‘What we need right now is hope’

You graduated with a degree in Drama and Theatre Arts, and you have said that with arts you tell stories in the most beautiful way possible. What stories are you hoping to tell through the European Congress?

Ones of hope. That's what we need right now. That's what the scientific committee want to see: using psychology in a way that helps address some inequities, and looks to solving some problems. The world is in such turmoil right now, there are just so many different crises. Psychology is sometimes overlooked, even through this pandemic. You could argue we're getting out of the emergency state, with the vaccines, and to that point where we need to be thinking about longer term coping, and particularly long Covid. There are pockets of ideas, of solutions, that we could upscale to make things better in this area and others. It sounds cliched, but I genuinely believe that's true.

It's clearly needed in terms of positivity. I'm interested in your focus on beauty and aesthetics… do you think the arts have a role to play in in a scientific Congress like this one?

Hugely, and I think it's often underestimated as well. We know that policymakers don't listen to science, they listen to anecdotes. There was a famous breast cancer drug that was looked at by NICE and not seen as beneficial from a health economic perspective, but some pretty, charismatic young women who had breast cancer and had amazing stories wrote to their MPs and that led to a change in policy. Individual people and individual stories, that's always what moves people and makes them reconsider. David Palmer in the TV series 24, that depiction of a charismatic President, paved the way for Barack Obama.

 Given the fractured societies we've got, it would be valuable for people to see how they may be marginalised in completely different ways, but by similar groups of people with similar interests

What happens a lot, particularly in conferences and scientists speaking to scientists, we talk about evidence and we can be very dry. But actually, what we have to say is very powerful. It's one of the reasons I enjoy qualitative work. Where I am right now draws together a lot of my different backgrounds. Whilst I do use evidence, I always start and end with an individual story or something powerful. That's what will hold people to then care about what the p value is or what the effect size is… it always starts with people. We're very basic creatures.

What the arts do really well is to say 'regardless of our differences, look, we're actually very similar in many contexts'. We're better together… we've got ways to support each other, and this problem that's happening there is actually mirrored with this completely different population and contexts. That galvanises people. Given the fractured societies we've got, it would be valuable for people to see how they may be marginalised in completely different ways, but by similar groups of people with similar interests. We would be better uniting on certain fronts.

We're fractured, obviously, in a European way as well, in a post-Brexit world? Do you feel like a European psychologist?

I've never thought about that. No, I don't know I ever have. I'm not from the UK. Like many Asians, we call ourselves British first rather than English. There's a legacy of colonial rule. I've always felt like the EU is a lovely thing, but no, I've never really felt European.

Maybe there's also part of me, given the fact that so much of Europe is wealthy and has more stable government, I guess my interests have always been in people who don't have voices or have voices that aren't heard. Even with Ukraine, I find it highly problematic as a person of colour that they are treated differently to other groups in very similar situations. There are good people who are able to cover those narratives well… there are less people like myself interested in slightly different narratives and different groups. My strengths lie in accessing those hidden populations.

In terms of the main theme of the Congress, of uniting communities for a sustainable world, does work of your own speak to that theme?

For the last six years or more I've been looking at elderly medicine and dementia. It's a growing problem everywhere that everybody's really worried about, on top of immediate political crises around the world. India, for example, don't have very good policy on mental health. Whole swathes of population don't know to ask for help, so you've just got a lot of suffering and a lot of costs, social, economic, and so on. The two big countries that are going to have huge rises in dementia are China and India, neither one of which are known for great health care for the majority of the population, let alone great mental health care.

So it's problem.

Increasingly, I've been interested in health networks. When I was doing a PhD, I was working in a primary care public health department, surrounded by people who are working in health services research, understanding how our health service works. There's no country that's not worried about dementia, there are just some countries that are pushing it downstream. Every country is going to have an explosion of people who have dementia. Optimists say that we'll have a treatment and effective treatment in around 20 years. Pessimists will say it's a lot longer. But we're looking at least one generation of elderly people who we can't really do very much for, in terms of stemming this disease or changing its structure. All we can give people right now is hope, and that's where our policy is, because when you speak to GPs on the ground they say they don't know whether the drugs work. The French government have defunded the dementia drugs that we are currently funding, arguing there's not enough evidence. We're potentially funding a fallacy or hope, because that's all we've got. For 20 to 50 years, that's the space we're in.

Some problems are just to worrying to even take on board, aren't they? We published an article a few years ago about climate change, 'Yawning at the apocalypse'. You see that with dementia, with the impact of Covid… perhaps it's only if you can introduce a bit of hope into the narrative that you can get people to even engage with them.

I often feel pretty bleak about climate change. And with dementia, people are interested when it's somebody they know, or they're worried about themselves. There's not much you can do on a broad scale. I can't change the trajectory, but I can give very small interventions that will just make their day-to-day a bit better. But that's a far cry from the public health or charity messaging: 'give us £5 a month, and we're going to have a drug soon'. It's difficult for people if they get a diagnosis to be told, 'the drugs aren't eligible for you'.

Do you feel that Brighton is a hopeful place?

It's a very different place to a lot of the other parts of the country, there's a certain vibe to Brighton. It's full of young people and scientists – we've got a big medical school, and have been the hub of HIV and AIDS research for such a long time. You've got people who are generally left wing liberal, very conscious about being ethical. People are thoughtful and kind, or want to be, to make things better for tomorrow. Brighton voted remain. But it is also because we have this space and capacity to be that. It's a privileged space, affluent. I recognise that in times of crises, the first thing we do is take care of ourselves. If we've been spun lots of narratives, it's really easy to be divisive when you're struggling.

The two big countries that are going to have huge rises in dementia are China and India, neither one of which are known for great health care for the majority of the population, let alone great mental health care.

There's an area in Brighton called Whitehawk, which is one of the poorest parts of the country. It's in a valley… whereas Brighton got gentrified, this area didn't have the main roads through so it's just stayed there. It sits out of kilter… there are cab drivers that wouldn't go there. So when you have privilege, you don't necessarily realise just how disadvantaged somebody else is. And, you know, there's a certain amount of, you know, many clinicians as kind as they can be in the you know, their work in health care and so on. There are times where clinicians will make judgments about individual circumstances because they might not recognise the lack of choice that might be involved.

That idea of needing a privileged space to care and offer hope is an important one. You mentioned medical professionals – you study GP decision making and behaviour, has that been in conjunction with inequity?

I've been around a lot of clinicians. There's a certain security – you can go anywhere in the world, and you'll probably get a job. If you're stuck for money, you can do an extra shift. It's not that clinicians don't have it hard, but it's a level of security, intelligence, affluence, because it costs so much to go to medical school… there are lots of people who don't have those opportunities.

That can make it harder for them to recognise how difficult it is for other people, who don't have any tacit knowledge of medicine, because they didn't have that background, those conversations around the dinner table.

I'm interested in deprivation medicine… this inverse care law, that the people who need it the most get it the least. The more deprived you are, the more likely you are to have long term illnesses. The poorer you are, the worse your diet will be. Your whole life is probably going to be more chaotic. And as a result, you will have more stress, you will have more cortisol, you will age quicker. A normal population will start to get dementia around the age of 65; prison populations and very deprived populations will be looking at getting dementia around 50. So you're also living with it for longer, you're more likely to have frailty and disabilities and worse.

Around the murder of George Floyd, it felt like the world stopped and we started to unite. We started to galvanise, but it so quickly became that the world feels like we're dividing again.

It's become a growing interest within the UK landscape, just because the starkness of it is so clear. It has been a narrative for quite a long time – we would say things like, in Glasgow, the average lifespan is 55. But the fact that it was Glasgow and Wales, there was a certain minimising of it… you know, 'Scottish people drink a lot', that was within the public discourse. We're seeing that grow within England, and the same kind of narratives in education. We don't have a problem when white boys do badly, we have a problem when white boys do badly against black boys. It's the same thing. Poor communities getting worse in main outcomes.

So there's an interest in how we cope with these communities, because we've shifted from acute medicine, where your big problems are these one-offs, to things where they are longer term. 90 per cent of healthcare interactions in the NHS are within primary care. They don't even get 20 per cent of the funding.

It's just shocking. It's not evidence based, it's policy driven – 'let's build these hospitals'. That's a lot sexier than saying, 'let's buy some more nurses', which is what we really need.

What's the main thing you want from the Congress?

Some hope! Can we just have one apocalypse at a time? It just feels like the whole world is burning.

And every time I start to get desensitised by something, something else seems to arise. On a personal level, it would be nice to know that there are other professionals that have bits that I don't understand in hand. People get really scared with dementia, and I'm able to go, 'the evidence is this, but actually there's stuff that we can do'… it would be nice to know that happening across the board. That we're turning the tide. It feels like we've been dividing and dividing. Around the murder of George Floyd, it felt like the world stopped and we started to unite. Like we started to galvanise, but it so quickly became that the world feels like we're dividing again. So it'd be helpful to see evidence that actually we are uniting, that there are people at local levels doing amazing things.