In this fourth instalment on the CEIPS (Centre of Excellence in Intervention and Prevention Science) seminar series Rebecca Zosel delves into the world of systems science and public health. What is systems thinking? How should we apply it? Or has the systems approach already run out of time to prove it’s worth?
Rebecca Zosel writes:
In the fourth of the CEIPS Seminar Series on Tuesday 23 June, Dr Therese Riley, Senior Research Fellow, explored two questions about quality in systems science in her presentation: ‘How do we know our systems science is any good?’
Therese spoke of ‘the turn to complexity’, which has seen an ever growing list of disciplines grappling with complexity theory and systems science. More recently, public health in Australia (and Victoria in particular) has seen the investment of significant effort and resources in systems science. Systems thinking has been positioned as a new way of thinking in public health, and the preferred approach when addressing complex health issues such as the rising rates of chronic disease.
Therese’s presentation dealt with two questions about quality in systems science. First, a moral question: what systems deserve our attention1? Are the systems we model (or map or investigate) the ‘safe’ or comfortable ones, those socially sanctioned as ok? Do we exclude the unmanageable and/or controversial ones? When we map systems, what do we leave out because of politics, privilege or pragmatism? As flagged by a participant, capitalism and consumerism influence mental wellbeing and obesity yet are not commonly targeted by public health efforts. Why? Because revolution isn’t on my agenda for tomorrow….but perhaps it should be.
Secondly, Therese asked: what is our position in the system2? Is our position (as scientists) in the dominant culture limiting our science? Where should our sympathies lay? We all take sides by virtue of our values, and Therese reminded us of the need to be mindful of how we occupy the ‘hierarchy of credibility’ and decide what’s in and out of the systems map. As social researchers, we often take the side of the underdog. But who is the underdog? Participants suggested that public health practitioners are the underdogs, because they are often not prioritised in the practice-policy-research nexus. Others suggested our sympathies should instead lie with policy makers.
Therese’s presentation raised additional questions for me about systems science and its contribution to public health.
Firstly – and to get back to basics – what is systems thinking? There are numerous and varied definitions in use which are generating confusion and scepticism in the field. If systems thinking is the new thinking required to solve current and emerging public health issues, we need to build consensus around a unified definition and resolve its ‘identity crisis’. Let’s find a way to communicate systems thinking that resonates with the diverse public health workforce – the abstract academics, pragmatic practitioners and prudent policy makers. We need to position systems thinking within the evolution of public health. To be clear about how systems thinking is unique, but also how it overlaps with and adds value to other biomedical, behavioural, environmental and social approaches. We need to continue having open and sophisticated conversations to better define and understand systems thinking in public health – and in doing so, address some of the myths and scepticism in the field (i.e. “systems thinking is a new label for old ways”).
Secondly, what is the current evidence on the effectiveness of a systems approach to tackling chronic disease? To revert to the seminar title, is systems science any good? Where have we seen successes in public health? Is a systems approach more suited to some areas than others? I realise it is early days, but if we are to continue embracing a systems approach then this question must remain front of mind.
Finally I can’t help but wonder: are we ditching systems science after such a short dalliance? As a public health practitioner in Victoria, I’ve been incredibly excited to see new organisations and initiatives established to better understand and use systems science to improve population health. In recent years this has included the establishment of the Centre of Excellence in Intervention and Prevention Science (CEIPS), The Australian Prevention Partnership Centre (TAPPC) and Healthy Together Victoria. However, much of the government funding and commitment to these systems thinking-oriented initiatives appears to have waned after just a few short years – despite the fact that we know change takes time.
Public health operates with an increasingly complex and inter-connected world – a world where people are living longer but getting sicker. As the Greek philosopher Heraclitus said, “change is the only constant”, and it is critical that as a field, we continue to evolve and respond to the changing context. Systems science offers public health a new approach and has much promise – at the very least, it provides us with an opportunity to reflect on our discipline and add some new tools to our toolkit. But perhaps it will provide us with much more – a more sophisticated and effective way to address current and emerging health issues. Granted, it is still early days and we certainly haven’t perfected it yet, but I hope that public health continues exploring systems science and how it can drive change to improve population health.
Rebecca Zosel is a public health practitioner, advocate and consultant. She tweets at @rzosel.
This article was originally posted at CEIPS blog here.
1 C Wright Mills (1959) The Sociological Imagination, Oxford University Press
2 Becker H. (1967) Whose side are we on, Social Problems (14) 3: 239-247