Guest blog: Beyond behaviour change

In the 1970s and 1980s, more than 1,400 babies a year in the UK would die suddenly and unexpectedly with no cause found – sudden infant death syndrome (SIDS). Parents and families bereaved by these tragedies worked tirelessly to fundraise for academic research into causes and prevention. The resulting ‘Back to Sleep’ campaign and safer sleep messaging has saved hundreds of thousands of babies’ lives around the world and is seen as one of the great successes of public health.

Moving the needle on inequality

While all of this is true, reductions in deaths in the general population also uncovered stark inequalities in society between richest and poorest. Families living in the poorest areas of the UK are five times more likely to experience a baby die from SIDS than those living in the most affluent areas. I started as a PhD student in 2012 to try to understand and move the needle on this inequality.

Recent data shows that three-quarters of the remaining deaths include an unsafe sleeping environment – most commonly a baby put down on their tummy for sleep or a baby co-sleeping with a parent impaired by drugs or alcohol. Babies experiencing adversity are also far less equipped to survive risks that other infants routinely survive. Intervention efforts have increasingly narrowed in on individual‑level behaviour change. Public health objectives are framed around “getting the messages across” or “making sure parents understand”. This framing subtly but powerfully locates the problem within families themselves. It contributes to a culture where parents may feel blamed for tragedies, while the wider systems that produce vulnerability remain largely unchallenged.

Widening the scope

As an academic who had long described herself as a behavioural scientist, this made me deeply uncomfortable. What are we doing about infant vulnerability? How can we address both ends of the problem, rather than only focussing on the one that requires parents to change?

It was this discomfort that drew me to begin widening out the scope of my research. Collaborations with the Bristol Poverty Institute ensued, and the creation of the National Child Mortality Database (NCMD) set off aspirations to find out how to influence narratives about poverty and parenting to bring about system level change that would not just save lives, but improve them as well. It’s going well – and we’ve seen changes to housing policy (requiring space for a cot in every temporary home where a child under two is present), childcare settings (new safer sleep guidance in place), and even medications labelling (advising about the risks of co-sleeping alongside medications that reduce responsiveness for caregivers of infants).

Narrative change for systems change

Then a colleague introduced me to FrameWorks UK and their work to understand and pivot narratives and cultural mindsets, and together with support from my local Integrated Care Board, I’ve been learning about their work and reflecting on how academics and behavioural scientists can get better at systems change.

Learning how to talk about issues in ways that draw attention to contexts, about how framing research can influence conversations and shift thinking has been eye-opening and deeply satisfying. Taking these lessons back to academia won’t be easy. It requires us to resist defaulting to behaviour as the only unit of change, but if we are serious about reducing inequalities then a framing overhaul is necessary. Changing how we talk about problems is a critical step toward changing the systems that create them, and offers genuine hope for babies and their families.