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Taking a systems approach to prevention


A system is a set of interacting pieces that combine for a common purpose. A system is not only the sum of its parts, but the product of their interaction.

Systems thinking has been successfully used in engineering, defence, economics, ecology and business since the mid-1950s. It is a way to understand and manage complex problems at a local and global level, and is both a way of thinking and a practical tool to aid decision making when tackling complex problems.

It helps us to see the big picture – how the problem we’re trying to solve is made up of connected and inter-related components, so that a change in one part will influence other parts. It is also a way to understand the complex nature of the problems we’re dealing with and how relationships and behaviours change over time to cause the situation to be as it is.

Beneath the surface

Traditional approaches to problem solving often address just the obvious symptoms of complex problems through quick fixes, and fail to recognise and intervene in the root causes of problems. Rather than just tackling the tip of the iceberg, systems thinking delves below the surface and identifies the fundamental and interconnecting causes of complex issues – the patterns of behaviour, the underlying structure and the beliefs (mental models) of the people and organisations responsible for creating that complex issue.

If we try to improve a situation without understanding these connected underlying causes, we can make things worse or create new problems that we or others have to solve in the future.

Systems thinking also refers to theories, tools or methods that help us describe, understand and analyse a system. Some of these tools provide ways to think about public health issues as problems within systems. Other tools allow us to map elements in a system and the connections among them, which helps to highlight the complexity of public health issues and allows us to test different interventions or policy options to see which are likely to produce the desired change.

Systems thinking can be useful in dealing with complex problems when:

  • We’re dealing with a stubborn long-term problem – not a one-off event – that has a known history.
  • There are multiple actors (organisations and people) and multiple causes that interact and influence each other.
  • There are competing or conflicting interests – or different views of the situation or problem.
  • There’s no single explanation for what is causing the problem and no single solution that fits all situations.

 

* The Prevention Centre acknowledges and thanks Gene Bellinger, whose systems thinking resources provided some of the ideas and wording for parts of this section. Gene produces a Wikipedia page and online course about systems thinking.

A system is a set of interacting pieces that combine for a common purpose. A system is not only the sum of its parts, but the product of their interaction.

Systems thinking has been successfully used in engineering, defence, economics, ecology and business since the mid-1950s. It is a way to understand and manage complex problems at a local and global level, and is both a way of thinking and a practical tool to aid decision making when tackling complex problems.

It helps us to see the big picture – how the problem we’re trying to solve is made up of connected and inter-related components, so that a change in one part will influence other parts. It is also a way to understand the complex nature of the problems we’re dealing with and how relationships and behaviours change over time to cause the situation to be as it is.

Beneath the surface

Traditional approaches to problem solving often address just the obvious symptoms of complex problems through quick fixes, and fail to recognise and intervene in the root causes of problems. Rather than just tackling the tip of the iceberg, systems thinking delves below the surface and identifies the fundamental and interconnecting causes of complex issues – the patterns of behaviour, the underlying structure and the beliefs (mental models) of the people and organisations responsible for creating that complex issue.

If we try to improve a situation without understanding these connected underlying causes, we can make things worse or create new problems that we or others have to solve in the future.

Systems thinking also refers to theories, tools or methods that help us describe, understand and analyse a system. Some of these tools provide ways to think about public health issues as problems within systems. Other tools allow us to map elements in a system and the connections among them, which helps to highlight the complexity of public health issues and allows us to test different interventions or policy options to see which are likely to produce the desired change.

Systems thinking can be useful in dealing with complex problems when:

  • We’re dealing with a stubborn long-term problem – not a one-off event – that has a known history.
  • There are multiple actors (organisations and people) and multiple causes that interact and influence each other.
  • There are competing or conflicting interests – or different views of the situation or problem.
  • There’s no single explanation for what is causing the problem and no single solution that fits all situations.

 

* The Prevention Centre acknowledges and thanks Gene Bellinger, whose systems thinking resources provided some of the ideas and wording for parts of this section. Gene produces a Wikipedia page and online course about systems thinking.

  • A system is a set of interacting pieces that combine for a common purpose. A system is not only the sum of its parts but the product of their interaction.
  • Systems thinking is about understanding relationships and their implications so that we can be better problem solvers.
  • Systems approaches and tools help us to better understand the relationships that cause complex problems and to find the most efficient, effective and equitable solutions. Unless we understand these relationships and how to deal with them, change can be temporary because we may have forced things to change inappropriately.
  • If we don’t understand why a situation is as it is (the context) before we intervene, we may make the situation worse or create new problems.
  • Systems thinking poses two fundamental questions about each interacting part of a complex problem: What does it influence and what influences it?

 

* The Prevention Centre acknowledges and thanks Gene Bellinger, whose systems thinking resources provided some of the ideas and wording for this section. Gene produces a Wikipedia page and online course about systems thinking.

Here are four ways in which public health practitioners and researchers, including the Prevention Centre, are using system approaches to prevention. These approaches are explored further in a discussion paper on systems approaches to prevention written by the Prevention Centre’s Systems Science and Implementation Capacity.

Being systematic about prevention

This approach involves exploring ways to transform one-off programs and partial investment in public health into a comprehensive pattern of delivery. It may involve change to funding cycles and formulas, recruitment and staffing, reporting and accountability, information and data for decision-making, and training in leadership and evaluation.

The purpose is to increase reliability, efficiency, accountability and reach. A lot of the literature that supports this type of work overlaps with the fields of capacity building, scale up, institutionalisation and sustainability.

What the Prevention Centre is doing in this area:

Working across different systems to improve health

Many determinants of health lie in systems outside the health sector, such as in the food system, the transport system, and the housing and economic systems. Taking a systems approach involves working in and with these other systems. This could mean taking a ‘health in all policies’ approach, or working to align objectives across sectors, focusing on actions that promote health and improve outcomes in education, transport and the economy for example.

What the Prevention Centre is doing in this area:

Recognising that prevention action takes place in ecological systems

Ecological thinking focuses on key resources in communities – that is, the people, events and settings that are the foundations of communities as systems.

It explores the range of local factors that might enable or hinder the success and sustainability of an intervention in a community, borrowing ideas and principles from the field of ecology. For example, schools, work places and communities are ecological systems, and the effectiveness of health promotion and prevention practice in these settings can be improved with better understanding of how these systems work.

Research in this area investigates how an intervention combines with the local system, how it changes roles and relationships, how it distributes resources and how it displaces previous activity.

In short, ecological systems thinking attempts to make full use of the power within the setting to create and reinforce change processes.

What the Prevention Centre is doing in this area:

Using systems tools and theories to analyse and improve policy and practice in prevention

Policy makers and practitioners working to prevent lifestyle-related chronic disease have recently started using system methods to map and better understand complex public health problems and inform their decision making.

For example, system dynamics uses a range of evidence sources and data to map and model complex problems, engaging academics, policy experts, practitioners and community members in the process. This results in a tool that can simulate and analyse the likely impact of a range of intervention and policy solutions.

Such tools have the advantage of allowing decision makers to experiment with different scenarios and policy options before they are implemented to reduce the risk of negative consequences and unexpected outcomes.

What the Prevention Centre is doing in this area: