Health: an intrinsic feature of video games

We don’t often think about it, but lives and health seems to be an essential part of playing a videogame. No matter when the game was published, unless it’s a sports simulation game, you’ll probably find some representation of your character’s health on the screen. Mario has mushrooms, Link has hearts, and Master Chief has shields.

There are some exceptions to the rules, though. In some games, you are given infinite lives or continues in order to keep you engaged in the game, so that repeated failure won’t lead to frustration. There are even some videogames where it is impossible to die, like Xbox Live Arcade’s Braid. In this game, you “die” in one hit, but you are always allowed to reverse time and get a second chance to sort out whatever killed you.

Many of today’s bestselling games display your avatar’s health in a way that attempts to fully immerse you in the game. Both Call of Duty: Modern Warfare 2 and Gears of War 2 show an increasing amount of blood spattering on the screen as you take more damage. Instead of using a simple 100-point number system to display your health, these games grab your attention by making it harder to see and move when your character is under fire.

The way health is displayed in videogames is of great interest to Alan Brooksby of the School of Medicine, Health Policy, and Practice at the University of East Anglia in the U.K. Brooksby recently published a study entitled “Exploring the Representation of Health in Videogames: A Content Analysis,” that seeks to gauge how health is displayed in games, using a specific set of measurements.

In essence, Brooksby aimed to “explore further ways in which the concept of health is represented in videogames beyond its most common usage in the interface.” When surveying gamers about the important of health displays, he found that “having a constant, onscreen representation of health was mentioned by the majority of players as an essential feature.”

Brooksby set out to measure how health was represented in a sample of 10 games, all released around 2005. He used five categories to measure health: mobility, ability, psychology, social, and pain. Mobility was any effect to your movement speed, such as a character getting shot and being forced to limp around. Ability meant that certain actions could not be performed if your character was too damaged. Psychological effects were changes in your character’s mood, be it happy or sad, based on its health. Social was measured in other non-player characters reacting to you in a different way based on your actions. Pain, which ended up being the most critical measurement, was defined as the expression of “pain behavior” such as wincing or grunting when the character was injured. Pain also included the display of red flashes or arrows pointing to wherever the avatar was being shot at from.

After playing each game for 2 hours, Brooksby filmed 15 minutes of gameplay and rated it based on these categories of health. Interestingly, these five categories are often used to rate “health-related quality of life” in many real-life patients. Brooksby’s results showed that pain was the most common representation of health in games, with 9 of the 10 games displaying it often. He noted that the games tried to give the player a sense of the “interruptive nature” of pain as they played the game. Brooksby noticed that “the representation of pain is used to halt the flow of the game, with flashes of red, cries of pain from the avatar, or the appearance of directional indicators that target the player’s attention to an in-game threat of danger or attack.” I found it interesting that only The Sims 2 showed any sign of Psychological health.

It’s interesting to discover that the representation of pain has become such a fundamental part of health in videogames. Perhaps we feel more connected to our avatar when they cry out in pain, and we want to prevent further harm from befalling our character. Brooksby notes at the end of his article that the study may have had some limitations, and the test itself was done on a very small scale. “Health is a complex concept,” Brooksby writes, “and [it] encompasses a broader range of behaviors than these five categories.” Still, his study is an interesting glimpse at one of the ways in which videogames try to pull us in and immerse us in a different world.