Q: Why does finding ways to address FOFO matter so much to public health?
AH: FOFO matters because it kills people. In the U.K., our cancer survival rates are still well below those of comparable European nations. A fifth of all cancers in England are diagnosed at the emergency room. People haven’t accessed any health services until they are so ill that they need to be taken by ambulance, which is so tragic because at that point there may be very little that can be done for them. And these are people who would have known, or suspected something was wrong but didn’t reach out for help.
Finding ways to address FOFO is important, because the longer you wait, the harder and more invasive the treatment is, and the less likely the chance of a good outcome.
Q: Is FOFO more problematic in certain cultures or socioeconomic groups?
AH: In England we talk about something called the inverse care law, which states that health services tend to be used disproportionately by people who are in the least need of them. Healthy, educated people – what some call the “worried well” – would be more likely to access services at the first sign that something might be wrong, whereas people who are most in need of services tend to be the slowest to access them. We also have continued inequities in life expectancies between men and women, which can be partly explained by psychological barriers.
Q: Most people don’t like to get lectured about their bad habits – is this part of the problem? People are just worried about getting told to stop smoking or exercise more?
A: The reasons are deeper than that. It’s about your optimism about your life and if you see yourself as someone who can change and fix things. If you’re a smoker, you may feel that if you go to the doctor, the doctor will most certainly tell you that you have to stop smoking and take away your cigarettes, which can feel like a really scary thought if you’re a heavily addicted smoker.
It also matters if you have a rather fatalistic attitude to your life. (We’ve found that) healthier, wealthier, empowered people tend to think that they can change the world; less healthy, less educated, less wealthy people may feel that what comes, comes. And when your number’s up, it’s time to go, and there’s nothing that can be done about this.
Q: What can be done then to fight FOFO? Can doctors do anything to help patients feel less fearful about seeking care?
I have a lot of sympathy for physicians. There’s a lot of thinking and attention in the medical community about how you break bad news, but you can only break the news if someone is there. A physician can only treat someone if they show up.
It’s not the physician’s job to fix this. It is society’s problem to fix, and perhaps we all need to fix this on behalf of the physicians.
To do so, we need to know a lot more about how these behaviors are learned and how they can be unlearned. We need to know if this is something that is picked up from the peer group – no one you know goes to the doctor, no one you know goes for health checks – but how would it be for you if you behaved differently and tried something new? We’re exploring ways to help people experience different ways of being, using techniques from gaming and virtual reality.
There is ample evidence that FOFO is a quite powerful phenomenon, but there isn’t much research on what you do about it. We’re hoping our work with Live:Lab will remedy that.
Visit https://www.live-lab.co.uk for more about Live:Lab and efforts to address FOFO.