It is not enough to look only at the physical system surrounding complex problems: the key is to change the deeply held beliefs that determine how people operate within the system.
That’s the message of leading Canadian public health researcher Professor Diane Finegood, who will speak at a Prevention Centre World Leadership Dialogue on ‘Exploring systems approaches to chronic disease prevention’ at the World Congress on Public Health in Melbourne in April.
Her presentation forms part of a large program of Prevention Centre activity at the World Congress, which also includes more than 15 presentations on Prevention Centre research projects and a panel presentation on researchers and decision-makers partnering to prevent chronic disease.
Professor Finegood said that many people assumed taking a systems approach’ meant changing the tangible things they could see, such as events, policies and organisations. “But that’s really only part of the system. They tend to be the easiest things to change but are also the least effective at changing outcomes,” she said.
“There are other levels in a system such as the goals, overall structure and feedback loops. At the top is the paradigms under which the system operates – the deeply held beliefs, values and assumptions of individuals, organisations and cultures. That’s the most powerful part of the system if you can change it.”
For example, a combination of interventions had led to a sustained reduction in tobacco consumption in recent decades. But the greatest gains were not achieved until there was a paradigm shift in society’s attitude to smoking, when non-smokers’ rights to a smoke-free environment became a strong component of policy and smokers went from being “cool” to being outcasts.
Lack of empirical evidence
Professor Finegood, a professor at Simon Fraser University and member of the Prevention Centre’s Scientific Advisory Committee, said policy makers internationally were interested in systems approaches to complex problems, but there was a lack of empirical evidence to help them understand whether a systems approach worked.1
“We are still trying to adapt methods that aim to figure out the cause of the problem,” she said.
“What we don’t have is empirical evidence for solutions appropriate for complex problems, such as creating networks and teams, building trust, or distributing decision, action and authority. That means we’re a long way from being able to convince policy makers, even though they intuitively think a systems approach makes sense.”
She said the Prevention Centre was unique in trying to create this evidence base.
“You are trying hard to both collect the evidence to understand what it means to take a systems approach and to walk the talk yourself, which is definitely not easy,” Dr Finegood said.
1Wutzke S, Morrice E, Benton M, Wilson A. Systems approaches for chronic disease prevention: sound logic and empirical evidence, but is this view shared outside of academia? Public Health Res Pract. 2016;26(3):e2631632. doi: http://dx.doi.org/10.17061/phrp2631632