Slide 1Implications of Systems Thinking and Complexity Science for the Social
Determinants of Health
Executive Director, The CAPTURE Project
@DTFinegood
WHO Commission on the Social Determinants of Health
Main principles for action:
2. tackle inequitable distributions of power, money and resources
3. measure and understand the problem and assess the impact of action.
Take Home Messages
• Addressing the social determinants of health is complex (not simple or even complicated).
• Accepting complexity does not mean we should give up, but we must turn to solutions appropriate for complex problems.
• Interactions between: levels, capacity & complexity, competition & cooperation, and networks are places to look for solutions.
Obesity System Map
INDIVIDUAL
Energy
Expenditure
POPULATION
“Causal Web”
Homogeneous Heterogeneous
Linear Nonlinear
Deterministic Stochastic
Static Dynamic
Independent Interdependent
No connection between levels or
subsystems Emergence
• Retreat
• Despair
• Assign blame, figure out who is responsible
• Simple solutions
Bar-Yam, Y. Making Things Work, 2004.
Places to Look for Solutions to Complex Problems
• In the interaction between levels
• In the relationship between capacity and complexity
• In the interdependence between competition and cooperation
• By influencing emergence
• International
• National
• United Nations
1. The power to transcend paradigms
2. The paradigm that the system arises out of
3. The goal of the system
4. The power to add, change, evolve, or self-organize system structure
5. The rules of the system
6. The structure of information flow
7. The gain around driving positive feedback loops
8. The strength of negative feedback loops
9. The length of delays
10. The structure of material stocks and flows
11. The size of buffers and other stabilizing stocks
12. Constants, parameters, numbers
D. Meadows. Thinking in Systems, A Primer, Chelsea Green, 2009.
One Approach to Scale:
Feedback & delays
Subsystems, actors, operating parameters
Finegood, DT. The Complex System Science of Obesity. In: The Social Science of Obesity, Ed. J Cawley. Oxford University Press, 2011
Intervention Levels: Research & Evaluation Ef
fe ct
iv en
es s
D if
fi cu
lt y
Level From
fe ct
iv en
es s
D if
fi cu
lt y
Coherent
Goals Close the gap within a generation
Structure Multi-lateral agencies, UN, WHO, national and local gov, civil society, private sector, research inst
Feedback & delays “Measure and understand the problem and assess the impact of action”
Structural elements
• In the interaction between levels
• In the relationship between capacity and complexity
• In the interdependence between competition and cooperation
• By influencing emergence
Complexity of Environment
(Capacity)
Fail
Survive
• Universal health care
• In the interaction between levels
• In the relationship between capacity and complexity
• In the interdependence between competition and cooperation
• By influencing emergence
Cooperation and Competition
Cooperation and Competition
Bar-Yam, Y. COMPLEX SYSTEMS AND SPORTS: Complex Systems insights to building effective teams
Foresight
Foresight Programme, B. Butland, unpublished observations
ActNowBC: Promising Practices
• Increasing collaborative action among government sectors with diverse strategies and mechanisms
– An incentive fund of $15 million supported pilot health promotion projects by ministries other than the Ministry of Health
• The involvement of civil society organizations
• In the interaction between levels
• In the relationship between capacity and complexity
• In the interdependence between competition and cooperation
• By influencing emergence
– self-organized
– also self-organized
– used to share knowledge, support one another, and to intentionally create new knowledge
– people commit to be there for each other, to serve the needs of others
– good ideas move rapidly amongst members.
M Wheatley and D Frieze ©2006, USING EMERGENCE TO TAKE SOCIAL INNOVATIONS TO SCALE
Life Cycle of Emergence
• Stage 3 – Systems of Influence:
– can’t be predicted; sudden appearance of a system that has real power and influence.
– pioneering efforts that hovered at the periphery suddenly become the norm.
– their approaches and methods are quickly adopted
– policy and funding debates now include the perspectives and experiences of these pioneers.
– critics who said it could never be done suddenly become chief supporters
M Wheatley and D Frieze ©2006, USING EMERGENCE TO TAKE SOCIAL INNOVATIONS TO SCALE
Influencing Emergence
• “Act locally, connect regionally, learn globally.”
M Wheatley and D Frieze ©2006, USING EMERGENCE TO TAKE SOCIAL INNOVATIONS TO SCALE
Methods and Tools for Solutions • Interaction between levels
– ABM, SD modeling, intervention level framework
• Matching capacity and complexity
• Competition and cooperation
• Influencing emergence
Take Home Messages
• Addressing the social determinants of health is complex (not simple or even complicated).
• Accepting complexity does not mean we should give up, but we must turn to solutions appropriate for complex problems.
• Interactions between: levels, capacity & complexity, competition & cooperation, and networks are places to look for solutions.