Many fascinating behavioral scientists came together at this year’s annual BSPHN virtual conference—titled Collaborating to Build Fairer Communities—to discuss the use of behavioral science to address health inequalities. Of the many presentations, the discussion between Professor Jim McManus, Professor Mike Kelly, and Professor Falko Sneihotta was particularly intriguing. While each speaker contributed their own unique perspective, they all converged on the importance of humility amongst researchers and policy makers and on the need to place the experience of the individual within the context of their local community at the forefront.
Professor Kelly focused on the limitations of “top-down” behavior change interventions in mitigating health inequalities. He pointed out the opportunity to “reverse-organize” the research by first taking time to understand individuals, communities, and cultures. Only afterwards should this more holistic understanding inform a behavior change intervention. Kelly argued that this bottom-up approach has often been overlooked by policy makers. For a historical precedent, he recalled the outbreak of HIV in the 1980’s. The lack of any treatment at the time meant that talking to gay men and communities was the only public health approach on the table. The “health promotion movement” surrounding the HIV epidemic stressed the importance of “working with” communities rather than “working on” communities. Kelly lamented the fact that the research surrounding the health promotion movement has been largely ignored. He emphasized the potential for our response to COVID to draw on the vast literature in the social sciences exploring the optimal ways to work with local communities.
Professor Falko, agreed with Kelly’s points and spoke of a “collective imposter syndrome” plaguing behavioral scientists. He then proceeded to list the shortcomings of the current state of affairs in applied behavioral science:
- First, there is a pressing need to update our behavioral science theories and methods based on real-world follow-up data.
- In addition, we must account for the fact that much of behavioral science research has been conducting amongst WEIRD (Western Educated Industrialized Rich and Democratic) individuals, and do our best to balance this by working with a more representative samples of researchers and participants in the future.
- Finally, we must move from a focus on individual, isolated cognitive factors to an exploration of social and environmental factors.
Professor McManus spoke passionately about his “philosophical as well as scientific conviction” that behavioral science knowledge is needed to fully understand public health challenges and disparities. He recounted his personal experience as a gay man during the start of the HIV epidemic, caring for friends who were dying as undergraduates. He agreed that the top-down approach to health promotion often ignores the lived realities of communities. To bring this to life, he brought the recent example of COVID vaccine campaigns. He felt these campaigns neglected to take the context and cultures of different communities into account. For example, some vaccine sites were only easily accessible to those with a car. Still, he reiterated that despite an underwhelming (and even infantilizing) public health response to COVID, public health interventions can be immensely impactful when they leverage the tools of behavioral science to unpick the complexity of the individuals and communities rather than settling for simple solutions.
The mentions of the HIV epidemic from Professor Kelly and Professor McManus were especially topical, as HRW behavioral scientist Emma Neville later presented a poster on a fascinating project that we had conducted on HIV prep. For this project, Emma and I used the socio- ecological model of health to illuminate a range of behavioral barriers to sexual health conversations that cropped up at the individual level, the interpersonal level, the community level, and the institutional level. The poster can be found here.
All in all, it was refreshing to hear the three speakers detail the shortcomings of behavioral science but, in the same breath, to paint an uplifting picture of the future of behavioral science and its potential to minimize health inequalities. We may still have a long road ahead of us, but there is plenty of light at the end of the tunnel.
By Jeremy Koloski