Glena Eoyang
Executive Director Human Systems Dynamics Institute
Introduction:
"The purpose of this paper is to investigate some of the aspects of public health practice from the perspective of human systems with the goal of illuminating both domains--public health and human systems dynamics."
Human Systems Dynamics (HSD) is an emerging field that applies various principles of complexity science to the theory and practice of the social science, including public health.
Public Health as a Complex, Adaptive System
Since it involves mobilizing collective action toward producing system-wide patterns of health, we may consider public health a complex, adaptive system. That is, that public health typically deals with the behaviors of a wide range of "semi-independent" agents that interact with and transform each other, we could call it complex and adaptive.
Six significant and complex systems at work in public health:
Individual Health
Emotional, spiritual, and physical well-being is determined by a complex interaction between genetic maps and environmental determinants of health. Each component of health (emotional, spiritual, and physical) is simultaneously independent of and shaped by one another.
Social Networks
Interactions between people in social contexts--such as in the home, at school, in the neighborhood, or in the office--have a profound influence on individual health choices and moral or ethical attitudes and behaviors relating to hygiene and health. Most people are part of several of these networks, are transformed by them, and in many cases, contribute to transformations of the networks themselves.
Political Systems
Interactions between municipalities, regional planning authorities, counties, states, and federal agencies; and legislative, judicial and executive groups have influence over the domain of public health practice.
Healthcare Industry
"Agents contributing to the emergent patterns in healthcare include pharmaceutical companies, insurances companies, managed care institutions, healthcare technology inventors and manufacturers, clinics and hospitals, emergency response teams, and a host of other for-profit and not-for-profit organizations, involved in developing , manufacturing, delivering, funding and/or evaluating health and the distribution of healthcare technologies."
Professional Affiliations
Healthcare professionals all bring different tools, languages, skills, and mental models to healthcare delivery systems. Multiple perspectives both enrich public health practice, they also complicate its theory and practice at any sort of system-wide level.
Traditions of Public Health:
A number of principles and assumptions underly public health practice because they have proven enduringly valuable to public health practitioners over the years. In order to more fully integrate public health and HSD, some of these assumptions must be qualified or challenged, while others must be rigorously upheld.
Use Widely Accepted, Quantitative Tools to Collect Analyze, Interpret and Report Data
There is something, of course, very important in studying causalities and phenomena within healthcare systems, but as relationships, interactions, and connections become less linear and observable, "stories and metaphors may capture many more facets of a complex dynamical human system than more simple quantitative tools. Computer simulations which predict outcomes based on a number of assumed conditions may helpful here.
Prepare for Cyclic Patterns of Threat and Response
History often repeats itself, and so it is in the interest of public health professionals to learn from the past to predict the future.
A few ways of doing this:
-Time series analysis: a method that captures the behavior of the system through time and helps distiguish a variety of populatio-wide expectations and likely outcomes.
-knowledge transfer between older and younger public health professionals
-Focusing on the patterns of yesteryear and understanding how they compare and may be contrasted with present issues.
Offer Core Services:
Basic services like preventing the spread of communicable disease, assuring normal growth and development of children and adults, preventing injuries and reducing risky behaviors, protecting against environmental hazards, and preparing to respond to disasters and health threats have always played a role in public health practice. But "core needs" which prompt the provision of core services are ever changing with society and culture. A battery of "core services" should be both comprehensive and flexible to ensure that basic health needs are and will continue to be met.
Invest in Reliable Health-Related Institutions
"Long-term planning, which supports investment in institutions and renewable resources, focuses on needs and opportunities beyond the current environment."
Find a Balance between Individual Rights and Public Good
The public health has always recognized and had to deal with a tension between individual freedoms and the common good. The tension has been resolved by focusing sometimes on one and sometimes on another. No definitive resolution of the tension has been proposed, but it is increasingly clear that a conceptual dichotomy between the two ought not exist. The individual cannot be healthy when his or her community is not, and vice versa.
Seek and Define and Identity for the field of Public Health
Despite the fact that public health workers are interspersed throughout various sectors and have various interests and priorities, there must be a way for them to communicate rationally about health action. "To be effective, the field must demonstrate both focused decisive action and broad-based systemic vision."
Focus on Prevention to Secure the Health of Populations
Although public health researchers have sought to define clear-cut, rational causalities between various phenomena and individual and population health, and between interventions and results, we are finding that the most influential determinants of health are not so easily conceptualized. The cause and effect of race, income, social status, gender and environment; and health, make it difficult to draw clear connections. HSD provides a means to analyze these issues in a practical way.
Lessons from Human Systems Dynamics
"They already know it"
Experts in public health have dealt with te complexities of public health, although doing so often with oversimplified models of systems. HSD thinking is focused on mapping what is already somewhat intuitive to the experts in order to build a sense of shared meaning and decision making priorities.
New understanding is not enough. Research must offer to new methods that help generate, select and implement new options for effective action.
Linear Ladders can lead to non-linearity
Although conceptual frameworks may reduce non-linear relationships and dynamics to linear maps, they will ideally will make room for non-linear innovation and adaptivity within the linearity.
Scaling is a radical concept:
Although the problems encountered at different levels of a system hierarchy vary widely, changes from one level to another impact others and lessons may be learned from the results, so far as complexity is taken into account. "Critical Lessons for the future will include both developments in the content of human systems dynamics, but also in the most effective and efficient ways to disseminate the theory and practice of this emerging field."
