Rebecca Brown

Exercise, Population Health and Paternalism

Written by Rebecca Brown

 

The NHS is emphatic in its confidence that exercise is highly beneficial for health. From their page on the “Benefits of exercise” come statements like:

“Step right up! It’s the miracle cure we’ve all been waiting for”

“This is no snake oil. Whatever your age, there’s strong scientific evidence that being physically active can help you lead a healthier and happier life”

“Given the overwhelming evidence, it seems obvious that we should all be physically active. It’s essential if you want to live a healthy and fulfilling life into old age”.

Setting aside any queries about the causal direction of the relationship between exercise and good health, or the precise effect size of the benefits exercise offers, it at least seems that the NHS is convinced that it is a remarkably potent health promotion tool. Continue reading

Decoupling, Contextualising and Rationality

Written by Rebecca Brown

In February 2020, just before science journalists had to start writing about covid full time, Tom Chivers wrote an article for Unherd, ‘‘Eugenics is possible’ is not the same as ‘eugenics is good’’. In it he describes a Twitter outcry provoked by Richard Dawkins who tweeted: 

It’s one thing to deplore eugenics on ideological, political, moral grounds. It’s quite another to conclude that it wouldn’t work in practice. Of course it would. It works for cows, horses, pigs, dogs & roses. Why on earth wouldn’t it work for humans? Facts ignore ideology.

Chivers analyses the fallout in terms of a distinction between ‘high decouplers’ and ‘low decouplers’, a distinction described by the blogger John Nerst, here and also here. Chivers (and Nerst) describe decoupling as a ‘magic ritual’ that a speaker can perform in order to disassociate the thing they are about to say from all of the baggage that might ordinarily attach to it. So, one might say “I don’t think we should kill healthy people and harvest their organs, but it is plausible that a survival lottery, where random people are killed and their organs redistributed, could effectively promote longevity and well-being.”

Continue reading

Are Public Health Institutions Honest?

By Rebecca Brown

The COVID-19 pandemic has highlighted various cracks in the function of our public institutions. One notable concern is the way in which scientific – including health – information is communicated to the public. Communication can serve different purposes. In the context of COVID-19, communication has been essential: describing the nature of the novel coronavirus, the risks it posed to health, the measures likely to reduce its spread. Some of this communication was aimed at changing people’s behaviour in order to control the infection. For instance, people were told to wash their hands regularly, for at least 20 seconds, and to avoid touching their face. Much of this information was uncertain. Emerging data on COVID-19 presented ever-changing estimates for infection and case fatality rates.

There are particular demands that are made of health communication. It needs to reach a wide audience, delivering often quite technical, uncertain information to people with varying degrees of health literacy. It needs to encourage behaviours likely to promote individual and public health and avoid causing unnecessary panic and alarm. It must also, one might argue, avoid misleading people about the facts as they are best understood. This last point suggests that health communication should adhere to the demands of honesty. 

Continue reading

Imposter Syndrome And Environmental Sampling

Written by Rebecca Brown

Imposter syndrome has received recent, though still fairly limited, philosophical discussion. Scholars such as Katherine Hawley (and, drawing upon Hawley in a recent and excellent podcast, Rebecca Roache), amongst a handful of others have illuminated issues such as how we can develop a useful definition of imposter syndrome, the extent to which imposter syndrome may be adaptive, and the relationship between imposter syndrome beliefs and rationality. I want to pick up on this last question and suggest a further way in which people might rationally adopt ‘imposter attitudes’.

Imposter syndrome, as described by Hawley, involves believing that the external markers of esteem and success one receives are undeserved, and feeling at risk of being exposed as a fraud. Imposter attitudes refer to the negative attitudes one might hold regarding one’s own ability. Hawley challenges the common assumption that those suffering from imposter syndrome are simply too unconfident. She describes how people might justifiably (though mistakenly) hold imposter attitudes as a result of ‘hostile social environments’. This includes, for instance, people who are less likely to receive positive feedback in their work environment, or have reason to believe that any positive feedback they receive is insincere. For such people, although they have some evidence of their talent (e.g. publishing papers or winning awards), they have other evidence that this could be undeserved (e.g. lack of positive feedback from colleagues). Hawley is particularly concerned about minority groups who she suggests are more likely to experience hostile social environments and feel like impostors. Continue reading

Antenatal Care During The COVID-19 Pandemic: Couples As Dyads

Written by Rebecca Brown

 

During the pandemic, many healthcare services have been reduced. One instance of this is the antenatal care of expectant mothers. Ordinarily, partners of pregnant women are permitted to attend appointments. This includes the 12 week scan: typically the first opportunity expectant parents get to see the developing foetus, to discover whether it has a heartbeat and is growing in the right place. This can be very exciting and, if there’s bad news, devastating. It also includes scans in mid pregnancy and (for first-time mothers) at 36 weeks, as well as the entirety of labour.

During the pandemic, many healthcare providers have restricted attendance at antenatal appointments as well as labour and postnatal care. Even when lockdown restrictions were eased, with pubs, zoos and swimming pools re-opening and diners in England being encouraged to Eat Out to Help Out, some hospitals continued to exclude partners from all antenatal appointments and all but the final stage of labour, requiring them to leave shortly after birth. This included cases where mother and newborn had to remain on wards for days following delivery. With covid cases rising, it seems likely that partners will once again be absent from much antenatal, labour, and postnatal care across the country. Continue reading

Ecological Rationality: When Is Bias A Good Thing?

By Rebecca Brown

Many people will be broadly familiar with the ‘heuristics and biases’ (H&B) program of work, made prominent by the psychologists Amos Tversky and Daniel Kahneman in the 1970s. H&B developed alongside the new sub-discipline of Behavioural Economics, both detailing the ways in which human decision-makers deviate from what would be expected of homo economicus – an imaginary, perfectly rational being that always aims at maximising utility. For instance, in a famous experiment, Tversky and Kahneman gave people the following information (1983: 297):

Linda is 31 years old, single, outspoken and very bright. She majored in philosophy. As a student, she was deeply concerned with issues of discrimination and social justice, and also participated in anti-nuclear demonstrations. 

Participants were then asked which of the two alternatives was more probable:

1. Linda is a bank teller.

2. Linda is a bank teller and is active in the feminist movement.

Continue reading

Bad Ads And Stereotypes

Written by Rebecca Brown

In June this year, the Advertising Standards Authority (ASA) brought into effect a ban on harmful gender stereotypes in advertising. In response to public outcry about adverts such as the 2015 ‘Are you beach body ready?’ campaign by Protein World, and growing discomfort with outdated depictions of gender roles in the media, the ASA undertook a project to consider whether existing regulation is fit for purpose. They concluded that “evidence suggests that a tougher line needs to be taken on ads that feature stereotypical gender roles and characteristics, which through their content and context may be potentially harmful to people.” (ASA, 2017: 3)

Continue reading

The Ethics of Social Prescribing: An Overview

Written by Rebecca Brown, Stephanie Tierney, Amadea Turk.

This post was originally published on the NIHR School for Primary Care Research website which can be accessed here

Health problems often co-occur with social and personal factors (e.g. isolation, debt, insecure housing, unemployment, relationship breakdown and bereavement). Such factors can be particularly important in the context of non-communicable diseases (NCDs), where they might contribute causally to disease, or reduce that capacity of patients to self-manage their conditions (leading to worse outcomes). This results in the suffering of individuals and a greater burden being placed on healthcare resources.

A potential point of intervention is at the level of addressing these upstream contributors to poor health. A suggested tool – gaining momentum amongst those involved in health policy – is the use of ‘social prescribing’. Social prescribing focuses on addressing people’s non-medical needs, which it is hoped will subsequently reduce their medical needs. In primary care, social prescribing can take a range of forms. For example, it may involve upskilling existing members of staff (e.g. receptionists) to signpost patients to relevant local assets (e.g. organisations, groups, charities) to address their non-medical needs. It is also becoming common for GPs to refer patients (or people may self-refer) to a link worker (sometimes called a care navigator) who can work with them to identify their broader social and personal needs. Together, they then develop a plan for how those needs could be met through engagement with activities, services or events in the local community. The resources that link workers direct people towards are often run by voluntary organisations and might include, among other things, sports groups, arts and crafts, drama, gardening, cookery, volunteering, housing advice, debt management, and welfare rights.

Supporting people to establish more stable and fulfilling social lives whilst at the same time reducing healthcare costs seems like a win-win. However, it is essential to evaluate the justifications for the introduction of social prescribing schemes, including their effectiveness. This raises a number of complicating factors, including some questions that require not just a consideration of empirical evidence, but a commitment to certain philosophical and ethical positions.

Continue reading

Criticising Stigma Whilst Reinforcing it: the Case of the Response to CRUK’s Anti-Obesity Campaign

Written by Rebecca Brown

There has been recent concern over CRUK’s (Cancer Research UK) latest campaign, which features the claim ‘obesity is a cause of cancer too’ made to look like cigarette packets. It follows criticism of a previous, related campaign which also publicised links between obesity and cancer. Presumably, CRUK’s aim is to increase awareness of obesity as a risk factor for cancer and, in doing so, encourage people to avoid (contributors to) obesity. It may also be hoped to encourage public support for policies which tackle obesity, pushing the Overton window in a direction which is likely to permit further political action in this domain.

The backlash is mostly focused around the comparison with smoking, and the use of smoking-related imagery to promote the message (there is further criticism of the central causal claim, since it is actually quite difficult to establish that obesity causes cancer). 

Continue reading

Responsibility Over Time And Across Agents

Rebecca Brown and Julian Savulescu

Cross-posted from the Journal of Medical Ethics blog, available here.

There is a rich literature on the philosophy of responsibility: how agents come to be responsible for certain actions or consequences; what conditions excuse people from responsibility; who counts as an ‘apt candidate’ for responsibility; how responsibility links to blameworthiness; what follows from deciding that someone is blameworthy. These questions can be asked of actions relating to health and the diseases people may suffer as a consequence. A familiar debate surrounds the provision of liver transplants (a scarce commodity) to people who suffer liver failure as a result of excessive alcohol consumption. For instance, if they are responsible for suffering liver failure, that could mean they are less deserving of a transplant than someone who suffers liver failure unrelated to alcohol consumption.

Continue reading

Authors

Affiliations