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The Stitch

Issue 5: July 13, 2018

Putting people at the centre of public health
Dear <<First Name>>,
It’s been a busy summer so far here at Common Thread. We’ve revisited old haunts like Pakistan, Ireland and Switzerland, while enjoying that burst of excitement that comes with exploring a new country like Tajikistan. 
Throughout our travels, we’ve been thinking a lot about context. Any behavioral scientist worth their salt knows that social context is everything. Solutions that work in one country may be a complete flop in another. Those same solutions may be a complete flop in the same country, at another moment in time or in another region.
But how does our field adapt to radically different political contexts? If participation, social inclusion and understanding the most disadvantaged are at the heart of social and behaviour change, how do these principles apply across the political spectrum? Does what works in a participatory democracy, work as well under authoritarian regimes?
Where do engagement, persuasion and communication fit into a system that routinely relies on law, punitive action or sanction to influence change? 
We’ve been encouraged to think that choice and participation are good things: the more the better. We've also been conditioned to assume that fruitful democratic societies are built on free will and choice: We’ll tell you why you should vaccinate, we’ll listen to your views and ideally, adjust, but then it’s up to you. 
But behavioural economists like Sunstein and Thaler have thrown a curveball into this world-view. With their theory of Libertarian Paternalism (later boiled down to the more airport bookshop-friendly idea, Nudge), they argue that less choice is better.  Bolstered by research, they've shown that offering fewer, more deliberately crafted choices, can encourage people to make better, healthier decisions.
Can libertarian paternalism become another form of state coercion with a friendlier face? Or as Elizabeth Kolbert once put it, 'if people can’t be trusted to make the right choices for themselves, how can they possibly be trusted to make the right decisions for the rest of us?'

Anyone have the answers? Please drop us a line.

See you next month!
Sherine, Tom and Mike


More freedom = better health?

In 2004, researchers created a database of political epidemiology, spanning 170 countries, or 98% of the world’s population. Their findings?  Where freedom ratings were highest, so too were the levels of health. The worst levels of health were in countries that were not considered free. Health in partially free countries was predictably somewhere in the middle. This remained the case, even after adjusting for wealth, inequality, and the size of the public sector. Cue research challenges! Including this study of local leadership structures in Eastern Congo found no difference in health outcomes in villages where chiefs were elected and where they were not.

Check this box to opt out of a nudge

Most democratic nations like to be nudged if they feel the objective is legitimate and fits within the norms and values of most people. It’s also really important for the nudgers to have won the trust of their population, otherwise people won’t support it - so who you think is behind it will inevitably impact your support.  A few nudges are off limits: those that threaten to take people’s money away without their consent, and those that willfully manipulate (like misrepresentative advertising). Two countries that stood apart from the crowd: Hungary (Government mistrust the most likely reason) and Denmark (researchers still trying to figure this one out. Personally, we blame hygge).

All roads lead to….trust?

When this study was updated to explore what happens in more authoritarian regimes like China and Russia, the results were surprising. Across a range of diverse nations, there is still strong support for nudges. Turns out most of the world falls into 3 big categories. The largely liberal democracies, who approve of nudges, so long as they’re contained within the realms of health and safety . Second: a small group of nations, with almost zealot-like approval of nearly all nudges, no matter the topic; China and South Korea fall into this category. The last group, which still  holds Hungary, Denmark and now Japan: people are fine with nudges, but support is much lower. Could trust in Government, more than anything else, make the difference?

The Stories We Can't Stop Talking About

One million French smokers quit in a year amid anti-smoking measures
In a challenge to lazy, outdated cultural stereotypes, over one million French smokers said, ça suffit to smoking in 2016-2017. An integrated approach of neutral packaging, higher prices, public information campaigns, and a ban on flavourings targeting younger smokers, have been cited as the key reasons.

Reconsidering the Stanford Experiment
The Stanford Experiment has long been rolled out in introductory psychology courses to show how our behavior is affected by the social roles and situations in which we find ourselves; that we can all turn to sadistic monsters under the right (or wrong) circumstance. By now you've probably heard the social psychology field is looking again at the Experiment both for its flawed design, and also because some participants say they exaggerated their response. Check out the Netflix film for a primer, or you can find actual footage online. Both make for difficult viewing.

What can we learn from museum exhibits
Museums have been thinking about how to present complex ideas in the best ways possible for decades -- and that includes the physical environment. Try reading this and switching the word ‘museum’ for public health and ‘exhibit’ for strategy or even clinic. It’s about emotion, real connection and apparently, writing short paragraphs. “You can’t foresee how everything will work, so do your best job, put your best knowledge to bear, and then listen.”

A Simple Beam of Light Could Catch Zika-Infected Mosquitoes
Scientists armed with near-infrared light beams can identify zika-infected mosquitoes. It’s faster, it’s cheaper and it’s 94-99% accurate. Oh, and did we mention it’s a (near) infrared light beam!

The Research We're Curious About

Predicting the cause of science skepticism: Tougher than it seems
In a series of studies researchers concluded that understanding the root of science skepticism depends on the issue. The best predictor of climate change skepticism? Political conservatism.  Religion and moral purity are associated with mistrust of vaccination, while GM food is not associated with either religion or politics. What’s the takeaway for increasing trust in science? Check your assumptions and acknowledge that those who suspect science are not a homogenous group.

Only a sandwich away: When Hungry becomes Hangry
The ‘affect-as-information theory’ holds that your mood can temporarily shape how you see the world. So, when you’re hungry, you may view things in a more negative light than when your stomach is full. That’s because you’re not thinking about your hunger, you’re thinking about the rude comment, a bad driver or an angry boss, making it easier to mistake these as the cause, rather than the fact that you skipped lunch again. Take note that the study was largely among healthy, well-fed subjects. What does it mean when being hungry is the norm, and alongside principles and research into scarcity.

The Lessons That Are Sticking With Us

Finding ‘Burstiness’ when working remotely
Common Thread’s exposed beam, stand-up desk, Soho loft office space exists only in our overactive imaginations. This generally means better coffee but less juicy weekend gossip. So it was encouraging to see that researchers feel the informal nature of in-person communication can be replicated from a distance. What makes an effective remote team? Bursty communication is obviously the answer.

Dodging the decoy effect
What would happen if instead of letting hiring panels look over résumés freely, they were shown pieces of information one at a time and, more importantly, exposed to important qualifications repeatedly? The lesson for public health? It’s tough to change people’s biases, but you can influence the process for how they make decisions. There’s even an app for that.

What's Distracting Us From Our Work

Contagious Cities
We’re pretty excited to see what comes out of this three-city (NY, Geneva and Hong Kong) “international cultural project which supports local conversations around the global challenges of epidemic preparedness.” Interactive storytelling, artists in residence, and multiple events will explore the past and future of global epidemics.

A comic book tackles the meaning of life
We’re obsessed with how to make complex information entertaining and accessible, which is why we’ve ordered The Dialogues. MIT physicist, Clifford V. Johnson, takes on such breezy topics as God, time, space, love and death and all in graphic novel form. (We all know the answer is 42, but still, it’s good to revisit the questions.)

This newsletter was produced while...

Mike wondered why penalty takers don’t take the middle path more often, while enjoying a historic Irish heatwave.

Sherine was ‘on vacation’ in Croatia. Drop her a line if you’ve figured out how to crack the work-life balance conundrum.

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