Despite my often distaste for Marvel films, I personally like Doctor Strange as a character - partially because of my obsession with Benedict Cumberbatch as an actor.
Let’s suppose that, for a second, we all live in the Marvel universe where Earth is, for some obscure reason, constantly under attack. As someone who fends off thousands of multiverse invaders on a daily basis before they even reach Earth, it is easy to argue that Doctor Strange saves more lives than any other Marvel hero. But to a common person, he is never on the news, and will be remembered more for surrendering a powerful artefact to a super villain and getting beaten up by a 17-year-old Spiderman on the streets.
That is because his job is to prevent disasters from taking place, rather than stopping disasters after cities have been levelled. Understandably, to a common person, it is impossible to recognise his work in preventing disasters, if these disasters have never taken place. Perhaps, every hero and legend needs a disaster.
I think that last sentence is brilliant. Unfortunately it did not come from me, but written by the economist Richard Koo, in his book The Holy Grail of Macroeconomics. By analysing retrospective data, he theorised that Japan’s “Great Recession” in the 1990s was the result of a rare economic phenomenon which he called the “Balance Sheet Recession”. This type of recession cannot be remedied by common monetary policies, but instead requires governments to increase spending. Luckily, according to Koo, the Japanese government recognised the underlying problem and increased public spending to 140 trillion Yen for the next 15 years, averting the collapse of the economy. Japan’s GDP even started to climb steadily after a short dip.
The precipitous drop in financial liabilities (debts) of private companies could reflect Japan's "Balance sheet recession" from 1990 to 2005. Source: Izabella Kaminska on Financial Times, 2012
To Koo, the 140-trillion-Yen public spending saved millions from losing their jobs and having their lives devastated. But to much of the Japanese public (and also the International Monetary Fund at the time), the government just spent 140 trillion Yen that did not lead to a proportional growth in GDP. The only viable theory was that tax money has been seriously misused. In 1997, the Japanese government led by Ryutaro Hashimoto cracked under political pressure, hence increased taxation and decreased government spending. The result in the next five years was the opposite of what they had hoped for: decreased tax revenue, increased fiscal deficit, and the worst economic downturn since WWII.
In my opinion, no one was to blame for the economic downturn. Humans learn about what-causes-what by observing two things that happen together - the thing that came right later must be caused by the thing that precedes. Realistically, it is a poor way to assess causal inferences, hence the corny saying “correlation ≠ causation”, but it’s pretty much the only tool humans have for most of human history. Even with scientific methods now, we still make this type of associations on a daily basis, consciously or subconsciously, which forms the foundation of behavioural psychology. In the same way, we know the economic crisis followed Hashimoto’s fiscal policies, but do we know if the policies really caused the crisis?
Disease prevention and healthy lifestyles
The COVID-19 pandemic rampaged the world for three years; during this time, effective vaccines were made available to the public, but vaccine hesitancy - which was revealed to be more than 20% of people in a large global study - severely hindered our road to herd immunity.
It strikes me that maybe vaccines go uncredited in the same way as Doctor Strange. The protective benefit cannot be felt after we receive the vaccine - and if anything, we notice mild side effects. You may see Doctor Strange leaving some mess on the streets, but you don’t see the 9000-ton creature that he kept out of Earth. We can learn about their contribution through a book, but we often can’t see it with our own eyes.
The same goes for disease prevention in general. How can you be sure that your appetite improved because you quit smoking two months ago, not because you started playing Minecraft last week? In contrast, no one turns down, say, hay fever pills, because your runny nose will go away in 10 minutes. Omission bias - the human preference to inaction over action despite clear understanding of the benefit of action - can further prevents us from making behavioural changes that our body needs.
The Health Belief Model
The Health Belief Model, source: Wikipedia, diagram adapted from Rosenstock 1974
The Health Belief Model (HBM) was developed in the 1950s by social psychologists at the US Public Health Services to predict one’s behaviours to prevent diseases and maintain good health. Four predictors in the model - perceived perceived susceptibility, perceived severity, perceived benefits and perceived barriers - have all been validated for their predictive powers by studies. On the other hand, the HBM also points to a fifth predictor, “cue to action”. Despite extensive research on the four other predictors, the original developers of HBM noted that the fifth predictor “cue to action” is severely under-researched. Indeed, when I attempted to find studies that validate/invalidate this fifth predictor, I came out with nothing.
While I recognise the difficulty in designing such studies, the absence of research after 70 years still baffles me. As highlighted in my previous article, the leading risk factors of cancer worldwide are behavioural in nature, hence understanding the interplay between behavioural psychology and public health will be increasingly important. I believe this “cue to action”, which can be things like seeing illness in the family or on TV, has the potential to overcome the barrier of omission bias in population. It could also be a powerful tool in health promotion, as it appears to me that seeing the benefit with our own eyes not only targets our conscious but unconscious thought processes.
Photo credit: Stockbyte on Canva
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