A game simulating poverty’s effect on one's health and health care access

Dwell™ was developed by an interdisciplinary team led by faculty at the University of Miami’s School of Communication and School of Nursing and Health Studies as an engaging tabletop simulation game to teach about poverty’s impact on one’s choices, health, livelihood, communities, and families. Given the importance of educating future healthcare providers about the implications of poverty, the Dwell team’s goal was to create a game with an educational impact that does not require long setup time or a significant amount of human capital to run the event, especially in comparison to similar tools currently used for health education.

Poverty is an issue that allied health and healthcare professionals face when practicing in any setting, including hospitals, clinics, and schools. Poverty is a ubiquitous condition that impacts half the world’s population indirectly and directly. Locally, the city of Miami is one of the poorest cities in the United States with 21.3 percent of residents living below the poverty level (Miami-Dade County Department of Regulatory and Economic Resources). In 2015, more than 43 million people were living in poverty nationally (World Hunger Education Service). Internationally, the World Bank estimated that 896 million people live on $1.90 day or less (World Hunger Education Service). Research has shown that poverty influences the five dimensions of family, including health, productivity, physical environment, emotional well-being, and family interaction (Park, Turnbull, & Turnbull).

Despite these facts, many individuals working with poverty stricken people require a much greater understanding of the global and often life-long impacts that being poor has particularly on health. By playing Dwell, participants roleplay as an individual or multi-person household and experience how poverty influences their ability to live a healthy life and access healthy resources. An emphasis on facilitated reflection and debrief are critical to the Dwell educational experience.

Findings from a comparative evaluation of Missouri Poverty Simulation and Dwell show that "students' perceptions regarding their willingness to help those living in poverty also improved after both simulation activities. Dwell was found to significantly increased students' empathy toward those living in poverty" (Sanko et al, 2021). The full paper is available here.


Sanko JS, Matsuda Y, Salani D, Tran L, Reaves R, Gerber K. (2021, January). A comparison of learning outcomes from two poverty simulation experiences. Public Health Nurs. 2021;00:1–12. https://doi.org/10.1111/phn.12853


In Dwell, players roleplay as one of five characters with daily as well as longer term goals, current living and working arrangements, and initial possessions and money available. Players take turns navigating Dwellville - represented by the gameboard - to accomplish these goals. Throughout the game, players track their (in)ability to go to school or work or complete a health check. A player’s in-game progress represents their character or household’s resiliency. The game also includes periodic facts related to poverty as well as built-in periodic discussion phases to fully anchor concepts through dialogue, reflection, and debriefing.

Dwell gameplay is ideally led by a trained facilitator who can also provide greater context for gameplay and facilitated debrief. However, the following slides may be used for self-led gameplay and are best viewed in full-screen mode.

Did You Know?

Are you currently playing Dwell and ready for a Did You Know fact? Use the following deck, which starts with instructions for how to navigate between categories and individual facts.


Lien Tran


Jill Sanko


Deborah Salani



Special thanks to Susana Barroso-Fernandez, Jacqueline Lopez, and Laura Albuja for their early contributions to character development; to Yui Matsuda and Regina Reeves for supporting research on the educational impacts of Dwell; and to Casey Lue and Pablo Obando, for their graphic design contributions.

Thank you to the University of Miami’s Center for Communication, Culture, and Change for providing the pilot funding necessary to prototype and test Dwell.