Bridging the Evidence Gap in Obesity Prevention A Framework to Inform Decision Making (2010) / Chapter Skim
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4 Defining the Problem: The Importance of Taking a Systems Perspective
4 Defining the Problem: The Importance of Taking a Systems Perspective
Pages 71-88
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From page 71... ...
O besity is a multifaceted problem that warrants complex thinking and a broad systems perspective to frame the problem, understand potential causes, identify critical leverage points of influence, and take effective action. Linear approaches to complex public health problems such as the obesity crisis are clearly useful, but can not address the multiple dimensions of the real world and the many influences on the energy balance equation (Foresight, 2007)
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From page 72... ...
Like tobacco control, which employed diverse and multilevel strategies (Abrams et al., 2003, 2010) , progress in the obesity field will require a paradigm shift toward an interdisciplinary knowledge base that integrates systems theory with concepts and practice from community development, social ecology, social networks, and public health (Best et al., 2003)
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From page 73... ...
The systems approach offers a further advantage with respect to the well recognized gap between research and practice, which limits the extent to which advances in research translate to advances in improving public health. Most efforts to Defining the Problem: The Importance of Taking a Systems Perspective
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From page 74... ...
, and interdisciplinary fields of inquiry (e.g., behavioral genet ics) with the capacity to tackle complex population health problems (Fowler et al., 2009)
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From page 75... ...
This lack of a well-defined process, together with the failure to take a systems perspective, can result in a number of unintended conse quences and perturbations to the system. For example, children may feel embarrassed or stigmatized during the process, parents may feel unequipped to act on the informa tion they receive, health care providers in the community may not be educated about obesity treatment, the community may lack adequate pediatric programming to which children can be referred, and schools may forego other screening programs to make room for BMI screening (for example, hearing and vision screenings were cut back when the Massachusetts Public Health Council voted to require BMI screening of schoolchildren [Mullen, 2009]
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From page 76... ...
Time delays Time delays in feedback processes are common and particularly troublesome. Most obviously, delays slow the accumulation of evidence.
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From page 77... ...
California's Air Resources Board seeks to reduce air pollution by promoting so-called zero emission vehicles (California Air Resources Board, 2010)
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From page 78... ...
As a result of strategic planning, the ISIS group identified four priority areas (Figure 4-3) that together serve as a synergistic foundation for understanding and improving public health from a systems perspective (Leischow et al., 2008; NCI, • Surgeon General's reports • Public service advertising Public Education • Media campaigns • Smoking cessation tools • Physician counseling Individual-level Intervention • Telephone quitlines • Community-based coalitions • Workplace smoking policies Community-level Intervention • NCI COMMIT project • Clean air laws • Tobacco taxation Population-level Intervention • NCI ASSIST • Epidemiological models • System models, networks, knowledge System-level Intervention • NCI ISIS project FIGURE 4-2 Evolution of tobacco control approaches toward systems thinking.
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From page 79... ...
. Milstein and Homer LearnnAbout tPolicy Lear Abou Policy Identify aa Identify Consequences Consequences Conver t tthheMaap Conver t e M p PeersistentProblem P rsistent Problem TTestproposed policies, est proposed policies, into aaSimulation Moodel Into Simulation Model Into Simulation M de Graph its behavior Graph its behavior searching for ones that best searching for ones that best Formally qquantif ythhe Formally uantif y t e over time over time gooverncchange g vern hange hhypothesisuusingall ypothesis sing all available eevidence available vidence Create aa Create Choose Amongg Choose Amon DyynamicHypothesis D namic Hypothesis Plausible FFutures Plausible utures Identify aandmap thhe Identify nd map t e Discusssvalues and Discus values and main causal forces that main causal forces that consider r trade-of fs conside trade-of fs create thheproblem create t e problem Run Simulation Run Simulation Exxperiments E periments Compare model'ssbehavior to Compare model' behavior to Enact Poolicies Enact P licies exxpectations and/or data to epectations and/or data to Builddppowerandd Build power and Buil ower an build cconfidencein the model l build onfidence in the mode organize aactorstoo oorganize ctors t rgani establish chosen policies eestablishchosen policies stablish chosen policies FIGURE 4-4 Iterative steps in system dynamics modeling.
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From page 80... ...
Using a systems approach, the group pursued objectives that included using the scientific evidence base across a wide range of disci plines to identify the many factors that influence obesity, looking beyond the obvious to achieve an integrated understanding of the relationships among these factors and their relative importance, building on this evidence to identify effective interventions, analyzing how future levels of obesity might change, and identifying what the most effective future responses might be. A detailed causal loop obesity system map was produced to display the interrelationships among the various contributors to energy balance; a simplified version of this map is shown in Figure 4-6.
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From page 81... ...
NOTES: Blue arrows indicate same-direction links; green arrows indicate opposite-direction links; R loops indicate reinforcing processes; B loops indicate balancing processes. All parameters vary by such factors as age, sex, race/ethnicity, income, and geography.
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From page 82... ...
Figure 4-6.eps SOURCES: Vandenbroeck et al., 2007. • systematic change that addresses the diverse determinants of obesity simultane ously to minimize the risk of compensatory actions; • integrated interventions at all levels of society -- individual, family, local, national and international -- recognizing that individual choices are shaped by the wider context; • interventions across the life course to reinforce and sustain long-term behavior change; Bridging the Evidence Gap in Obesity Prevention
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From page 83... ...
Although outcomes of systems approaches such as the Foresight Group's causal loop system map appear complex, they are useful for informing practical, real-world intervention strategies. For example, Foresight's Tackling Obesities: Future Choices Project was used to inform a cross-government strategy for England that was part of a sustained program to reduce obesity and support healthy weight maintenance (Cross Government Obesity Unit, 2010)
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From page 84... ...
First, cur rent and future leaders should be trained in the science and understanding of systems and their application to the obesity crisis. This training would include causal mapping, conceptualization of interventions, and computational and simulation modeling tech niques.
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From page 85... ...
. California Air Resources Board.
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2006. Background on system dynamics simulation modeling with a summary of major public health studies.
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From page 87... ...
Letter to Massachusetts Public Health Council from Director, Bureau of Community Health Access and Promotion, Massachusetts Department of Public Health. NCI (National Cancer Institute)
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