Talking about health: Healthy Canadians podcast episode 9

Transcript

Transcript

Megan Beahen: Hi and welcome to Healthy Canadians: your space for nuanced conversations and expert insights about the health topics that matter to all of us. We have important resources and information to help you and your family stay healthy. I'm your host, Megan Beahen.

Whether you're talking to your health care provider about something super personal or trying to figure out how to talk to a friend about sensitive health issues, conversations about health can be hard. But, that's why we're here: to talk about those things that affect our individual and collective health. Today, we're going to talk about talking about health, and why it can be challenging. But first, a word from us.

Healthy Canadians is brought to you by Health Canada and the Public Health Agency of Canada. We aim to give you information and perspectives about the health topics that matter to all of us living in Canada. What we discuss won't always reflect the official positions or policies of the Government of Canada, but that's okay. These are conversations, not news releases. Okay, let's jump right in.

Today, I sat down with Mark Morrissey, a behavioral scientist with the Public Health Agency of Canada.

Hi, Mark. Welcome to healthy Canadians.

Mark Morrissey: Hi Megan. Happy to be here.

Megan: Mark, what is behavioral science?

Mark: Behavioral science is a very broad term that encompasses a number of different fields. Technically, it's the study of human behavior, everything that goes into human behavior: decision making, learning, memory, habits, emotions. It's really born out of many different fields of academic study. Psychology, neuroscience, social psychology, other social sciences. So, I think it's, it's a term that gets thrown around a lot. And I think there's maybe a bit of confusion around [it]. I think that comes from the fact that, what often people are talking about, or what's become more popular, in the last 10 years is this kind of idea of applied behavioral science. Applied behavioral science is essentially taking the study out of academia; study that's been taking place for hundreds of years, and implementing the insights, the tools and the methods into the private sector or government challenges. And, trying to address problems in the real world outside of just understanding how people behave, how people make decisions, but what it actually means for different programs, different policies, the way that they interact with, customers or the public.

Megan: So, you are a behavioral scientist at the Public Health Agency, correct?

Mark: Yes.

Megan: And how does the Public Health Agency benefit from having someone like you on the team?

Mark: I think it comes down to this challenge of how we are building programs, policies… designing, essentially, touch points with the public communications. How we engage with the public, how we convey information to them. So, having behavioral science within public health is helping to kind of grow and mainstream that thinking: that we should be taking a more scientific approach into how we design our communications, how we implement policies, how we create programs that at [their] core is a built-in understanding of how people are behaving, how they're making decisions, and how we can use the scientific method to come up with hypotheses of ways to maybe improve things and then actually test to see what works better. And so, using the evidence to guide the different activities that we're doing.

Megan: That is very, very cool. And maybe you could just tell us a little bit: what is the benefit of that? Like, what is the benefit to people in Canada when they're receiving policies, program messaging that is informed by behavioral science?

Mark: Well, it means that the things that matter to them in a decision-making context have been taken into account. People's better outcome is kind of our big interest, then, you know, they can be assured or at least have the awareness that the things that they're engaging with have been thought thoughtfully created. So, eliminating things like unnecessary steps, unnecessary friction that may prevent them from following through on something; a recognition that they have. A lot is probably on their minds, a lot on their plate, and sometimes just doing something easier is kind of the conduit to it actually happening. So, making things as least confusing as possible, building in kind of, some empathy and understanding of how people typically engage with information and what barriers there may be when they're learning something new. Or, if they're experiencing a challenge and looking for something and can't find it, that there has been, at the back end, some thought into how to better provide some of these services, some of this information that people are looking for and may need – or, that ultimately may help them with the choices that they want to make for themselves.

Megan: That makes sense, and I think particularly now, I assume, that is even more important in this digital age where people are overwhelmed with information, options, sources, and people are having to make, you know, pretty tough decisions – potentially about their health – all the time.

Mark: We've had so much access to information, which is an amazing thing. There's really nothing that you can't find out there. But, there's also this level of, “what kind of background knowledge do you have in some of that?” In some of those areas to kind of really dive in and dissect and understand for yourself and we can't expect… not everyone's going to be – is not expected to be – an epidemiologist, or a physician, or have a strong background in respiratory illness or heart disease. And so, with all this wealth of information, what do you do with all of that? It's all out there, but how do you actually unpack it and understand it to what it means for you? So, there's a trust element there that is essential. And people without that expertise need to feel like they can trust the person or the provider of the information that's important to them.

Megan: Okay, I want to come back to that in a little bit to talk more about: what are all the things that people consider when they're making decisions about their health? Because I think there are some things that listeners might find is a little interesting or surprising.

But first, I want to just take one little step back to talk about why conversations around health are challenging and how we can make them more productive and positive. So maybe let's start with a conversation that someone might have with a healthcare professional. I think that's a particular type of conversation that someone might find challenging in a one on one. Why are those conversations sometimes hard?

Mark: There's so many individual factors there to someone's comfort, going back to their experience, to their history. For someone, it might be the easiest thing ever. They have an issue, and they've had nothing but great experiences with the medical system or with doctors. You could have another person who has the same issue who has the exact opposite. So there's going to be so many kind of variabilities across people that it's, I think, hard to kind of pinpoint what is challenging about that particular context.

Now, there are some things that I think maybe make initiating that conversation challenging. Then, what you do with the information that you receive on the back end, that can make it kind of more or less impactful for you. Things like we would study in in behavioral science, things like the optimism bias. Humans have a very natural preference to assume that the best will work out. Not everyone, of course, but there is a lot of literature and study that show a majority of people actually tend to have a optimism bias and in most of their thinking. So, you know, when it comes to their health: “Probably not going to happen to me.” “I'll probably be okay.” These are some challenges in our thinking that can prevent us from actually going out and maybe starting some of those conversations.

If you carry that into that conversation, some things that can kind of creep up are this idea of temporal discount. So, the things in the moment matter more for you than the things two years, or five years from now. We call that the “present bias.” We're very much focused on the present day, our current self. And so, some conversations with doctors that could be very beneficial to your long-term health, where maybe they're kind of flagging something that is a potential sign, like: “maybe you should think about exercising more” or, “watching this in your diet, you've got certain kind of levels here that that might be concerning down the road.” In the moment, I'm okay and I feel okay. I'll save that for another day, another time. There's lots of intricacies to our psychology that can prevent those conversations from happening to begin with, and then can also present some challenges and what we do with that with that information.

So, I think, you know, for me, for behavioral science, I think we're more interested with some of those kind of broader pieces than necessarily the individual variabilities of why some people may have concerns about raising a sensitive topic, and other people's don't. But I think the getting there, and then kind of taking away the most amount of information and actions from that conversation, are things that really drive a lot of my thinking.

Megan: So I imagine accessibility has a lot to do with having a conversation with a healthcare professional. Could you talk to us a little bit about that?

Mark: Yeah. I mean, this is something that we're seeing across the board, and I would say is another kind of element of when we're trying to study things like challenges to getting information, having conversations, acting on advice… part of that behavioral science approach is also looking at the context itself, and what are the full realm of barriers to that?

Megan: I think a lot of people have – most people have had an experience talking to a family member or a loved one or even just an acquaintance and have had difficult conversations about health. Can you tell us a little bit more about that?

Mark: I would say there's lots to unpack there, and there's lots of kind of layers to that. For starters, health is a very personal thing. People feel very passionate and, I think most people probably feel like they want to make the best decisions for their health. They don't want to make decisions that are going to be bad for their health.

So, I think everyone is coming into this with a very similar goal in mind, right? Very similar outcome in mind. It’s everything else that that kind of clouds that. The other layer there is, is that as human beings, we want to feel that we're confident in our decisions. If we have a belief about something; if we've heard something, and it really resonates with us, it can be difficult to admit that we were wrong, or that we're making decisions that are actually not the best for us. If you challenge someone on their belief – where, in their minds, this is the best information for them, this is what they believe. They're doing the best, for them. You're telling them that they're doing something, the opposite of that, and that can create a lot of emotions, maybe inner turmoil. Or, it could cause a push away or push back on that.

It's kind of tangled up in this idea that we want to feel confident in what we believe. If we weren't, it'd be very difficult to make decisions, and to carry on in our day to day lives if you kind of have this overwhelming doubt. You're always kind of, you don't know things and you're always kind of making, you know, the wrong choices.

So, we can trick ourselves or convince ourselves that we are doing the best and we are correct. And so if you try to – there are different ways to have these conversations, but if you go at it from the angle that “you're wrong and I'm right,” you're most likely to be met with the opposite. There are some strategies that can be helpful in those situations. One of those, I think is identifying that underlying goal that ultimately we all want the same outcome. We want the best for ourselves. We want the best for each other. We also want to feel that we're doing good things. We're making right decisions. And so maybe, creating some connection and common ground around those goals and then maybe trying to have these conversations a little more collaboratively in terms of, “okay, so what does that mean? So what should we use to, to make these decisions?” What information is reliable, and what information isn't reliable?

Megan: I love that. So coming to a conversation, which might be tricky with someone, and maybe just putting that out on the table right away, saying we both know that we're coming to this with the right mindset or intention that we want to make the right decisions for our health together. And then sort of taking it from there and understanding the other side, perhaps difference of opinion.

Mark: It's difficult to constantly be a skeptic of information, right? And so, this concept of confirmation bias, which I'm sure many are familiar with…

Megan: Tell us about it. We want to hear about confirmation bias.

Mark: Confirmation bias! So, you know, it goes back to that idea that you want to feel confident in what you believe and what you decide, and that you have confidence that, you are an intelligent person and can make sense of information. Your beliefs kind of shape the way that you ingest information and seek out information. It can be a difficult thing to, to have a very strong belief about something and then encounter some article, some piece of information or something someone says that kind of flies counter to that, can create a lot of inner turmoil if you don't know how to deal with that.

So, what often happens is people tend to downplay; dismiss things that that fly counter to what they believe, and tend to place more weight, more emphasis on information that affirms what they believe. And, it may actually lead to people seeking out information that affirms and confirms what they believe, because it feels good, right? “I believe this. Oh, look at that person says the exact same thing. You know, thank goodness I was right. I knew I was right.”

It’s a much more challenging thing to see something and realize that maybe what you've thought this whole time was completely wrong. And that “all these different decisions and things that I've said related to this may be actually incorrect.” That is a very challenging thing to face.

So, we can jump to this maybe in the next point, but I'll just, quickly: I think that's one of the issues of communicating with the public about information is that a lot of the experts in these different areas, especially when we're talking about health, have some kind of a science background. I don't want to speak for all scientists, but I can speak for myself, that there is a very different world in in science than outside of science.

And by that, I mean things are very different [and] often change. New results come out that that disprove previous results. Our understanding of a topic or situation is constantly evolving as we're learning more and doing more investigation and more experiments.

So, the world of science kind of sets you up; if you want to be successful, ultimately kind of be a skeptic. One of my post-doc advisors gave me one of the best pieces of advice in actually doing science: you’re designing your experiments, asking your research questions, instead of trying to prove what you think is correct, which is kind of how we often think of it.

You have a hypothesis. You think it's a great hypothesis. You think it's going to work. And so, let's see if it works. You kind of have this positive mindset throughout that study; you really want to show that your hypothesis is correct. But, actually, what can be a much more impactful approach is to try to prove yourself wrong. “So here's my idea. Now I'm going to try as hard as I can to show that that's actually incorrect and that it's something else.” And it's a completely different approach, right? To try to attack your own belief. And so, you start looking at things that maybe you would have ignored otherwise. You start really trying to squash that confirmation bias as much as possible. So I think when we're, as scientists, trying to communicate people who maybe haven't gone through some of these types of experiences of constantly trying to challenge their own beliefs, there may be a bit of a disconnect there into why things are changing. Why knowledge is evolving.

Megan: I love that. And I think maybe we should all adopt that mindset a little bit. Is that what you're saying? We should all have a scientist brain where we're trying to disprove our beliefs. Is that a way to approach a difficult conversation? Maybe?

Mark: Yeah, I love that. I mean, it's in a conversation with someone else, it can be tricky because you really need both people.

Megan: They both need to have that mindset.

Mark: You both need to have that mindset. It's something worth talking about with someone else is. “This is what I kind of believe based on what I've seen. I am completely open to completely overriding that if I can be shown otherwise and, what about you? You’ve said what you believe. Are you open to completely flipping that to completely challenging your own beliefs?”

I think it'd be an interesting way to kind of start a conversation and obviously if the person is uncomfortable doing that, then probably not going to have a very successful effort or conversation.

Megan: I love that. So we're starting with saying we have a shared goal in our health and then, you know, agreeing that we're both open to seeing things differently or open to other ideas. That's a good way to start a difficult conversation, sounds like. You touched on a little bit about like broader messaging or having like larger conversations conveying information, and we've worked together before and conveying information to people in Canada from the government. One of the things you touched on that I want to pick up on is about how difficult it is. One of the challenges around that is conveying how things are changing all the time. So maybe, could you unpack that a little bit? Why is that hard for people to hear or how does that impact their decision-making on health?

Mark: Yeah, I mean, I think it has a huge impact and again, it's one of those things where I think there's a number of kind of layers to it. Essentially what we're talking about is kind of changing information and operating in this kind of realm of uncertainty. I think, you know, for science – it’s not so much of a challenge because science essentially operates in constant uncertainty. You're never proving a hypothesis; you’re disproving that the opposite hypothesis isn't valid. You’re never kind of showing that this is absolutely the way it is; you’re kind of building evidence towards that idea. And there's always this chance that something else will come out that will completely change how we think about things. So, that is kind of the realm where science operates.

Outside of science, people prefer a lot more certainty. They want to make sure that they're making the right decision. So, you know, “this food is healthy.” Okay, “so I should be eating this food.” If all of a sudden, six months later, they hear, “actually, it may not be that good for you.” It creates a lot of doubt in the recommendations that they're getting.

So, ultimately for me, what I think it boils down [is] trust, right? Trust is a very difficult thing to build up, and it's something that's very easy to lose. People want to feel like they can trust the information, the recommendations that they're getting, that they're reliable. Again, because most people don't have that extensive training and expertise in a very niche area, right? So, go back to COVID, things were constantly changing; the actual scientists themselves, the experts in that area were learning, about this new virus, and what it means and what it does.

So they're operating in their norm of: “Let's try to understand it. Let's try to learn as much as we can. Things may change as we learn more.” But, they're also being asked, “so what does this mean for us? What can you tell us about this?” And for a lot of scientists, I think that's a very uncomfortable position to be in, because [they are] used to operating in this realm of uncertainty. Now, you're getting pushed for some kind of certain information. “What can you tell me? What can you recommend?”

So for people: if they start putting their trust in that person or that expert, and all of a sudden the advice or information starts changing, it can start creating doubt in people's minds. “Maybe they're not reliable. Maybe they don't know what they're talking about.” You add to that this constant kind of bombardment of information, and people have other things to also think about and worry about. They don't know what to believe. They don't know what information is accurate, is inaccurate; and really just to kind of continue with what's important to them. They just want something that they can kind of hang on to as, “okay, that makes sense. This is what we should do.” So, kind of building up that trust piece is super challenging when things are constantly changing.

Megan: And is there such a thing as “decision making fatigue?”

Mark: Yes, there's what we call “information overload.” So I mentioned at the beginning that we are not kind of completely rational agents. We are animals. We are governed by the processes in our brain of the computations that our brain can make. We have limited attention, we have limited processing power, and we can only take in so much information at one time, right? Some things just may not make it through. Some things may get ignored. We may get tired and have to disengage from something, and decisions go with that as well.

If you are constantly making decisions, trying to use the best and most information possible to inform all those decisions, that can become very fatiguing as well. There's this classic idea in psychology and behavioral science that there's kind of two systems that operate in the brain and kind of guide decision making. We have system one and system two.

One of them is very fast, using these kind of mental shortcuts that I mentioned. Heuristics. The other one is more thoughtful. So, a lot of the big decisions we like to think we would engage that slower system. We would take in all of the different pieces of information and evaluate: “What is correct? What is the best course of action?” For some other things, we can just rely on these mental shortcuts. It allows us to navigate through our world. You can imagine trying to take slow, thoughtful decisions about everything that you do in your day. Almost every moment, you're making a decision about something: “Am I going to pick this up? What am I going to eat for breakfast? Where am I going to go? What do I have to do today?”

If you're thoughtfully engaging and trying to gather as much information about every single decision that you have to make in your day, your brain is going to run out of energy. You're going to get cognitive drain. You're not going to be functioning very efficiently. So we need, we rely on these mental shortcuts to get us through the day; to make the best(ish) decisions, and then devote the cognitive resources for some of the bigger pieces.

But when we have a situation like we experienced with COVID where almost everything seemed like a huge decision... it can become exhausting. And so what that leads to, is you essentially start relying more on faster systems to help you make some of those decisions. So, you start getting governed more by your mental shortcuts, your biases start coming into play more, to help you navigate some of those big decisions that you just don't have the energy and capacity to deal with.

Megan: And that's happening automatically. It's not like I get to choose which decision making system I'm going to use, right? That's just happening in the moment?

Mark: Yeah, there’s lots of factors that can engage one or the other. There are even cues in the environment that can actually help you. So, just having a reminder, or stop and think for a moment: are you using all of the information? Having those cues can actually make you snap out of it in some instances, and say, “maybe I do need to reflect. Why am I making this decision? Am I really getting all of the information that I need?” Or, “am I just kind of taking the path of least resistance?”

Megan: I love that because that touches on our earlier point about information overload and how we are all overloaded with tons of information that could influence our decision-making about health. So, I think about myself: I'm getting information from trusted government websites. I know which ones of those to use. But then, I have a myriad of different social media channels that I follow, that even if I'm not necessarily following someone for health information, they're giving it to me. I might be passively receiving that without even necessarily selecting it because an algorithm is giving it to me. Then, I'm getting information from my colleagues, my friends, my family. Just hearing about their own decision making. So, I love that tip of: stop and think, “what am I making my decision based on? And is it the best information?” Is that like your most practical tip in terms of like, how do I navigate, you know, an infodemic?

Mark: It's also, it's not necessarily something that that needs to happen in the moment. And I think this goes back to that scientists’ brain of being open to challenging yourself. So even if you've been making a decision or following a flow of information, it’s never too late to take a step back and say, “wait a second, is this being guided by some biases? Am I ignoring certain things?” Right? The last thing you want to do is just get caught in what we call the status quo bias: “I've already started kind of down this path, so that's where I am.”

I would say it's good advice. I wouldn't want to create the expectation that we should be constantly doing this because it's challenging. You have other things to focus on. You have work, you have family, your friends, just getting through your day. It’s not an expectation that you should feel like, “oh, I didn't reflect on that decision” or “I didn't do enough reflecting today.” You shouldn't be hard on yourself for the fact that you haven't, but I think it's never too late to take a step back and be able to think back: “how have I been getting shaped by some of this information?”

So, yes, the information landscape is challenging and I think one of the themes that kind of keeps coming up in our conversation is this idea of trust. That's something that we're seeing time and time again; coming to the top in terms of where people are getting information, and how that information is affecting what they believe, the behaviors that they're taking, the dissent that they're making. Ultimately, it comes down to trust. Who they trust. It’s no one's fault that they're following a particular piece of advice. They happen to trust that advice. They happen to trust that person. But, it’s always worth reflecting: “Why do I trust? What are their intentions?”

We recently ran a focus group, some qualitative research study with young adults in Canada. [We were] trying to understand: how are they accessing information? How do they view health information? What are some of their challenges as they're navigating this information landscape?

That was one of the things, [an] interesting insight that came out of that, is that people recognize – what they want to recognize – is what people's intentions are. It was very clear what a person's intentions are, what they stand to benefit, is a big driver of whether they trust that.

Megan: So is this, I mean, that's a good thing, right? That's good news.

Mark: It is a good thing.

Megan: People are thinking about that, right?

Mark: Right. The challenge, I think for me, comes from how do they do that analysis, right? How do they unpack what a person's intentions are? It may seem like someone has great intentions. They're just trying to get this information out there that everyone should know. They're purely motivated by altruism. I think  it's worth checking that confirmation bias, and evaluating: what is the intention of this person? Do they really have my best outcomes at the core of what they're recommending? Or maybe there's something else going on here.

Megan: So sometimes it's not easily verified too, right? What someone's intentions are?

Mark: Definitely. Yeah. When you are, like you said, when you're flooded with information, when you're experiencing decision fatigue, it can be easy [to] fall back on some of those mental shortcuts. So, someone saying something that you agree with, it’s probably already someone that you likely trust and someone who says something that you didn’t [agree] with is probably lower on that trust scale. Because of this kind of confirmation, you may be more critical or look deeper into the person that you're disagreeing with. What are their motivations? Why are they…? Maybe there's something off about this person. Maybe they have some kind of ulterior motive, whereas the person that you agree with, and maybe intuitively trust higher, you're not looking as deep into, you're not asking those same types of questions.

Megan: That makes sense, and it explains, one, how, some of the reasons why it's challenging to have conversations about health. But, it also explains why people use the sources that they use, and why misinformation can be easily consumed and followed, right? There's a very good explanation for that. We're just seeking out information from a trusted source.

Mark: Yeah. And, these algorithms are very sophisticated. They have a goal in mind. Their goal is maybe different from what our goal is, but they're very good at achieving it. In doing that, it's kind of tapped into something about human psychology that can cause people to start viewing things that arouse emotion out of them, that tap into certain emotions and, and [the algorithms are] doing this progressively. Viewing, being shown content that kind of takes you deeper and deeper into an issue that's meant to kind of arouse emotion, with the ultimate goal of keeping you there. One thing that we've seen that I think that is very interesting and promising, is that that people have a very variable awareness of some of these algorithms that are at play and that are governing the information that we're seeing. One thing that's promising is that there is some evidence that people who have a more stated awareness of how this kind of information diet is being curated for them and how these algorithms work, tend to have different views on who they trust. And so, they actually tend to be less susceptible to things like verifiably false statements, things that we would call it misinformation. There may be something there in terms of helping people understand that we can't control the amount of information out there. But, maybe building up people's digital literacy, media literacy, understanding how the information that that they're receiving is getting presented to them, can actually maybe help them kind of navigate the space and maybe put less trust in certain places.

Megan: Sounds like there is a big role for behavioral science to play in general, dealing with misinformation.

Mark: Yeah, I think for me, what I think most interesting, is just understanding why it happens. Why are people drawn to certain things? How can something that was created in some pocket that was completely false, then spread and get followed and kind of clung to? I think there's a lot to look at in terms of how we can help people better navigate this space, and be better prepared to encounter misleading false information that may have a narrative or a hidden agenda behind it.

People state that they're aware that it's out there, they've encountered it. But, better preparing people; the reasons why they may be drawn to a certain piece of information or a certain statement. Maybe some tactics or tools to use when they’re navigating this information space.

Megan: I love that. So empowering people and educating people, providing people with information so they can make their own best decisions about their health.

Mark: Yeah, absolutely.

Megan: I feel like I could talk about this forever with you – I have so many more questions, but we have to close and I want to end with a big question for you: In your work at the Public Health Agency now, in behavioral science, what is the most exciting thing, to you, coming up in the future, where you think you can make the most impact? What's getting you all excited?

Mark: Yeah, I think this trust piece is something that I'm really interested in. I think there's a lot there; how to better empower people, and from a government perspective, what do we need to do to gain people's trust and maintain that trust? Right? What are some tried and true ways in which we can change our practices to show that we have people's best interests at heart? So that’s a big one for me.

Megan: I'm giving you a virtual high five. I’m with you!

Mark: That concept of trust and what, you know, what we can do to, to essentially be to be better and give people what they need. The other one for me that just gets me excited is Public Health’s openness to behavioral science. Taking evidence and using that evidence to guide decisions. This idea of testing our hypotheses; I think there seems to be a growing appetite, which excites me. We can always come up with: “We know this. This will be the best way to do this thing.” Relying on our intuition, our hunch. But, we have no idea if that's the best way. Just because it worked at somewhere else doesn't mean it's going to work in a different context or different environment.

So, instead of just rolling something out and hoping that it works, actually evaluating and testing different ways of doing something and seeing what actually moves the needle. And then, using that information to then full scale some of those programs and communications.

Megan: Love it. That is a super positive way to end this episode. Mark, I think we need to have you back to talk more about this exciting topic.

Mark: Thank you. I'd love to.

Megan: Okay, great. Thank you so much for joining us today, Mark Morrissey, Behavioral Scientist at the Public Health Agency of Canada. Thank you.

Mark: Thank you and very happy to be here. Love what you guys are doing with this platform and podcast, and getting information out to people in a very unique and digestible way for public health.

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Megan: Thanks for tuning into Healthy Canadians. If you're watching on YouTube, don't forget to click the “like” button below and subscribe to stay up to date on future episodes. Find us wherever you get your podcasts and leave us a review if you like what you've heard. For more information on the health topics that matter to you, visit canada.ca/health.

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