A breast cancer diagnosis can be life-changing. Thats rarely been truer than in the case of , Senior Lecturer in Marketing and Sales at the 窪蹋勛圖.
Judiths diagnosis came in 2010. Following a mastectomy, Judiths sister took her on holiday to India.
It was a sort of recuperation, but as a reward, something to look forward to.
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.
India is such a complex country, Judith explains. Its got everything wealth, extreme poverty, amazing high-rise buildings and people living in shacks in the middle of motorways.
But it struck me what happens to that woman going into that office block, what happens to that women out in that field, if she gets breast cancer?
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 Indias economy is finding its way into the health service. There is no focus at all on womens healthcare. Breast cancer is still a taboo. There is a huge lack of awareness. Women dont know the signs, they cant spot the signs, they dont 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 Indias rapid economic development. As the economy booms, more women pursue careers. This leads to what Judith terms their Westernisation.
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: Im a living example that if its caught early enough, nobody needs to die. So I delved a little deeper, and found a whole host of reasons.
This rising rate is linked to Indias rapid economic development. As the economy booms, more women pursue careers. This leads to what Judith terms their Westernisation.
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: Im a living example that if its caught early enough, nobody needs to die. So I delved a little deeper, and found a whole host of reasons.
Marketing the key
You might expect a booming economy to go hand-in-hand with longer life expectancy.
India is outstripping China. Its going to be the number one economy in 2020, Judith notes. Youve got a lot of Western firms internationalising there, but not a lot of the money being injected into Indias economy is finding its way into the health service. There is no focus at all on womens healthcare.
But theres an even bigger challenge than lack of funding.
The biggest problem is cultural. Breast cancer is still a taboo. There is a huge lack of awareness. Women dont know the signs, they cant spot the signs, they dont know how to self-examine.
Judith believes that social marketing could be part of the answer:
Social marketing is all about intervention messages. Its 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 normal for wives and husbands, mothers and sons, boyfriends and girlfriends to talk about it.
It 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.
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.
When youre 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.
This is where social marketing in India poses particular challenges.
Think 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.
But in India, its complex. There are over a billion people in 29 states, and theyre all different. Its too costly to have so many different campaigns in different dialects. Plus youre talking about the female body, which is taboo.
Judiths research made the challenge clear:
Our research showed lack of awareness was a problem, so we were looking for a sustainable strategy that makes breast examination normal normal for wives and husbands, mothers and sons, boyfriends and girlfriends to talk about it.
And we needed buy-in at every level. Hospitals, schools, universities, and the government they should all be normalising the message. And obviously it also needs to be done at the micro level, the individual.
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.
When youre 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.
This is where social marketing in India poses particular challenges.
Think 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.
But in India, its complex. There are over a billion people in 29 states, and theyre all different. Its too costly to have so many different campaigns in different dialects. Plus youre talking about the female body, which is taboo.
Judiths research made the challenge clear:
Our research showed lack of awareness was a problem, so we were looking for a sustainable strategy that makes breast examination normal normal for wives and husbands, mothers and sons, boyfriends and girlfriends to talk about it.
And we needed buy-in at every level. Hospitals, schools, universities, and the government they should all be normalising the message. And obviously it also needs to be done at the micro level, the individual.
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.
Some Indian women who fitted the demographic agreed to come and talk to me about breast cancer and what its like being a woman in India. Id told them that I had experienced it myself, so they knew where I was coming from.
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, My God, what am I going to do now?
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, My 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.
They wanted to come, but they didnt want to talk about such a sensitive thing with a stranger. Others said they had thought about it and decided their husband wouldnt want them to come.
They wanted to come, but they didnt want to talk about such a sensitive thing with a stranger. Others said they had thought about it and decided their husband wouldnt 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.
So 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.
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.
You can see why there is such lack of awareness.
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 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, its 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.
They go out into peoples homes and theyre almost like the frontline of medicine and healthcare. Theyve got a big remit, and part of it is about prevention.
In India, its complex. There are over a billion people in 29 states, and theyre all different. Its too costly to have so many different campaigns in different dialects. Plus youre talking about the female body, which is taboo.
Judiths contacts in the medical professions agreed that ASHAs were the conduit to making change happen.
We discovered in our research that the ASHAs have the trust of the families, of the menfolk.
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.
We discovered in our research that the ASHAs have the trust of the families, of the menfolk.
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 Indias 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.
Weve moved from eHealth, which is all about disseminating information via a website. Now its mobile health using apps. So the message can get a lot closer. Also, mHealth is being promoted by the World Health Organisation.
Back in Portsmouth, Judith was having coffee with her friend Diane Carter, Academic Skills Tutor in the Universitys Faculty of Cultural and Creative Industries. Diane agreed to come on board the project. This interdisciplinary collaboration was a game-changer for Judiths research.
mHealth is being promoted by the World Health Organisation. Weve moved from eHealth, which is all about disseminating information via a website. Now its mobile health using apps. So the message can get a lot closer.
I needed someone who would know all about the capabilities and possibilities, and what sort of things can be constructed.
Judith and Diane came up with a conceptual model for an mHealth solution to Indias breast cancer crisis.
The idea is to equip ASHAs with a digital device, probably a tablet, enhanced with computer gaming technology.
On the device, well 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 whats happening in the breast and signs to look out for.
We 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.
Judith is clear about the potential of this concept.
It will empower women. Theyll know what to do, how to do it, and where to go for help.
Judith and Diane came up with a conceptual model for an mHealth solution to Indias breast cancer crisis.
The idea is to equip ASHAs with a digital device, probably a tablet, enhanced with computer gaming technology.
On the device, well 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 whats happening in the breast and signs to look out for.
We 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.
Judith is clear about the potential of this concept.
It will empower women. Theyll know what to do, how to do it, and where to go for help.
Real-world research
Judith has big ambitions for her research. After all, its a matter of life and death. And it has personal resonance.
Id like to see mortality rates decline, and if the model works Id like it to be transferred to other similar hotspots Brazil and South America generally. It seems to be the pattern where economies develop too quickly for support infrastructure, such as healthcare, to cope.
Judith has huge drive, and believes this may be partly due to coming to research after having already built a career and a family.
Id like to see mortality rates decline, and if the model works Id like it to be transferred to other similar hotspots Brazil and South America generally. It seems to be the pattern where economies develop too quickly for support infrastructure, such as healthcare, to cope.
窪蹋勛圖has given me this opportunity to start my research career, and has been very open to the different angle Ive brought to our marketing subject.
Were starting an undergraduate module in social marketing, which will have research-led teaching. Its 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.
Marketing can actually be really useful in society.
Judith Fletcher-Brown is the epitome of a 窪蹋勛圖 researcher. Driven to make a difference, open to the wider world, and with a personal passion for what she does.
Were starting an undergraduate module in social marketing, which will have research-led teaching. Its 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.
Marketing can actually be really useful in society.
Judith Fletcher-Brown is the epitome of a 窪蹋勛圖 researcher. Driven to make a difference, open to the wider world, and with a personal passion for what she does.