Applying a Systems Perspective to Preventive Health: How Can It Be Useful?; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”

Document Type: Commentary

Authors

1 Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK

2 Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK

Abstract

Advocates suggest that a paradigm shift in preventive health towards systems thinking is desirable and may be underway. In a recent study of policy-makers’ opinions, Haynes and colleagues found a mixed response to an Australian initiative that sought to apply systems theories and associated methods to preventive health. Some were enthusiastic about systems, but others were concerned or unconvinced about its usefulness. This commentary responds to such concerns. We argue that a systems perspective can help provide policy-makers with timely evidence to inform decisions about intervention planning and delivery. We also suggest that research applying a systems perspective could provide policy-makers with evidence to support planning and incremental decision-making; make recommendations to support intervention adaptability; consider potential barriers due to incoherent systems, and consider the political consequences of interventions.

Keywords


  1. Haynes A, Garvey K, Davidson S, Milat A. What can policy-makers get out of systems thinking? policy partners' experiences of a systems-focused research collaboration in preventive health. Int J Health Policy Manag. 2020;9(2):65-76. doi:10.15171/ijhpm.2019.86
  2. Kuhn TS. The Structure of Scientific Revolutions. Chicago, Illinois: University of Chicago Press; 2012.
  3. Gates EF. Making sense of the emerging conversation in evaluation about systems thinking and complexity science. Eval Program Plann. 2016;59:62-73. doi:10.1016/j.evalprogplan.2016.08.004
  4. Checkland P, Poulter J. Learning for Action: A Short Definitive Account of Soft Systems Methodology, and its use for Practitioners, Teachers and Students. Chichester, West Sussex: John Wiley & Sons Ltd; 2006.
  5. Williams B, Hummelbrunner R. Systems Concepts in Action: A Practitioner's Toolkit. Stanford, CA: Stanford University Press; 2010.
  6. Lee BY, Ferguson MC, Hertenstein DL, et al. Simulating the impact of sugar-sweetened beverage warning labels in three cities. Am J Prev Med. 2018;54(2):197-204. doi:10.1016/j.amepre.2017.11.003
  7. Hirsch G, Homer J, Evans E, Zielinski A. A system dynamics model for planning cardiovascular disease interventions. Am J Public Health. 2010;100(4):616-622. doi:10.2105/ajph.2009.159434
  8. Tobias MI, Cavana RY, Bloomfield A. Application of a system dynamics model to inform investment in smoking cessation services in New Zealand. Am J Public Health. 2010;100(7):1274-1281. doi:10.2105/ajph.2009.171165
  9. Combs TB, McKay VR, Ornstein J, et al. Modelling the impact of menthol sales restrictions and retailer density reduction policies: insights from tobacco town Minnesota. Tob Control. 2019. doi:10.1136/tobaccocontrol-2019-054986
  10. Weiss CH. The many meanings of research utilization. Public Adm Rev. 1979;39(5):426-431.
  11. Nutley S, Webb J. Evidence and the policy process. In: Davies H, Nutley S, Smith P, eds. What Works? Evidence-Based Policy and Practice in Public Services. Bristol: The Policy Press; 2000:13-41.
  12. White M, Cummins S, Rayner M, et al. Protocol - Evaluation of the Health Impacts of the UK Treasury Soft Drinks Industry Levy (SDIL). NIHR Journals Library; 2017. https://www.journalslibrary.nihr.ac.uk/programmes/phr/1613001/#/.
  13. Egan M, McGill E, Penney T, et al. NIHR SPHR Guidance on Systems Approaches to Local Public Health Evaluation. Part 1: Introducing Systems Thinking. London: National Institute for Health Research School for Public Health Research; 2019. https://sphr.nihr.ac.uk/research/developing-a-systems-perspective-for-the-evaluation-of-local-public-health-interventions-theory-methods-and-practice/.
  14. Patton MQ. Developmental evaluation. Eval Pract. 1994;15(3):311-319. doi:10.1177/109821409401500312
  15. Poli R. A note on the difference between complicated and complex social systems. Cadmus. 2013;2(1):142-147.
  16. Snowden DJ, Boone ME. A leader's framework for decision making. Harv Bus Rev. 2007;85(11):68-76.
  17. Petticrew M, Knai C, Thomas J, et al. Implications of a complexity perspective for systematic reviews and guideline development in health decision making. BMJ Glob Health. 2019;4(Suppl 1):e000899. doi:10.1136/bmjgh-2018-000899
  18. McGill E, Marks D, Sumpter C, Egan M. Consequences of removing cheap, super-strength beer and cider: a qualitative study of a UK local alcohol availability intervention. BMJ Open. 2016;6(9):e010759. doi:10.1136/bmjopen-2015-010759
  19. Bartelink NHM, van Assema P, Jansen MWJ, et al. Process evaluation of the healthy primary school of the future: the key learning points. BMC Public Health. 2019;19(1):698. doi:10.1186/s12889-019-6947-2
  20. Knowles E. What They Didn't Say: A Book of Misquotations. Oxford: Oxford University Press; 2006.
  21. Bambra C, Smith KE, Pearce J. Scaling up: the politics of health and place. Soc Sci Med. 2019;232:36-42. doi:10.1016/j.socscimed.2019.04.036
  22. Savell E, Fooks G, Gilmore AB. How does the alcohol industry attempt to influence marketing regulations? a systematic review. Addiction. 2016;111(1):18-32. doi:10.1111/add.13048
  23. Petticrew M, Katikireddi SV, Knai C, et al. ‘Nothing can be done until everything is done’: the use of complexity arguments by food, beverage, alcohol and gambling industries. J Epidemiol Community Health. 2017;71(11):1078-1083. doi:10.1136/jech-2017-209710
  24. Bambra C, Smith KE, Garthwaite K, Joyce KE, Hunter DJ. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. J Epidemiol Community Health. 2011;65(5):399-406. doi:10.1136/jech.2010.111195