The Prevention Centre’s approach to 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, sustainability, 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:

• Informing a national approach to Aboriginal and Torres Strait Islander tobacco control
• Compiling the evidence on the cost effectiveness of prevention
• Identifying the prevention workforce
• Building capacity for systems thinking in prevention researchers, practitioners and policy makers.
• Investigating how a digital information and management system aids the roll out of a suite of programs
• Devising a framework to conceptualise what a prevention system would look like nationally.

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:

• Examining the food system in Australia to identify what is needed to create a healthy and equitable eating system
• Developing, measuring and validating national liveability indicators associated with chronic disease risk factors and health outcomes
• Evaluating the NSW Get Healthy at Work initiative.

Recognising that prevention action takes place in a local system

Ecological systems 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, systems thinking attempts to make full use of the power within the setting to create and reinforce change processes. It also helps people to consider how system thinking might change their approach to program design and evaluation. Other activities that the Prevention Centre is doing in this area:

• The Rapid Response Evaluation Capacity is collaborating with ACT Health to evaluate the whole-of-government approach to healthy weight (eg, the routines and practices of education, health and community services have to be understood together).
• Prevention Tracker is encouraging system thinking at a local community level to maximise prevention effectiveness.

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:

• Developing a system dynamic model of the harmful effects of alcohol consumption over a lifetime, including alcohol-related incidents and the longer-term chronic disease impacts. The model can be used to experiment with different intervention combinations to forecast their impact on alcohol-related emergency department presentations, chronic disease prevalence over time, and cost implications for the health system.