PCU Profile Special for International Women’s Day
Chloe Gamlin, University of Cambridge medical student and President of the Cambridge student society for general practice, asked leading behavioural scientist Professor Dame Theresa Marteau to describe her career and how being a woman has influenced her work.
Chloe said: “I’m leading our GP Society for medical students at Cambridge and am interested in general practice and public health as a possible career. I wanted to discuss the importance of social and environmental factors that influence our health and think about how doctors could incorporate these ideas into medical practice. After all, doctors treat whole people and not just the molecular basis of disease. I was particularly interested to learn how the theories of behavioural ‘nudging’ via policy interventions are tested and put into practice.”
Chloe: How did your interest in risk information and public health develop?
My interest started with my PhD. I studied perceptions and management of risks in childhood diabetes and compared the perspectives of parents and clinicians. More recently I studied how people respond to learning about modifiable risks for common diseases, such as diabetes and heart disease. With Wellcome and MRC funding, I led several large studies assessing the impact on behaviour of communicating personalised genetic risks of disease. We found no evidence that this modified their behaviour to reduce the risks identified.
This prompted us to conduct a systematic review to see if similar findings were evident in other studies. There were high hopes amongst researchers and policymakers that communicating such personalised expectations would cause people to change their behaviour. But the review reflected the findings from the studies run in my group: personalizing risk information using biomarkers including those based on genetics did not seem to change peoples’ behaviour to reduce the identified risks.
Understanding why such information did not change behaviour has been critical in developing my current research focus. In short, information-based approaches to changing behaviour are based on partial models of human behaviour, neglecting the non-conscious processes that activate most of our behaviour. So targeting the non-conscious processes readily activated by the cues that surround us is now the focus of the research in my group. These cues include the size of plates, wine glasses and cigarette packets, as well as the positioning of these products in stores. We live in multiple, overlapping environments—physical, economic, digital, social, cultural, and more. All of these contain a myriad of cues that, most often without our awareness, activate the many behaviours in which we engage at any one time. Identifying the most potent cues is a Herculean task in which my group – and others – is now engaged.
Chloe: What do you most enjoy in your work?
The freedom to follow an idea – going from inception to generating evidence to meeting policy makers to discuss the research findings and their implications for policies that could improve health.
Chloe: What has been the biggest challenge in your career so far?
Responding well to not getting a grant! The vast majority of researchers won’t advertise when this happens, but it is part of the experience of every researcher.
Responding well means recognizing the visceral feeling that accompanies any loss – and then analysing what the decision means and persisting. Was the research question and study design sound but poorly communicated? Does the question or design need refining?
Chloe: And the biggest highlights?
The other side of the coin from the big challenge is of course getting grants!
The award of a Damehood to me last year was a different highlight – a huge honour that recognised the contribution the teams I’ve led have made to generating evidence with the potential to improve population health. It was the first such honour awarded to a woman in the Clinical School in Cambridge and at Christs’ College, where I am a Fellow. Hopefully there will be several more in Cambridge before too long.
Chloe: How has being a woman researcher influenced your work?
Being a woman hasn’t affected what I’ve chosen to work on. But I suspect that it has affected my attitude towards time, which would have been different if I hadn’t juggled nannies, children and au pairs as well as students and research teams all at the same time.
Increasing numbers of men are active parents. But I think that it is different being the woman. Breastfeeding my two week old daughter while giving a talk sticks in my mind as one example of difference. I feel that we don’t see enough of women who are able to weave in and out of work as it suits them when their children are very small.
I made some choices not to move jobs. I was a single parent for much of the time my children were at school and I wanted them to be close to their father in London. Female academics tend to move less than men due to family responsibilities, something that contributes to the gender pay gap because moving jobs usually results in pay rises.
Chloe: What changes would you like to see for women embarking on STEM careers in the future?
The more mentoring schemes we have, for everyone in the early stages of their careers, the better. I’m part of a national scheme through the Academy of Medical Sciences where relatively junior academics seek senior academics from different institutions to act as mentors.
This is just one of several schemes aiming to help push for the cultural changes that need to be made. The Cambridge Breaking the Silence initiative is another, attempting to shift the culture around sexual bullying and harassment. Moving towards gender parity means tackling the pay gap, which reflects how we continue to value women less highly than men.
Chloe: In your opinion, what is the greatest public health challenge we are currently facing, and what should be done?
Our unhealthy behaviours are the main causes of preventable premature death worldwide. The gap in life expectancy between the rich and the poor and the bigger gaps in the number of years lived in good health are persisting and growing. The prize for taking effective action is huge. It is estimated that over 40% of cancers and 75% of type 2 diabetes could be prevented and the gap in life expectancy halved if we successfully tackled smoking, excessive consumption of food and alcohol and physical inactivity.
People talked about the Human Genome Project as huge, but the human behaviour change project is even bigger. Many fields need to come together – behavioural science, economics, political science, philosophy and economic history being just some of them.” – Professor Theresa Marteau
Chloe: What would you like doctors to do?
Doctors are trusted. They have a powerful voice. While they often work with patients at an individual level – helping them to stop smoking or to lose weight – they could use their voice to call for more changes to the environments to make it more likely their patients sustain any changes they manage to make. For examples, doctors could be more vocal in ushering in healthy food environments in hospitals – of the kind that are currently all too rare.
Professor Theresa Marteau is Director of the Behaviour and Health Research Unit and Director of Studies in Psychological and Behavioural Sciences at Christs’ College, University of Cambridge.
To learn more about the challenges of improving population health and unconscious behaviours, please see Professor Theresa Marteau’s recent essay in the Lancet: ‘Changing Minds about Changing Behaviour’ – http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)33324-X/abstract
Media contact: Lucy Lloyd
Image credit: Nick Saffell