This post was inspired by a brilliant 2018 SXSW panel discussion on default options in health among Karen DeSalvo, Thomas Goetz, Andy Chim, and Ryan Panchadsaram

Increasingly the market share of options available to us are poor options when it comes to our health. Our default options too often push us further from health.

An example of a default option is the availability of escalators in meeting venues. The majority audiences at major meetings take the escalator between mezzanines and floors. When stairs are the only option we move closer to encouraging healthy behaviors. Urban design and land utilization can similarly shape community standards of behavior. Fewer spaces for parking force alternative means of getting to work.

Defaults can be the simple choices we make like food availability. When the only option is diced fresh fruit as a snack, kids choose fruit in the face of nothing. As I tell mothers in my clinic, Twinkies don’t fly into the shopping cart. We put them there.

How can companies, governments, and individuals create better default options? How should choice architecture be part of the way we shape our environments?

This isn’t healthcare but health. It’s shaping lifestyles by design. This seems like the perfect space for design thinking in health care.

There is a brilliant review on the subject in The New England Journal of Medicine. Despite the call-to-action for the more aggressive use of defaults in health, over a decade later we’re still thinking about how we can pull this off.

Our current approach to default options in health care has itself been too passive, and opportunities exist throughout the health care system to use these options more strategically. We urge health care providers and consumers to seek out default options in their own domains of ex- perience and to ask whether these options are serving their intended goals.

The implementation of the default option should not preclude other choices. The failure to understand options can create an ethical dilemma in both business and health. See The Subtle Power of Default Choices in Fast Company for the angle on defaults gone wild.