City planning — or a lack thereof — can significantly affect people’s health and wellbeing, particularly where noncommunicable diseases (NCDs) are concerned. A lack of green spaces can reduce the ability to exercise outdoors, which can in turn have negative effects on physical and mental health. Residents of cities with poor public transport infrastructure are more likely to rely on personal vehicles to get to work and other destinations, leading to respiratory illnesses caused by higher levels of exhaust and air pollution. And in some cities, vast areas remain without proper grocery stores or food shopping options, leading to the “food desert” phenomenon in which residents are unable to affordably purchase produce and other healthy foods.

What can be done to ensure that these and other problems are adequately considered by urban planners — and that residents are able to recognise these challenges in their own communities? As part of our studies at Saxion University of Applied Sciences in Enschede, in the Netherlands, we have been partnering with NCDFREE to create a city-builder video game called Cities & Hassles, which is intended to encourage greater engagement with NCD-related urban planning issues.


There are several ways to use video games as a medium to teach people. If you want to use a game to primarily teach players certain information, you would usually create a serious game. But as the name implies, serious games are not made with player entertainment in mind, thereby contradicting our goal of creating a fun learning environment for players. People are less likely to play a game if playing it feels like getting lectured, which defeats the entire purpose of creating a learning game in the first place. We believe that if the player chooses to voluntarily play the game for themselves, they are more willing to process the information and play more.

So how do we make a game that is fun, but still lets the player learn about real-world issues?  We found that if the player has the ability to make choices and see the consequences in their city, it enforces the player to think about their decisions to steer them towards creating a healthier city.

This process is called stealth learning, and we believe it is the best way to make a game aimed at an audience such as millennials because they have the ability to reflect on their actions.


A screenshot from Cities & Hassles

The gaming industry is a rapidly growing market, reaching more than 2 billion people and expected to generate nearly $138bn in revenues worldwide in 2018. Video games also comprise a variety of art forms, bringing audio, visual arts, programming, and design into one collective product. If done right, a game can be a useful tool in engaging and educating players. A well-designed and -implemented game can greatly influence the user.


The development of our game started as a five-month project in early 2018, with a team of seven developers from interdisciplinary study courses. We had media, game development and IT students participating in the group for the first part of the project. At the time, our team consisted of three artists and four programmers. Everyone chose the project for different assignments, with the same goal in mind.

The first weeks were spent mostly on game design, prototyping and learning new software. As a team, we decided the Unreal Engine would be the game engine we were going to use for our project. Since only one of the four programmers had worked with the engine before, all others needed to learn the workflow and programming language. For the artist and designers, the tasks were divided based on their own strengths, be they modelling, game/user interface design or 2-D art.

During our design phase, we had bi-weekly skype calls with NCDFREE to brainstorm together about the game ideas and how we were going to address NCDFREE’s cause in our game. Even though we live and work from the Netherlands, we never had a problem scheduling check-in calls with NCDFREE colleagues in Australia, the UK, the US, and other parts of Europe. Their involvement in the project was an asset, and has always been beneficial in bringing across the NCDFREE message in our game.


To make sure we were on track we set milestones and a small roadmap towards releases. Planning for each milestone was difficult because the game changed so much along the way, with some features being added while others were scrapped because we were not happy with the impact they had on the game.

At the end of the first semester of work, after having already settled on a design and working towards a product, it became clear that five months was not nearly enough time for the game design. That meant that we had to scale down and simplify certain mechanics in order to maintain a scope we could work with as we brought the game into a second semester

As our team is interdisciplinary, some members of the original team had other courses that they needed to do and decided to leave the team. Four members of the original team decided to continue working after the summer vacation, at a company where some of the members are working there for their internship or graduation. We also opened the project up for new members to help us continue, so we now have two new members on board.


We will be previewing the game in Geneva this week at the First WHO Global Conference on Air Pollution and Health, where policymakers from around the world will be discussing the effects of poor air quality on population health. We hope the presentation of our game will add to the dialogue on innovative ways to address widespread global health challenges.  

Following the conference in Geneva, we plan to polish the game and make it ready for a full release in 2019, while keeping the possibility open to expand on the game over time with additional content.

Authors: Anhille Christiaans, Alexander Elzinga, Kristiyana Georgieva, Yorrick Lubbers, Yannick Lucassen, Keimpe Snip. The authors are students at Saxion University of Applied Sciences in the Netherlands.