My Unexpected Guide; learning from cancer: September 2020

I recently came across a series of funny, sensitive videos that tackles some of the silence around black America’s prostate cancer crisis - a situation not dissimilar to the UK.

I’ve covered a bit here with my film of two wonderful activists about raising awareness and the local Prostate group in Gloucester - I also know the Black community in Gloucester have done some great awareness raising work. One in Four Black Men will get Prostate Cancer. For the rest of guys the stats are one in eight will get prostate cancer. You can see more about the reasons why this is so important in my blog about Yes to Life standing in solidarity with Black Lives Matters.

The Prostate Health Education Network (PHEN) worked with GDavis Productions to produce Daddy’s Boys. The story is about Jessie, a father of three living with a prostate cancer diagnosis. The PHEN motto is: “Knowledge is the best defense against prostate cancer.” Hence the series has lots of good info as well as challenging the taboos and silence.

Apparently half the audiences are someone with prostate cancer or a family member - and they say they are also hoping this will educate women as they often have some influence over the men in their lives. Certainly the dramas will aid communication and enable folk to better support people - just knowing you can talk means people feel less alone - and plays/drama/creativity is such a great way to raise awareness.

See first two episodes at: https://www.daddysboys.net/tickets and they are hoping to tour again next year - sadly I guess they won’t come here but maybe there is a UK project that is similar?

Update 30/10/20: Here's some interesting new research which is better news - 'Black Men Have Better Outcomes From Radiation-Based Tx for High-Risk PCa': https://www.oncologynurseadvisor.com/home/cancer-types/prostate-cancer/racial-differences-radiotherapy-prostate-cancer-recurrence-metastasis/

Juicing every morning

It’s all very well talking about stuff like exercise, times to eat, self massage and more (see ‘Getting the basics Right’ blog here or ’Showering Like James Bond’ here) (i), but the biggest challenge is often how to make those behaviours part of everyday life. There is loads and loads written about 'behaviour change’ but I’ve not found it so accessible. In this blog I want to start by looking at broad approaches to change but then look at ways I have found useful.

A while back for work I went on an online half day ‘Healthy Lifestyles’ course. It looked at drivers and enablers to making change - so for example if someone says ‘I want to feel less stressed and know how it is to be relaxed’ this might be a useful ‘driver’ to helping them to improve wellbeing. On the course there was also lots about how to work with helping someone make changes. Interestingly if you take responsibility for helping the change then the person will often take the other view - this even has a name; ‘the righting reflex’. So staying away from telling someone is key and instead try to reflect back what the person is saying. If you hear 'change talk’ then explore and clarify to enable the person to come up with the answers.

The course was great at helping folk explore where they are and changes they may wish to make. However I always get a little cross with all that, as so many of these approaches focus on the individual - and this seems to play into wider societal views that blame individuals for problems (ii). So for example overweight people are fat because of their personal choices about eating and exercise. This ignores the role of economic status, upbringing, genetics, neighbourhoods being less walkable, the explosion in cheap fast-food and processed foods, and the way parents talk to their children about weight - all of these have an impact on obesity. It is also over forty years since Susie Orbach wrote, ‘Fat is a Feminist Issue’; we really don’t seem to have learnt much over those years (see Suzie comment in The Guardian here) (iii)!

A research paper in 'Health Affairs’ they explore this idea of personal responsibility, they write (iv): "The notion that obesity is caused by the irresponsibility of individuals, and hence not corporate behavior or weak or counterproductive government policies, is the centerpiece of food industry arguments against government action. Its conceptual cousin is that government intervention unfairly demonizes industry, promotes a “nanny” state, and intrudes on personal freedoms. This libertarian call for freedom was the tobacco industry’s first line of defense against regulation. It is frequently sounded today by the food industry and its allies, often in terms of vice and virtue that are deeply rooted in American history and that cast problems like obesity, smoking, heavy drinking, and poverty as personal failures.”

The same can be said of the UK. Boris Johnson has just unveiled a ‘Better Health Campaign' to combat obesity - there are some useful bits like banning junk food ads before 9pm and barring 'buy one get one free’ on some unhealthy foods. However all this is more focus on personal responsibility - it doesn’t look at attacking the root causes of obesity—poverty and inequality. And hey what’s with their idea of calorie counts in restaurants - for a start calorie counting is not that useful with obesity (v) and I can’t see how that is going to have a significant impact on behaviour.

In a previous blog I noted the links between inequality and obesity in the research by Kate Pickett and Richard Wilkinson (vi). The government does at least acknowledge that “obesity is more common in people living in deprived areas”, but their focus is all about reducing people’s weight, as opposed to reducing their deprivation. In another previous blog (vii) I covered Cancer Research UK's campaign about obesity causing cancer - that again framed obesity as a lifestyle choice and encourage weight stigma. Yet we know ‘fat shaming’ has a counter-productive effect and leads to further weight gains. Long-lasting change is most likely to happen when it's self-motivated and rooted in positive thinking.

The ‘Healthy Lifestyles’ course didn’t look at any of these wider issues and similarly messages in the media are too often simplified down to the personal responsibility approach - and of course at the end of the day that is how, as individuals, we can affect personal changes. However isn’t it time for a more holistic approach that seek to change lifestyle habits by looking at the psychological and physical factors that underpin them but also recognise those wider factors?

A Model of Change

One of the interesting ways of accounting for success and failure in making healthy changes, is the transtheoretical model (TTM). TTM is one of the most widely used and sees change as a process not an event - although it is not without criticism. In brief you can go from precontemplation to contemplation to preparation to action to maintenance where the changes adopted to practicing it for the rest of your life. Understanding where you are in that process can help look at what intervention is best at that point - and therefore move to the next step. Although it's acknowledged that these stages are not as discreet as the model suggests; folks come in and out of the process, relapse and restart (viii). This is not for this blog as you can read lots about this in many places.

Making self care habitual

As noted the ‘Healthy Lifestyles’ course also didn’t really get into more specific tools to embed new behaviours - possibly not being enough time in the session? Yet it seems to me this is possibly one of the more valuable ways we can support ourselves and others? B.J. Fogg writing in the acclaimed book, "Tiny Habits: The Small Changes That Change Everything” (ix) says 3 things will change your behavior in the long term:

Option A: Have an epiphany
Option B: Change your environment
Option C: Take baby steps

He writes on the website: "Creating an epiphany is difficult. So rule out Option A unless you have magical powers—I don’t. On the other hand, Option B and Option C are practical. And they can lead to lasting change if you follow the right program".

The book is full of much good info. Ayurvedic practitioner Dr Sam Watts of Mind, Body, Medical in a recent FaceTime video suggested four key tools that are covered in the book:

1. Tagging. This is where you ’tag’ your new behaviour onto an existing behaviour. So for example tagging meditation onto doing the school run; using time sitting in the car after dropping the children off. Or as in my case, a self massage after a shower. This is such a brilliant way of embedding new behaviours.

2. Small goals. The more we are successful, the more successful we are; success breeds success. So small goals will lead to dopamine hits which will help us perceive we are successful and encourage us more.

3. Deadtime. Where can we fit stuff in? While the kettle is boiling is there time for squats, stretches or breathing? Or using 10 mins in lunch break for a mindfulness activity?

4. Positive mindset. We can change reality by changing perceptions - one example that I remember is Victor Frankl, who maintained his body weight in the concentration camp by creating his own reality. So are there ways to turn negative thoughts into positive ones before going to sleep?

For me knowledge is one of the key factors that help - knowing that something can have an impact is a significant motivators for me. I therefore also liked this blog which covers that aspect, '10 Science-backed Tips to Making a Health Behavior Change that Sticks': https://medium.com/lifeomic/10-science-backed-tips-to-making-a-health-behavior-change-that-sticks-8655c3bbde50

Although when I find so many useful behaviours which ones should I prioritise? Finding our 'protocol' or self-care practices is an on-going challenge - and sometimes delight! I also see some of those practices changing and adapting as life goes on.....

Lastly it is said that it takes 21 days to structurally alter the brain so that a new behaviour becomes a habit. Good luck!

Update 7/11/20: I like this tip from Gloucestershire's Katie Elliott of 'Little Challenges': "I’ve learned that a new behaviour should feel so easy that we’ll be able to do it successfully at least 80% of the time. If not, the aim is to keep making the behaviour simpler until it feels like something that would be manageable on pretty much any day - even a really dreadful one. Only once we’re in the habit of doing that one small thing successfully - and having experienced an increased sense of self-efficacy as a result - is it time to scale up to something a little more ambitious. And then again. And again. It sounds slow, but it’s actually a lot quicker than setting huge goals and never reaching them".

Update 12/01/21: This TEDx talk says just do it for a minute and take the struggle out: https://www.ted.com/talks/christine_carter_the_1_minute_secret_to_forming_a_new_habit

Updated 12/01/22; Love this quote!