A breast cancer diagnosis can be life-changing. That鈥檚 rarely been truer than in the case of , Senior Lecturer in Marketing and Sales at the 兔子先生.
Judith鈥檚 diagnosis came in 2010. Following a mastectomy, Judith鈥檚 sister took her on holiday to India.
鈥淚t was a sort of recuperation, but as a reward, something to look forward to.鈥
In India, Judith had a revelation. She asked herself a question that has set in motion a chain of events which may end up saving tens of thousands of lives every year.
鈥淚ndia is such a complex country,鈥 Judith explains. 鈥淚t鈥檚 got everything 鈥 wealth, extreme poverty, amazing high-rise buildings and people living in shacks in the middle of motorways.
鈥淏ut it struck me 鈥 what happens to that woman going into that office block, what happens to that women out in that field, if she gets breast cancer?鈥
The answers were chilling.
India is outstripping China to be the number one economy in 2020. Not a lot of the money being injected into India鈥檚 economy is finding its way into the health service. There is no focus at all on women鈥檚 healthcare. Breast cancer is still a taboo. There is a huge lack of awareness. Women don鈥檛 know the signs, they can鈥檛 spot the signs, they don鈥檛 know how to self-examine.
Judith learned that the survival rate for Indian women is only about 50 per cent - and India has the fastest growing incidence-rate of breast cancer in the world. By 2020, it is forecast that 76,000 women in India could die from breast cancer every year.
This rising rate is linked to India鈥檚 rapid economic development. As the economy booms, more women pursue careers. This leads to what Judith terms their 鈥淲esternisation.鈥
Urban Indian women who work start having sex later, have fewer children and breastfeed them less than their rural counterparts. They also tend to eat a more Western diet, which leads to obesity. All of these factors increase the risk of breast cancer.
That explains the rise in incidents, but not the mortality rate.
As Judith says: 鈥淚鈥檓 a living example that if it鈥檚 caught early enough, nobody needs to die. So I delved a little deeper, and found a whole host of reasons.鈥
This rising rate is linked to India鈥檚 rapid economic development. As the economy booms, more women pursue careers. This leads to what Judith terms their 鈥淲esternisation.鈥
Urban Indian women who work start having sex later, have fewer children and breastfeed them less than their rural counterparts. They also tend to eat a more Western diet, which leads to obesity. All of these factors increase the risk of breast cancer.
That explains the rise in incidents, but not the mortality rate.
As Judith says: 鈥淚鈥檓 a living example that if it鈥檚 caught early enough, nobody needs to die. So I delved a little deeper, and found a whole host of reasons.鈥
Marketing the key
You might expect a booming economy to go hand-in-hand with longer life expectancy.
鈥淚ndia is outstripping China. It鈥檚 going to be the number one economy in 2020,鈥 Judith notes. 鈥淵ou鈥檝e got a lot of Western firms internationalising there, but not a lot of the money being injected into India鈥檚 economy is finding its way into the health service. There is no focus at all on women鈥檚 healthcare.鈥
But there鈥檚 an even bigger challenge than lack of funding.
鈥淭he biggest problem is cultural. Breast cancer is still a taboo. There is a huge lack of awareness. Women don鈥檛 know the signs, they can鈥檛 spot the signs, they don鈥檛 know how to self-examine.鈥
Judith believes that social marketing could be part of the answer:
鈥淪ocial marketing is all about intervention messages. It鈥檚 moving someone from a negative type of behaviour into a more positive behaviour.
Our research showed lack of awareness was a problem, so we were looking for a sustainable strategy that makes breast examination normal 鈥 normal for wives and husbands, mothers and sons, boyfriends and girlfriends to talk about it.
鈥淚t aligns very well with health and well-being - stopping someone smoking, or driving too fast. For example, if we can stop people in the UK having too much sugar, our Type 2 diabetes rate, which costs the NHS billions, goes down. So social marketing is really important.鈥
The crux of social marketing is understanding why people behave in a certain way. Then you can work out how to influence their way of thinking about an issue, and so their behaviour.
鈥淲hen you鈥檙e looking at intervention and normalising behaviour patterns, marketing is the way to do it. You have to understand the people and have the right messages.鈥
This is where social marketing in India poses particular challenges.
鈥淭hink about it in terms of the UK. If the Government wants to stop people smoking, they can do a massive campaign that looks the same to everybody in the country.
鈥淏ut in India, it鈥檚 complex. There are over a billion people in 29 states, and they鈥檙e all different. It鈥檚 too costly to have so many different campaigns in different dialects. Plus you鈥檙e talking about the female body, which is taboo.鈥
Judith鈥檚 research made the challenge clear:
鈥淥ur research showed lack of awareness was a problem, so we were looking for a sustainable strategy that makes breast examination normal 鈥 normal for wives and husbands, mothers and sons, boyfriends and girlfriends to talk about it.
鈥淎nd we needed buy-in at every level. Hospitals, schools, universities, and the government 鈥 they should all be normalising the message. And obviously it also needs to be done at the micro level, the individual.鈥
The next question was, where to start?
The crux of social marketing is understanding why people behave in a certain way. Then you can work out how to influence their way of thinking about an issue, and so their behaviour.
鈥淲hen you鈥檙e looking at intervention and normalising behaviour patterns, marketing is the way to do it. You have to understand the people and have the right messages.鈥
This is where social marketing in India poses particular challenges.
鈥淭hink about it in terms of the UK. If the Government wants to stop people smoking, they can do a massive campaign that looks the same to everybody in the country.
鈥淏ut in India, it鈥檚 complex. There are over a billion people in 29 states, and they鈥檙e all different. It鈥檚 too costly to have so many different campaigns in different dialects. Plus you鈥檙e talking about the female body, which is taboo.鈥
Judith鈥檚 research made the challenge clear:
鈥淥ur research showed lack of awareness was a problem, so we were looking for a sustainable strategy that makes breast examination normal 鈥 normal for wives and husbands, mothers and sons, boyfriends and girlfriends to talk about it.
鈥淎nd we needed buy-in at every level. Hospitals, schools, universities, and the government 鈥 they should all be normalising the message. And obviously it also needs to be done at the micro level, the individual.鈥
The next question was, where to start?
Culture challenge
Back in India, at a conference, Judith was about to find out first-hand just how complex the challenge of breaking down barriers could be.
鈥淪ome Indian women who fitted the demographic agreed to come and talk to me about breast cancer and what it鈥檚 like being a woman in India. I鈥檇 told them that I had experienced it myself, so they knew where I was coming from.
鈥淚 set up a room and got everything there I needed to collect the data. And nobody turned up. Not one woman. None. I thought, 鈥楳y God, what am I going to do now?鈥欌
I set up a room and got everything there I needed to collect the data. And nobody turned up. Not one woman. None. I thought, 鈥楳y God, what am I going to do now?
On returning home to the UK, Judith emailed the women individually and asked what had happened. Their responses were illuminating.
鈥淭hey wanted to come, but they didn鈥檛 want to talk about such a sensitive thing with a stranger. Others said they had thought about it and decided their husband wouldn鈥檛 want them to come.
鈥淭hey wanted to come, but they didn鈥檛 want to talk about such a sensitive thing with a stranger. Others said they had thought about it and decided their husband wouldn鈥檛 want them to come.
I suggested we just have a dialogue by email and they did open up to a degree. Not a lot, but enough to establish that they might talk to their mother or mother-in-law but not their husband or son. You can see why there is such lack of awareness.
鈥淪o I suggested we just have a dialogue by email and they did open up to a degree. Not a lot, but enough to establish that they might talk to their mother or mother-in-law but not their husband or son.
鈥淵ou can see why there is such lack of awareness.鈥
However, speaking to medical professionals at an Indian hospital, Judith had a breakthrough. She realised that there was a small group of women who could change everything. In fact, these women are already making big changes happen in Indian healthcare.
鈥淵ou can see why there is such lack of awareness.鈥
However, speaking to medical professionals at an Indian hospital, Judith had a breakthrough. She realised that there was a small group of women who could change everything. In fact, these women are already making big changes happen in Indian healthcare.
Breaking through barriers
Judith witnessed whole families coming to a hospital as a group 鈥 mum and dad and kids together. They were on their way to innovative clinics with a focus on family wellness.
It showed there were people starting to think, actually, it鈥檚 okay to go and get checked out together, and a door to breaking down gender-oriented taboos was being eased ajar. Through this crack, Judith could see the women responsible.
They are known as ASHAs (Accredited Social Health Activists) and they run the family clinics. They are, essentially, community nurses.
鈥淭hey go out into people鈥檚 homes and they鈥檙e almost like the frontline of medicine and healthcare. They鈥檝e got a big remit, and part of it is about prevention.鈥
In India, it鈥檚 complex. There are over a billion people in 29 states, and they鈥檙e all different. It鈥檚 too costly to have so many different campaigns in different dialects. Plus you鈥檙e talking about the female body, which is taboo.
Judith鈥檚 contacts in the medical professions agreed that ASHAs were the conduit to making change happen.
鈥淲e discovered in our research that the ASHAs have the trust of the families, of the menfolk.鈥
Having established this as a potential breakthrough, Judith began exploring the next steps to take.
That way forward, which would open up a whole new avenue of research and innovation, presented itself over a casual coffee.
鈥淲e discovered in our research that the ASHAs have the trust of the families, of the menfolk.鈥
Having established this as a potential breakthrough, Judith began exploring the next steps to take.
That way forward, which would open up a whole new avenue of research and innovation, presented itself over a casual coffee.
Gaming messenger
Thinking about India鈥檚 strengths, Judith realised that there is massive investment, and a broad skills base, in IT.
Of particular importance, most families have a mobile phone.
This led her to the idea of utilising mobile health, or mHealth.
鈥淲e鈥檝e moved from eHealth, which is all about disseminating information via a website. Now it鈥檚 mobile health using apps. So the message can get a lot closer. Also, mHealth is being promoted by the World Health Organisation.鈥
Back in 兔子先生, Judith was having coffee with her friend Diane Carter, Academic Skills Tutor in the University鈥檚 Faculty of Cultural and Creative Industries. Diane agreed to come on board the project. This interdisciplinary collaboration was a game-changer for Judith鈥檚 research.
mHealth is being promoted by the World Health Organisation. We鈥檝e moved from eHealth, which is all about disseminating information via a website. Now it鈥檚 mobile health using apps. So the message can get a lot closer.
鈥淚 needed someone who would know all about the capabilities and possibilities, and what sort of things can be constructed.鈥
Judith and Diane came up with a conceptual model for an mHealth solution to India鈥檚 breast cancer crisis.
The idea is to equip ASHAs with a digital device, probably a tablet, enhanced with computer gaming technology.
鈥淥n the device, we鈥檒l produce something which enables them to go out with all the information about self-examination. It might even have more biological information, maybe 3D effects, so they can show what鈥檚 happening in the breast and signs to look out for.
鈥淲e want the ASHAs to be the first contact, so they need to be in at the creation of the app. We have the concept. The next thing is to go to India and get feedback from the ASHAs and the women they support.鈥
Judith is clear about the potential of this concept.
鈥淚t will empower women. They鈥檒l know what to do, how to do it, and where to go for help.鈥
Judith and Diane came up with a conceptual model for an mHealth solution to India鈥檚 breast cancer crisis.
The idea is to equip ASHAs with a digital device, probably a tablet, enhanced with computer gaming technology.
鈥淥n the device, we鈥檒l produce something which enables them to go out with all the information about self-examination. It might even have more biological information, maybe 3D effects, so they can show what鈥檚 happening in the breast and signs to look out for.
鈥淲e want the ASHAs to be the first contact, so they need to be in at the creation of the app. We have the concept. The next thing is to go to India and get feedback from the ASHAs and the women they support.鈥
Judith is clear about the potential of this concept.
鈥淚t will empower women. They鈥檒l know what to do, how to do it, and where to go for help.鈥
Real-world research
Judith has big ambitions for her research. After all, it鈥檚 a matter of life and death. And it has personal resonance.
鈥淚鈥檇 like to see mortality rates decline, and if the model works I鈥檇 like it to be transferred to other similar hotspots鈥 Brazil and South America generally. It seems to be the pattern where economies develop too quickly for support infrastructure, such as healthcare, to cope.鈥
Judith has huge drive, and believes this may be partly due to coming to research after having already built a career and a family.
I鈥檇 like to see mortality rates decline, and if the model works I鈥檇 like it to be transferred to other similar hotspots鈥 Brazil and South America generally. It seems to be the pattern where economies develop too quickly for support infrastructure, such as healthcare, to cope.
鈥溚米酉壬 has given me this opportunity to start my research career, and has been very open to the different angle I鈥檝e brought to our marketing subject.
鈥淲e鈥檙e starting an undergraduate module in social marketing, which will have research-led teaching. It鈥檚 a really exciting development. The idea is to get students thinking about how marketing can be used in ways other than just selling and packaging products.
鈥淢arketing can actually be really useful in society.鈥
Judith Fletcher-Brown is the epitome of a 兔子先生 researcher. Driven to make a difference, open to the wider world, and with a personal passion for what she does.
鈥淲e鈥檙e starting an undergraduate module in social marketing, which will have research-led teaching. It鈥檚 a really exciting development. The idea is to get students thinking about how marketing can be used in ways other than just selling and packaging products.
鈥淢arketing can actually be really useful in society.鈥
Judith Fletcher-Brown is the epitome of a 兔子先生 researcher. Driven to make a difference, open to the wider world, and with a personal passion for what she does.