The path of systems realisation for public health

Recently, I was welcoming students into the weekly yoga class I teach, and one of my students, who’s also a friend asked me what I was up to these days. I briefly outlined the research I was doing with the Prevention Centre and, in particular, systems thinking research.

After class, two other students mentioned they were surprised and delighted in equal measure to hear me mention systems thinking, explaining that it is embedded in their everyday work. One of them reminded me that it’s important not to reinvent the wheel with systems thinking, as so many other disciplines have long established histories of using this approach. The other – a systems engineer – met with me the following week for a further chat.

This sharing of perspectives was great for me. At one point though, my systems engineering friend became frustrated by my constant use of the phrase ‘systems thinking’ asking why I kept it. He explained that in his field the term wasn’t used at all; ”we just do it, it’s our whole way of working and we don’t need to name it!”.

But applying systems theory and systems science is relatively new to public health, with the emergence of research papers in the field only beginning to sprout in the early 1990s and then proliferate in the past 10 years.

The more I study and learn, the more I realise there is so much more to know and apply when it comes to systems thinking, systems approaches, and systems science methods for addressing complexity in chronic disease prevention.

Dr Melanie Pescud

I’ve heard people jokingly confess that they still don’t know what systems thinking means, or they kind of get it but would struggle to explain it if asked. As an area of enquiry, public health systems thinking does not have an agreed definition, so it’s no wonder there is confusion around its application. Further to that, the field of complexity sciences is diverse with multiple lineages, theoretical underpinnings, terms, and authors, so it’s easy to land in a cloud of confusion about this systems ‘business’.

The more I study and learn, the more I realise there is so much more to know when it comes to systems thinking, systems approaches, and systems science methods for addressing complexity in chronic disease prevention.

But it makes sense to me as a way of understanding problems, designing solutions to solve them, and working in a way such that key aspects of a system are tweaked and changed until a desired outcome is achieved. In preventing chronic disease, we are, after all, dealing with complex adaptive systems.

After talking further with the systems engineer, it did strike me that as a discipline we in prevention do seem to find it challenging to move beyond the rhetoric of systems thinking. We are yet to build the solid bridges that connect theory with practice. We love to say we’re taking a systems approach and then hop, skip, jump, and gloss over the details of how we’re thinking, what we’re actually doing, and why.

Our reductionist neural pathways are deeply embedded. In order to create new systems thinking pathways, we need to become aware of our assumptions, to be able to catch our thoughts, and reorient ourselves towards taking a truly systems perspective.

Dr Melanie Pescud

This may be because, in part, many of us aren’t formally trained in systems thinking. Our reductionist neural pathways are deeply embedded. It is hard mental work to train our minds to think so differently, to see and understand whole systems and how they are likely to behave in response to our interventions. In order to create new systems thinking pathways, we need to become aware of our assumptions, be able to catch our thoughts, and reorient ourselves towards taking a truly systems perspective.

Scholars like Ray Ison and Barry Richmond know this all too well after decades in the game of systems thinking education. It’s a hard concept to teach and it’s hard to learn for those who are not naturally adept at this way of thinking. Ultimately, it takes time, feedback, a process of reflection, and non-attachment to that which passed before. But sometimes it gets too hard and we give up.

When it comes to applying systems science methods, my systems engineering friend said that they all know what’s in the toolbox, how the tools work, and therefore, they just use what’s required when needed. Whereas we in public health find ourselves picking up the metaphorical hammer, studying its conceptual origins, and the in-depth details of how it’s used.

I believe this is a clear sign of how the two disciplines are at very different stages of maturity of ‘systems realisation’. Public health clearly has a way to go before our training is embedded with systems thinking and systems science methods to guide our research and practice. We still need to pick up the hammer to examine it – and figure out how it may be different to other systems tools.

I would argue therefore that our field is where it has needed to be, but we are also at a turning point and it’s time to shift gears and amplify our efforts.

As someone relatively new to the world of studying systems, my thoughts as to what’s required are as follows:

• Agreed definitions of systems thinking and a glossary of key terms, methods and tools for prevention (this way we can study them in-depth and then move on from thinking they are somehow special)
• More funding for real-world efforts to operationalise whole of systems approaches to addressing chronic disease prevention (more practice using the different tools)
• Greater interconnections with systems experts from other disciplines who have long walked the path before us and can impart their wisdom so we do not have to reinvent the wheel.

It was the late Donella Meadows who showed us that the paradigm level is the hardest place to intervene in a system.

Systems thinking is indeed a paradigm and it will take time, patience, persistence and a deepening of practice before this abstract idea becomes truly instilled in all our ways of thinking, seeing, and acting.