COPD,” 2023. [Online]. Available: https://www.panton.nl/project/copilot-app-voor-copd/ . [Accessed September 1, 2023]. 
[18] S. Krug, in Don’t Make Me Think, Revisited : a Common Sense Approach to Web Usability, Berkeley, Calif, New Riders, 2014. 
[19] J. O’Donoghue, “Designing For Social Good: How Designers Can Make A Difference,” sd. [Online]. Available: https://makeiterate.com/designing-for-social-good-how-designers-can-make-a-difference/ . [Accessed September 1, 2023].