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Join hosts Doctor Xand van Tulleken and Dr Rochelle Burgess for Season 3, Episode 3 of Public Health Disrupted with Prof Cath Mercer and Prof Sir David Spiegelhalter.
Xand Van Tulleken 00:06
Hello and welcome to season 3 of public health disrupted with me Xand van Tulleken
Rochelle Burgess 00:11
…and me Rochelle Burgess. Xand is a doctor, writer & TV presenter, and I’m a community health psychologist and Associate Professor at the UCL Institute for Global Health.
Xand Van Tulleken 00:23
This podcast is about public health, but more importantly, it’s about the systems that need disrupting to make public health better. Join us each month as we challenge the status quo of the public health field, asking what needs to change, why and how to get there.
Rochelle Burgess 00:37
In today's episode, we're going to be exploring sexual attitudes and behaviours, how they're changing and asking the question, what's really going on behind closed doors? I'm going to try not to sing that salt and pepper song from the 90s. But that's all that's been playing in my head in the lead up to preparing for this episode, because we're basically doing that we're talking about sex. And there are lots of myths. Do you know the song? I mean,
Xand Van Tulleken 01:02
I know the song I'm just they be promised you wouldn't?
Rochelle Burgess 01:08
I did it. I know. I know.
Xand Van Tulleken 01:10
It's fair use, I think we can get the permission.
Rochelle Burgess 01:15
There were lots of myths and misunderstandings about sex and it can be tricky to get to the truth. So what does the average British person think about sex? And what are their experience of it?
Xand Van Tulleken 01:24
Well, other than you singing that song, it would be incredible if there was a way to find out what is an incredibly kind of intimate, difficult form of knowledge to get hold of. And amazingly, there is so we are introducing the national surveys of sexual attitudes, and lifestyles. The NATSAL and the NATSAL are among the largest surveys of sexual behaviour in the world. It was initiated in the mid 1980s. In response to the emerging HIV epidemic with the first surveys run in 1990. It's taken place every 10 years since then, the surveys use a probability sampling method to randomly select people from across Britain to take part, which means that the results are broadly representative of the British general population. So far over 45,000 people have taken part in NATSAL. The surveys are administered by an interviewer face to face in the participants home. It's a computer assisted interview with SELF completion sections used for more sensitive topics, and the consistent methodology and repetition of the surveys have made it possible to capture striking changes in the sexual behaviour, attitudes and healthcare behaviour of people born over much of the 20th century. So helping us to understand the vast kind of fascination of this and usefulness and why it's so important our today's experts Prof. Cath Mercer and David Spiegelhalter.
Rochelle Burgess 02:48
and Cath Mercer, who I am lucky enough to know already is a professor of sexual health science at UCL and CO lead of UCL Centre for population research and sexual health and HIV, a statistician and demographer by training, Cath is recognised internationally as an expert in developing and employing robust methods that advanced the study of sexual behaviour, one of the most socially sensitive areas of scientific inquiry. For more than 20 years, Cath has played a key role in delivering Britain's NATSAL study. And she is now co leading the fourth NATSAL cath also champions myth busting and promoting the public conversations around sex, including rather nerverackingly through stand up comedy sets for UCL is bright Club, which I did not know about cath and now you will see me there and her TED talk. Let's talk about real sex. So Cath knows the song already. So I'm sure she enjoyed that.
Xand Van Tulleken 03:41
You're sure are you you're
Rochelle Burgess 03:42
She smiled, I saw it.
Xand Van Tulleken 03:47
Well, our other incredible guest is David Spiegelhalter, who is emeritus professor of statistics in the Centre for Mathematical Sciences at the University of Cambridge. He was previously Chair of the Winton Centre for risk and evidence communication which aimed to improve the way that statistical evidence is used by lawyers, professionals, patients, lawyers, judges, media and policymakers. He was very busy over the COVID crisis, not least because he was constantly being interviewed by me and my brother and the documentaries that we were making, which he was endlessly helpful about and then churning out articles, podcasts and so on which over my career and particularly during COVID really helped me and so many broadcasters communicate evidence to the public and understand it ourselves. I will say he presented the BBC four documentaries tells you when the science of chance the award winning climate change by numbers. His best selling book, The Art of statistics was published in March 2019. I highly recommend it and COVID by numbers came out in September 2021. His career highlights include, I don't know if you'd... I guess this is a career highlight appearing on Desert Island Discs in 2022. I don't believe one of your discs was let's talk about sex by salt and pepper. And you can correct me if I'm wrong about that. And in 2011, he came seventh in an episode of BBC ones winter wipe out.
Welcome to you both. Thank you so much for joining us. Just so that listeners know David pulled an amazing facial expression when recalling his BBC one winter Wipeout triumph. Cath can I start with you, though, because the British national surveys of Sexual Attitudes and Lifestyles is, I think, just so intriguing to so many people because it allows us access to information that you can't get from anyone maybe other than yourself, or your maybe the people you're most intimate with. Can you tell us more about it? Why it's so important scientifically?
Cath Mercer 05:40
Absolutely. So, as we said, Just now the idea of having a nationally representative survey began really back in the mid 80s, with the emergence of HIV and AIDS, because back then, there was this realisation that that we really didn't have reliable data with which to inform public health response, you know, back then we really didn't know who was at risk, or, more specifically, what kinds of behaviour put people at an increased risk of HIV. And the the, the tombstone, don't die of ignorance campaign that I'm sure many will remember, was initially targeted to the population as a whole, which obviously caused alarm for many people. And personally, I remember coming home from school, secondary school, I hasten to add, and sat on the doormat was the tombstone leaflet, that being sent to every household across the country. And I just remember thinking, that's it, we're all doomed by this thing called HIV. But as we came to learn our individual behaviours, and also those of our sexual partners, mean that HIV risk varies hugely across the population. And that learning was largely influenced by the findings from the first National Survey of Sexual Attitudes and Lifestyles, or NATSAL for short.
Although the first NATSAL study team led by UCL Anne Johnson didn't exactly have an easy journey in getting the first NATSAL up and running. So despite having done a pilot study that demonstrates that doing a survey like natsal Will was largely acceptable with the British public. And the scientific community has called for robust evidence on HIV risk, and the government agreeing to fund the first national study at the 11th hour. So just as the main study was due to be fielded in September 1989, the then Prime Minister Margaret Thatcher pulled the plug on the government's promise of funding NATSAL because Thatcher thought it would, quote, invade the privacy of those due to be questioned. Still a story that made the front page of The Sunday Times no less. But fortunately, the Wellcome Trust stepped in with the funding so that the first NATSAL study could and did go ahead in 1990, with nearly 19,000 people aged 16 to 59, randomly selected from across Britain, completing around about an hour long interview administered survey that asked participants questions about their their sexuality, moods and behaviours related to at the time hypothesised HIV risk.
Now, the findings from NAtSAL one were initially published in the journal Nature in 1992, but went on to be absolutely key for for shaping HIV, public health policy and practice in the UK, and internationally, too.
But that's not the end of NSATSAL story, as by the mid 90s, it became apparent that actually that source data were incredibly helpful for understanding the epidemiology and public health implications of sexually transmitted infections STIs, including but not just HIV, but also that the data from the first net sale work, we're getting outdated. And so a second that sell survey was proposed and then carried out at the start of the millennium, and then a third survey in 2010. And we're now currently fielding the fourth and NATSAL survey with each round of the survey, having a widening remit in how sexual and reproductive health conceptualise so so these days in the latest NASAL we're asking about behaviours rating to STIs, pregnancy, sexual function and sexual violence. Although intersectionality means that often these behaviours and outcomes are related. And crucially, as we said, right at the start, each survey has been based on the methodology used for the very first NetSol such as many of the questions included in that first survey still being asked in 2023. It means that we can make valid comparisons when we examine how behaviour and sexual reproductive health have changed over time.
So, in a nutshell, for over 30 years, NATSAL has provided robust evidence of the context that influences and consequences of sexual lifestyles in Britain, and as such has been vital for informing intervention strategies and guidelines, including the National chlamydia screening programme, HPV vaccination policy, the teenage pregnancy strategy to name just three, as well as advancing the science of and also the public dialogue around sex and sexual health.
Xand Van Tulleken 10:28
Can you just give us a little bit more of a sense of what it means to try and get this information out of people how sensitive it is? Because your story about Margaret Thatcher is amazing in terms of, you know, politicians, I suppose she dressed it up as privacy, but we can imagine it may well have been her prudishness or squeamishness about the topic in general? What are the barriers? And how do you get this detail out of people?
Cath Mercer 10:54
Well, that's, that's a really good question. Because, you know, how do we get people to open up about something that is hugely personal, often socially sensitive, sometimes it's taboo.so as a study team, we go to great lengths to enable participants to answer the questions in NATSAL as honestly and as accurately as they can. So this includes even how we sell the survey. So in the participant facing literature, on the NASAL website, and so on, so that potential participants realise that this isn't, this isn't any old sex survey, it's not a sex survey that they might see in a tabloid newspaper or a magazine out to sensationalise. But NATSAL is a genuine scientific study of sexual behaviour that seeks to be so scientifically rigorous that, in fact, that's all only takes place once a decade, if you like, you know a sec census. And because of this net sales findings are, yeah, as I said, hugely important for health policy and practice, which is something that we convey to participants when we invite them to participate. we also have to think very carefully about how we collect the data, especially for for the more sensitive questions that a sixer they like that sound needs to ask. So so this includes using show cards with response code so that participants can just give a letter code rather than having to say a loud word, aloud words that they may find embarrassing. And for the most sensitive questions that NATSAL have asked them, that says always use a self completion module for the participant then reads the questions themselves, and types their response straight into the interviewers laptop, so the interviewer doesn't need to see or hear what they're reporting
But we do acknowledge, though, that that sex lives can be complicated. And sometimes, you know, the questions that we need to ask don't work for people. So what may seem like an inconsistency for the researchers may just reflect life's complexities. I do think it's encouraging that, you know, when we hear from participants, the vast majority say that well, yes, I took notice how seriously, they realise its scientific importance
Rochelle Burgess 15:28
David, I wonder if you could reflect a little bit on what other types of evidence exists out there about people's lifestyles and sexual attitudes? And how do we deal with tensions in quality? If we're collecting research from different spaces outside of the survey landscape?
David Spiegelhalter 15:53
Yes, yeah, because I'm a statistician, and we we count and measure things. And these are very difficult things to count and measure, because we can't don't observe them directly. As Cath said, we're largely reliant on reports, there's some things we can count with, you know, there's some administrative data that is very relevant. For example, a teenage conceptions that's published by the Office of National Statistics tells us a lot, and we can count them. We know that in 1970 50 years ago, I was just checking isn't that 50 years ago, 1973. Every year, one in 20 16 year old girls got pregnant in the UK isn't extraordinary. So that you know, more than one in every class got pregnant on average. Now, it's one in 100. These are extraordinary changes in conception and how much that's a change of sexual behaviour, better access to contraception, who requires additional data from surveys like that, so, but these are extraordinary things that we can count. And we can know,
I wrote this book, sex by numbers, and I got obsessed with going back and looking at historical trends in these things. In 1938, half the brides who got married, were pregnant, they know anyone under 20. There's all sorts of amazing, you know, patterns of behaviour, we can spot just from official statistics. But it goes some administers statistics. So not so reliable. If we look at, you know, attendances at sexual health clinics for sexually transmitted infections, we can get some good data on these and they're published. But because that doesn't tell us directly how many people have got sexually transmitted infections, because it relies on people going into the clinic. So we have to allow for that. And when I was writing the book, I actually just introduced a star rating system and these ideas of in a way rating statistics and how confident you are about them, is becoming more common. And across a wide range of areas. And these administrative data, like teenage pregnancy rates, I've put us four stars, things like NATSAL really well done surveys, which are broadly very reliable, I put us three star, then you've got other, you know, not so well done, people have made an effort, but not actually that well done surveys. And then you got ones with the surveys, you know, just voluntary surveys, you know, right in in, you know, in magazines, the whole height report sort of stuff where people just either wrote in their experiences, well, it kind of tells you what can happen, or what does happen. But in terms of quantification, it's pretty useless. And then, of course, you've got zero stars, which are numbers that just people make up. Like, men think about sex every seven seconds, you know, this sort of stuff that people just make up stories. And remarkable number of claims you see in newspapers or magazines about sex are essentially made up.
I got fascinated by this issue of how many sexual partners people have had in their lifetime. And, and then you can look for some consistency, because if you're looking at opposite sex, sexual partners, then actually the the average and it was the mean number of partners that a man has had that men have had, should be exactly the same as the average number of partners in terms of the mean that women have had been because every pair takes two. And so the average number, the total number of partnerships is this is constant. And one is a man one is a woman. So the average number should be the same, because they differ, man on average report having more sexual partners than women. And it'll hold cats team has written whole papers about why this is the case. And what you can do to try to avoid it. How much of this is social acceptability bias, either by women not wanting to admit some of the relationships they've had or not consider them as as partnerships. And men, you know, some exaggerations, or boasting? I think, on the interesting theories is this is actually a lot of this is just how people count that women will be tending to enumerate their relationships by name and catching up image images, whereas men, it was 10 20. You know, you can see this by the use of Rand huge net use of rounding and the figures that men give women to some extent, but a lesser extent. So men will say, Oh, 20 30 40, exactly. I remember that. So certainly, there's one man who said 48. So I think, you know, it's probably a statistician, i Except I don't think. So there is some measures of consistency when and the NetSol survey and uses all sorts of consistency checks, both within interviews, and between interviews, to try to reconcile and triangulate the different sources of information.
Xand Van Tulleken 21:28
Can I ask, I guess the question that everyone's wants to know, which is, what is your best guess as to the the number?
David Spiegelhalter 21:36
Well, it's a massive distribution, though. The modal number, the most most common number is one is really monogamy. Oh, yes. Yeah, the mode is one. But then the Oba is a very long tail, this distribution so long, then when I show graphs a bit, I can't, I have to walk out, I just have to point out outside the room and say it goes up.
Xand Van Tulleken 21:57
Another protecter
Rochelle Burgess 22:00
unfold and more and more like pieces of paper as you walk out the door
David Spiegelhalter 22:03
Exactly, yeah. Yeah. So I tend to cut it off at 50 to show the distribution.
Xand Van Tulleken 22:11
That's, that's great. If
Cath Mercer 22:13
you want to know the total number that the largest number reported in the last survey, it was 3200. Oh, which does sound there's clearly some evidence and digit heaping, you know. But at the same time, was that reporting error? Should it have been? Two to 300? I don't know. So but yeah, as David says, we we trim, so that we were looking at the 95 percentile, so that we yeah, we can lose those where we think actually, not so sure. But at the same time, you know, these are real people's lives, they're giving their time. So you know, the extent to which we meddle with the data? You know, we don't we have to trust what people tell us, which is why I said, we talk about reported data. So 3200 is the maximum, one thing
Rochelle Burgess 23:01
that just keeps popping into my mind listening to you guys talk. And, David, your last comments that sort of highlight gender norms, and how societal norms and structures and ideals really shaped the way that people talk about things and report things. I just wondered, like, how do you deal with that, in terms of thinking about quality of research? So if like this space is where you know that the norms are going to be particularly powerful, in sort of potentially driving reporting bias, right, so then, are there ways in which research studies then get identified as being of different quality because of that?
David Spiegelhalter 23:41
Yeah, I mean, there have been some randomised trials of asking people questions, and where some people were randomised to a group where they knew the data would be completely confidential and others, to a group where they suspected somebody could see it when they picked up the piece of paper and took it to the thing and you do get differential responses there. So we know that the assurance of confidentiality and all the techniques that Katz describing are important in terms of people, you know, accurately describing their behaviour. And of course, I suppose this gets more extreme when we get to perhaps more, you know, for behaviours that maybe maybe considered, you know, socially well, and also a diverse, shall we say, is as a as a nice as a good way of saying it. And Kath, I mean, I don't know what you feel with the weather now. Weather This is a bigger issue with the range of behaviours that people have. I'm thinking of things like weather people just saying they're asexual, for example, which has been an issue this appears to be growing from as one hears from reports but again, I don't believe things until I've heard that scene are proper, sir. they'd done about these about these possible changes in behaviour.
Cath Mercer 25:05
I mean, I think I think it's really interesting to look at society more broadly. And the influence that that has on people's willingness to report their sexual behaviour in a survey, like NATSAL but more generally, to talk about the reality of their sex lives, you know, how often they have sex, how they find it? I think there's just a greater acceptance for people to say, you know, actually, we don't have sex all that often these days, or when we do it's not that fantastic. And I think it just reflects how people react recognise that sex, perhaps isn't the be all and end all in life or even in a relationship? And that, yeah, there's, there's something about just being honest, you know, what, why lie Why exaggerate. I think this may also reflects, you know, the rise in online dating, where people are cool to think about what kind of relationships they they're interested in? Are they looking for sex? Are they just looking for companionship, and to, you know, to be explicit about that, on on online dating apps, and so on? You know,
and then when we think about what the world looks like, today, Every era has its challenges. But when we think, you know, during COVID, what did sex life look like then? Now, on the back of COVID, cost of living crisis? You know, where does sex feature in people's sort of list of priorities these days? You know, if they're worried about redundancy, if they're worried about putting food on the table, you know, where does sex fit? In that respect, you know, the bringing elements like, the increasingly digital age that we live in, you know, the fact that we're always connected to our devices. So it seems, you know, we talk about what is the decline in the frequency of sex that we've seen over the last three rounds of NATSAL, due to iPads in the bedrooms? And syndrome? So, so yeah, I just think there's been a shift in how we view sex and a shift in, in our willingness to talk about sex.
Xand Van Tulleken 27:46
Can you talk about some of the other changes that you might have observed, it feels like in my lifetime, there has been a vast shift in the way that people have even conceived of sort of categories of sex. And as I've been teaching, and working in global health, it feels like we've learned more and more about really quite specific details of the kinds of sex that you have and your risks of different diseases and how different groups of people might interact. So can you can you talk a bit more about those trends? Because if that's my sense, but I haven't loaded the data.
Cath Mercer 28:22
I think that's really interesting. And I think that that shift has been reflected in the NATSAL surveys over time in terms of the questions asked, and the data that we've got in thinking about, for example, relationship status, the first couple of natsals, we just asked about marital status. So you know, if people someone was legally and married legally single, well, fine. But that's not to say that they weren't having sex. So it's only been in the last couple of surveys that we've actually asked people about the type for all types of relationship that they may be in recognising that it's not necessarily monogamy for everyone. And that having multiple partners is not necessarily bad. In some people's eyes, it's the sexual lifestyle that they choose. A nice example of this is thinking about the question, because obviously, NATSALs about looking at sexual attitudes as well as behaviours. One of the questions that the first couple of surveys asked was about someone's attitude towards sex outside of a marriage relationship, you know, did they think it was right or wrong? And there was a there's a Likert scale, so you're always wrong through to always right? Or rather, at least not wrong at all. So five possible response options to try and capture the you know, this society's attitude to non exclusive non exclusivity in relationships. And it was, it was interesting because it's only in NATSAL three that people say idea to sort of think, well, actually, it's not necessarily wrong if it's an open relationship, we're all partners that I'm happy with the fact that other multiple partners involved and then fine. So is that really a judgement as to someone's attitudes, sexual attitudes towards the morality of, of monogamy? Or, or conversely, the morality of, of, of polyamory. So now in NATSAL four we're asking about multiple having multiple partners in the context, is it in the, in the context of swinging? Is it in the context of an open relationship and the extent to which partners are aware? And, and, and okay with that, that that relationship set up? So just, you know, reflecting that it's, it's, it's, it's not a case of you're either a relationship or you're not? Or you're either marriage or you're not. But yeah, sexual lifestyles that they look can look very, very different. And the judgments attached to those vary across the population.
Xand Van Tulleken 31:06
David said earlier, you know, unless unless you've seen a really good survey doesn't believe it with this sort of, you know, the claims in the newspapers saying that men think about sex every seven seconds, or whatever the statistic is, but presumably in in designing the questions and saying, Well, look, I think we'd better ask about polyamory. Now, you have an instinct that is gathered from I don't know the headlines, social media personal experience, where you're having to gather information that is not statistical to say, look, there seem to be exploding dating apps that literally help people get into polyamorous relationships, which you didn't see a while ago. How are you lead towards certain questions? And how do you identify the changing trends that you want to dig into in more detail?,
Cath Mercer 31:56
a real challenge for Natsal, given how its remit has broadened from initially being just about HIV Rif. And factoring in that it's, you know, we can't really have the survey taking longer than 45 minutes to an hour to complete. So given this broadening remit, and this broadening in the range of sexual health outcomes and sexual lifestyles that we're interested in, how do we shoehorn all those questions into an hour long interview? So, you know, we consult with our that our stakeholders, so the people are going to use the data. And we've asked them, we'd spent a whole year during the development phase for this latest round consulting stakeholders, you know, what are the most important issues? What are the questions, and that's how it needs to ask, we did flag up, but it needs to fit within an hour. So you know, let us know what can go. And just we had all these additional questions, we want to ask about this, this, this, this, what should go? Nothing? Because it's all in. So it's, it's really challenging to you know, to address everything. But that's where we need to think well, what's NATSALs USP? What can it tell us that other set of studies can't, why the data sources can't. And I think for NATSAL for example, looking at same sex relationships, NATSAL has a key role in providing the population prevalence estimate of, say, men who have sex with men. We can't get that for convenience surveys. We can't get that from routine data. But NATSAL isn't the place to to dig down and to understand the complexities of relationships, same sex relationship, we can perhaps leave that to a community based survey of gay men, but natsal can provide the headline stats. And so that's, that's gonna, that's the kind of decision making process we're going through is like, is it about depth? Or is it about the breadth of the survey, and I think that NATSALs role is providing the breadth, but then thinking about how we link in with other data sources to enhance and enrich what NATSAL tells us. So NATSALs at the core, and then we can link in with other data sources.
Rochelle Burgess 36:19
My question for you, David, I just wondered if you could reflect a little bit on on how public health messaging might need to look or shift or change in order to keep up with all of these differences in behaviours and practices that we're, we're seeing?
David Spiegelhalter 36:47
If you're talking about disruption, I'm very disruptive when it comes to public health messaging, because I'm a slight is sort of, you know, a bit extremist on this because I don't like public health message, the idea of public health messaging, I'm against it on the hill, because the Winton centre, I was chair for five years really developed this idea of that we for trustworthy communication, you should be informing and not persuading, that actually trying to do messaging, which is trying to make people do something or think something, manipulate their emotions in order to make them frightened. The tombstone stuff that ghastly aids advert, they're that awful stuff that came out during COVID. Look into his eyes, you know, trying to induce fear in the group of people, this backfires all the time. So those fear based messages are disastrous, and actually unethical, deeply unethical. And all the evidence suggests that the messaging we actually give a balanced view of the situation of the benefits and harms or certain behaviours of what can be, you know, the positives and negatives, and so on. The evidence suggests that, especially for people who are more hard to reach, they find that much more trustworthy and much more likely to listen to it. And then there's, we've done it randomised trials, others have shown us as well, empirical evidence that this is important. So actually, I think that's why the statistics are so vital, in that I, what I believe public health messaging should be about is about informing people, and telling people what goes on, of what the possible harms can be of behaviours, but not to make out these behaviours. As Cath said, people got a very broad view of that people do these things for a reason, you know, because they might actually enjoy. So it just to try to condemn certain behaviours is, I think, a really anachronistic way to go about this. So I strongly believe and I think there is good evidence for this, that in public health messaging, one should be trained to inform people. Now we know that just informing people tends not to change behaviours on or is because that's not the intention really. At the same time, I think it's actually essential that any messaging like that is accompanied by information about services available to people. And that's the whole reason behind NATSAL was about providing Sexual Health Services. And instead it's. And so I think that I added the advocacy and the way that persuasion that might be necessary is to get people engaged with the fact that there is our services available, And to suggest that they could take advantage of these if they if they wanted to. So I'm, I think part of the whole basis of public health messaging needs really great clarity about what attitude is, are you just trying to persuade people? In which case, what are you doing? You just give me one side of the picture? Are you are you using all those manipulative tricks that advertisers do? Fear, reassurance, and so on? Alright, you're actually trying to inform the public better, the public have a right to good information. I'm afraid I said, if we if this is a disruptive podcast, this is one place where I am like to be tried to be disruptive.
Xand Van Tulleken 40:58
Well, we do want to end on on disruption, you both bled public health in hugely disruptive ways, and pushed against the norms, or the or the lack of interest in these topics in incredible ways. But we asked every, every guest about this, do you have a piece of art or a piece of music or piece of poetry, something in your life that you look to that you found disruptive, that's inspirational.
Cath Mercer 41:41
For me, it was a tapestry that my mom made for me, one of our dogs, Casper, which at first glance looks like a photo. But because Casper was a golden retriever, when you look up close, you can see many different colours. So you know different shades of yellow, gold, orange, red, and so on, sometimes very different coloured stitches next to one another, but still contributing to the picture of Casper as a whole. And I find this idea helpful for thinking about, you know, the tapestry of evidence that we need to understand sexual health across the population, often what's what seem like different elements that we might treat in silos, actually, you know, how they relate to, to one another, and also then how sexual health fits into the bigger picture of health and well being, you know, sexual health is part of us, you know, it's part of our general health and well being. But I also like this idea of having different bits of evidence, different sources of evidence, whether that's that's our, you know, routine, clinic data, census data, qualitative data, that by themselves are interesting and colourful, but together, enable us to have a better understanding of the picture of the whole. So yeah, it's my tapestry of Casper the dog
Xand Van Tulleken 43:01
Oh, that's so amazing.
Rochelle Burgess 43:02
That's lovely.
Xand Van Tulleken 43:03
David, what about you?
David Spiegelhalter 43:16
Yeah, I've been thinking about this, as well, as music for me, as you mentioned, I did Desert Island Discs that made me think about it quite a lot about influences on my life. And I realised that the very strong influences are our music, and particularly what I might call, you know, socially, not I wouldn't say unacceptable, but they know music, music by people that sort of pushes the boundaries of it, you know, whether it's pogues with a drinking with it, Levellers, you know, all this quite loud, you know, rocker stuff, but also Leonard Cohen, who I think has got a wonderful attitude of age, you know, I'm old now. 69. So I need to think about what it's like to be ageing and, and I like highly emotional music of foreign female singers and things like that. So, and all these things are out of touch. For me, what it's giving me is an inspiration, because I'm a naturally quite cautious English person, to take more risks, that we should be out there that we shouldn't be unashamed about enjoying yourselves and having fun. And that, you know, and the whole tapestry of human behaviour is glorious, and is made me really, as I might have put it here. suggested earlier really fed up with finger wagging public health messaging that we all should be you're not drinking, not smoking, not doing anything. And I think I've been influenced a lot by that by this music that actually, we have a right to live our lives as we want, you know, as we wander all day, no, I remember when I was 16. Listening to Jimi Hendrix singing I'm the one who's gonna die when it's time for me to die. Let me live my life the way I want to. And I was so influenced by that when I was 15 has never ever left me. I still think of that. And so that's why I really revel In the sort of surveys that Cath is doing, because it's exploring the whole tapestry of human behaviour, without moral judgement, with a genuine interest that everyone's lives are important what they choose to do. And we should be very, very reluctant to wag our fingers and say people shouldn't be doing these things. I love that because the normal constraints about not harming other people.
Xand Van Tulleken 45:23
You're the kind of rock and rollers of of epidemiology and surveys I love it. It's really it really has like it is lit up my morning talking to you about it, both the methods, the conclusions, and just both of your inherent kind of joy and curiosity about it all. It's a brilliant collision of worlds, the sort of the bedroom or not even necessarily the bedroom, but but whatever goes on privately and then and then the ways we can all understand and learn from it. So thank you both very much. Those are lovely, disruptive thoughts to end with.
Rochelle Burgess 46:15
Yeah, really beautiful. Thank you both. It was fantastic.
David Spiegelhalter 46:19
Right. So you, thank you so much. That's a lot of fun. Thank you.
Rochelle Burgess 46:24
You've been listening to public health disrupted. This episode was presented by me Rochelle Burgess and Xand van Tulleken, produced by UCL health public and edited by Annabel Buckland at decibelle creative. Our thanks again to today's amazing guests, CathMercer and David Spiegelhalter.
Xand Van Tulleken 46:42
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