For the past three months, I have been an intern with The Australian Prevention Partnership Centre in Sydney. This internship is part of my Masters program in Global Health at McMaster University in Canada, and has been supported by the Queen Elizabeth Scholarship through the McMaster Health Forum. I’ve been involved in a number of activities during my internship including participating in the Centre’s Research Network, observing the implementation of the National Liveability Study, and learning about systems change from international expert Professor Pennie Foster-Fishman. One of my key activities was developing a resource library for policy makers and practitioners that highlights applications of systems thinking to preventive health. From my range of experiences at the Prevention Centre, here are five key things I have learnt about health research, policy and practice.
1. We live in a world of systems
I struggled with systems thinking until I thought about soup. Soup is a mixture of individual ingredients – broth, vegetables and meat – that together form something new and unique and much more than any of the ingredients on their own. So soup is a system because it is more than the sum of its parts. Our health also depends on systems. Most of us recognise that factors like genetics and lifestyle influence our health, but there are also underlying factors that may be less obvious. For example, lifestyle can depend on everything from income and home kitchens to city design. Low income means fresh food is a significant portion of the food budget, and small kitchens with few utensils make meal preparation challenging. Few footpaths or bike lanes mean greater reliance on cars and less physical activity to get around. So we need to address the larger system to properly address the health of our communities.
2. We need to address the whole problem from multiple angles
Given the complexity of systems, we need to simultaneously address the many factors underlying health problems if we want long-term, sustainable changes and improvements in public health. But how do we do that? One organisation cannot address complex problems on its own. Through partnerships, the various members can focus on certain aspects of the system and be targeted in their approaches. For example, the National Liveability Study involves researchers from each state, and each group of researchers focuses on a specific domain of liveability, such as access to food and the walkability of neighbourhoods. With this approach, each group can offer their strengths and expertise, and there is opportunity for collaboration, learning and adaptation to changing circumstances. In this way, organisations themselves form and behave as systems, which are greater than the sum of their parts.
3. Partnerships are just like any other relationship
Different organisations don’t automatically form strong bonds even if they share interests. Organisations are made up of people and it takes time and consistent work to form relationships. With sufficient rapport and trust, members of organisations can be open with and supportive of each other, allowing for real problem solving and progress.
4. Learn what policy makers need
Public health research is meant to inform policy and improve health, and to do that you need to understand policy makers’ needs. Speaking at a recent Prevention Centre meeting, senior NSW Health executive Associate Professor Sarah Thackway said brevity, conciseness and relevance to political and policy imperatives were important when communicating with policy makers. If you communicate in a way that suits policy makers, you will increase the chance that they will use your evidence in their policy making. Also, policy makers don’t only base decisions on research evidence. Stakeholders’ opinions and experiences of organisations, among other things, also count. Policy makers also have to consider state budgets and timelines for implementation. Researchers need to understand the reality that policy makers face and account for their needs. It all comes down to understanding the perspectives, pressures and priorities of policy makers.
5. Work with the people you’re working for
Public health organisations, research and policies are meant to help the public, but most people are not aware of all the work to help them live healthy and fulfilling lives. Lack of community engagement can be a problem, since people may only see interventions at the end of the line, without knowing the underlying reasoning or evidence. People may get upset if they don’t feel the changes are in their best interests, especially when changes include new rules or regulations. Professor Pennie Foster-Fishman from Michigan State University, an expert in community level systems change, highlighted the importance of working with the community in her Prevention Centre seminar and webinar. Professor Foster-Fishman has developed the ABLe Change Framework, a model for applying this approach to social issues affecting children, youth and families. She says that if the community is consulted and engaged – not just told something is good for them – there is a far greater chance interventions will meet the needs of the community, be accepted and, ultimately lead to positive changes.