What the World Health Organization Has Wrong About Video Games

ESA's acting CEO, Stan Pierre-Louis, spoke recently at the 2019 D.I.C.E. Summit about how video games influence our culture, the positive economic impact the industry has, and about the World Health Organization's recent proposal to classify certain levels of video game use as a "mental disorder." 

A full transcript of Pierre-Louis' talk can be found below:

Hello, everyone I’m Stan Pierre-Louis with the Entertainment Software Association.  These days, I hold several titles. I’m in my fourth year of serving as ESA’s general counsel. For the past several months, I’ve also served as ESA’s acting CEO. But perhaps the most important designation I hold today—aside from husband, father, and old school gamer—is chief advocate for the video game industry.  

I love what I do because I love what you do. And I love to blow people’s minds bragging about our industry. We produce the most compelling, dynamic, interactive, entertaining experiences on earth. Thanks to our innovative technologies, engaging content, and the ability to connect with others, today’s video game playing population is more connected than ever before.

In terms of numbers, there are more than 150 million players in the United States, and more than 2.6 billion worldwide. 60 percent of Americans play video games daily, and 45 percent of U.S. gamers are women.  It’s easy to understand why. If you love stunning landscapes in your action-adventure games, there’s Red Dead Redemption 2. If you love sports games, there’s FIFA and NBA 2K.  And, if you’ve got a 12-year old like I do, there’s nothing like testing your skills against a pro at Super Smash Bros. Ultimate.

It seems that today, everyone wants to be a gamer.  This includes former U.S. Supreme Court Justice Sandra Day O’Connor.  She wanted to inspire kids to learn more about the political process and founded iCivics, which creates innovative games that teach civics. Her program is now the largest provider of civics curriculum in the nation, reaching nearly 200,000 teachers and more than 5 million students, in all 50 states. Like I said, this is all mind-blowing.  Stories like this are incredibly impactful—they change minds, whether you’re talking with a government official or a parent at a PTA meeting.

Our economic story is equally impactful.  In 2018 alone, the U.S. video game industry generated $43.4 billion dollars in total revenue. That figure is triple what it was in 2008. All of this growth has made our industry a source of stable, high-paying jobs for more than 220,000 people across the United States. And given that most video game companies qualify as small businesses, we are as Main Street as any other industry.  

Now, let’s be real. It’s not all rainbows and butterflies when you represent any industry. But coming out of a career in film, television, and music, I didn’t expect a lot to surprise me when I entered the video game industry. The claim that media content is corroding our society? Been there. The claim that media content causes violence? Done that. The claim that excessive exposure to video games—not all media content, just video games—could be deemed a “mental disorder?” Consider me gob smacked—and even more so after digging into this issue and seeing the quote “evidence-based findings” end quote claimed by the World Health Organization, which is spearheading this effort.

By way of background, the W-H-O is an agency of the United Nations that focuses on improving public health. Its efforts contribute to many positive advancements in global health.  Think about its initiatives to eradicate HIV/AIDS, malaria, and tuberculosis – or its work to address visual impairment.  The W-H-O also maintains a catalogue of diseases – known as the International Classification of Diseases, or the ICD – to track health developments.  These are all commendable and needed efforts.

But, over the years, the W-H-O has begun to expand its mission—and they haven’t always gotten it right.  In fact, the W-H-O has had to backtrack on its conclusions on important issues like those involving sexual orientation, gender identity, ADHD, and post-traumatic stress disorder. Some of those reversals took decades to occur. For example, the W-H-O classified differences in sexual orientation as a disease for more than 40 years. And for more than 60 years, it has classified differences in gender identity as a disease. Here’s the kicker:  when the W-H-O gets it wrong, there’s only one place to appeal—the W-H-O. So, when they get it wrong, it takes a really, really long time and a sustained effort to right the ship.

So, why is the W-H-O proposing to classify certain levels of video game use as a “mental disorder” – which they call “gaming disorder” – and what should we do about it?

Here’s what we know. The W-H-O started this effort by gathering a group of hand-selected medical experts in 2014.  The group’s task was to review the public health implications of the excessive use of computers, the Internet, smartphones, and other devices. The group began to meet yearly – and with each meeting, the focus on video games began to emerge. It is unclear why video games became their chief concern – and whether any video game experts were ever consulted.

What we do know is that there is no medical consensus supporting the adoption of “gaming disorder.”  Mental health experts who study this issue at world-class institutions, like Johns Hopkins University and Oxford University, warn over and over, that creating some kind of “gaming disorder” classification isn’t advisable because it puts patients at risk. In fact, three leading medical associations – the American Medical Association, American Psychiatric Association, and the American Psychological Association – have each reviewed the evidence and declined to describe any level of video game use as a “disorder.”  

Even the W-H-O’s sister organization, UNICEF, authored a study in 2017 on children in the digital age with findings contrary to the W-H-O.  According to UNICEF, there is very little evidence demonstrating that any significant number of children are so dependent on their devices that they experience health risks.

None of this should suggest that those needing help shouldn’t seek the treatment they need. However, there is no medical consensus that video game play is an underlying cause of these concerns, as opposed to a symptom of a more pressing issue.

Regardless of the W-H-O’s intent—and we do not question their good intent here—its proposal downplays some very real unintended consequences.  First, formalizing a link between video games and medical disorders could lead to harmful regulations that negatively impact access to games, even in cases where they have therapeutic value. Second, a misapplication of this classification could stigmatize the billions of people who play video games around the world. Third, and most alarming, a misdiagnosis could have seriously harmful consequences. There are countries where kids are now being sent to harsh treatment camps to rid them of “gaming disorder.” And, there are several instances where kids who have turned to video games to escape mental and physical abuse are undergoing treatment for “gaming disorder” instead of the underlying abuse they’ve endured.

We will continue to raise the specter of these unintended consequences in the hopes that the W-H-O will take a full view of the evidence and reverses course on its path.  And we have seen moments that give us encouragement. Just last month at the annual meeting of the W-H-O’s Executive Board, the United States delegation of experts formally objected to the inclusion of video games in the ICD based on a lack of scientific evidence.  

Still, we are not standing idly by. We have reached out to other stakeholders—including government officials, academics, medical experts, and the video game community—to ensure that the facts of this debate are known and understood.  We have also collaborated with our international counterparts in Asia, Australia, Canada, and Europe to ensure that a consistent message is being shared in all regions. And together, we have engaged directly with the W-H-O to ensure they are aware of our industry’s proactive efforts to promote digital wellness and the lengths we’ve gone to help consumers, especially parents, make video games a positive and healthy part of their lives and their children’s lives.      

As one example, all consoles have password-protected parental controls, giving parents the ability to control time spent playing video games and to decide what’s best for their children. In addition, the Entertainment Software Rating Board, or ESRB, provides parents with the information they need to decide what games are appropriate for their children based on their age or any number of factors. Our system of self-regulation has been consistently praised and trusted by parents, child advocates, and educators nationwide.  It has been called a model for other entertainment industries by the U.S. Federal Trade Commission.  

We know that the systems in place are working. In fact, 86 percent of parents with children who play video games are aware of the ESRB ratings. 74 percent of parents regularly check game ratings before making a purchase. And, 70 percent of parents view video games as a positive influence on their children’s lives.

The reality is that the overwhelming majority of the world’s 2.6 billion gamers enjoy video games as part of a well-rounded, healthy lifestyle. A misstep here could erode many of the positive effects that video games have in our society.   What the W-H-O overlooks is that video games are fun, educational, and increasingly therapeutic. For example, video games help cancer patients cope with confusion and treatment-related side effects. One of these games, called “I Hope,” supports children with cancer by providing a creative outlet during treatment that helps them visualize beating their disease. In addition, doctors are seeing impressive results among Alzheimer’s patients who play video games. And, video games are now being used to help rehabilitate stroke victims through eye-hand coordination exercises. 

Video games are a fixture of American life and have a massive impact on our culture worldwide.  And, I’m not just referring to the explosion of end zone celebrations inspired by Fortnite. They influence how we learn, how we interact with each other, and how we live. And that influence goes far beyond entertainment. Think about education, where video games play a transformative role.   I talked earlier about Justice O’Connor’s initiative to introduce the political system to students through iCivics.  Beyond that, teachers use video games as tools to develop literacy skills among children with dyslexia and other learning challenges. The game Minecraft: Education Edition has been used by 35 million teachers worldwide for interactive lessons in science, math, history, language, and art.  

The Xbox Adaptive Controller also represents a breakthrough in expanding gameplay to passionate gamers of different abilities and has driven a broader conversation around accessibility in the industry.  Many of you may have seen the very moving Super Bowl Ad featuring gamers who rely on the Xbox Adaptive Controller to connect and compete with others.  That is the power of video games.

The way that video games empower and inspire young minds has a lasting impact.  That’s why colleges and universities across the country are expanding their curriculums to include video-game related topics.  There are even dedicated video game majors that prepare students for lucrative STEM careers.  And, as a happy development, young women who play videos games are three times as likely to earn a STEM degree in college.   

I’m proud of how video games stand above the fray.  We’re dedicated to supporting the industry in building on the unique power games have to bring people together.

I said it earlier, and I’ll say it again. I love being an advocate for our industry. And, I encourage you to be one as well.  Here’s what you can do.   First, amplify the good that we do.  We have so many positive stories that get outshined by glossy headlines or the day-to-day grind. Second, don’t shy away from opportunities to correct the record.  So many times in our daily lives, either at a public event or a PTA meeting, someone attacks our industry – usually based on limited or inaccurate information.  Don’t stand idly by.  Third, get politically engaged.  Political officeholders listen to constituents who speak up.  So, speak up.

But most importantly, keep making great games and experiences.  Doing so expands our ability to grow and to do good in our communities and around the world.

I know that all of you care as deeply as I do about video games and how they’ve made the world a better place.  So, I ask that you join us in telling that story.  Thank you.


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