Integrating Systems and Sectors Toward Obesity Solutions Proceedings of a Workshop (2021) / Chapter Skim
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3 Complex Systems in Society and the Context for Obesity
3 Complex Systems in Society and the Context for Obesity
Pages 31-52
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From page 31... ...
Therefore, much potential exists to leverage social networks as part of a systems science approach to solutions for obesity. (Kayla de la Haye)
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From page 32... ...
Giselle Corbie-Smith, the Kenan Distinguished Professor and director of the Center for Health Equity Research at the University of North Carolina at Chapel Hill, moder ated the second half of the session, during which two additional speakers discussed resources, place-based issues, policy, and political will. POWER DYNAMICS AND STRUCTURAL RACISM: INSIGHTS FROM CRITICAL RACE THEORY Chandra Ford, associate professor of community health sciences and founding director of the Center for the Study of Racism, Social Justice & Health at the University of California, Los Angeles, discussed power d ynamics and structural racism from the lens of critical race theory (CRT)
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She briefly noted that ethnicity is also a social construct and that strategies exist for measuring it as such. Ford's second suggestion for helping systems science approaches better represent reality was to address racialized power dynamics.
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She pointed out that social movements, such as Data for Black Lives,2 are emerging to challenge these practices, with the objectives of limiting surveillance of communities and democratizing access to data. Ford's third suggestion for improving systems science approaches was to address the social construction of knowledge.
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From page 35... ...
She stressed that people with low incomes and communities of color are unequally exposed to structural influences that do not support healthful habits; therefore, interventions need to target multiple factors across layers of individual, social, physical, and macro environmental systems that influence obesity risk. de la Haye suggested that much potential exists to leverage social envi ronments, particularly the rich social networks that make up social fabrics, in systems science solutions for obesity.
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From page 36... ...
Social network analysis is also used to study the impact of social struc tures on individual and group outcomes, de la Haye continued, referencing research indicating that adults and children with obesity tend to cluster in social networks and that social connections with obesity increase a person's obesity risk over time. She added that longitudinal research has linked these patterns to several contributing factors, which include homophily, propin quity, and stigma (see Figure 3-3)
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Weight-based stigma is a third driver of these patterns of obesity in social networks, she
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From page 38... ...
In the final portion of her presentation, de la Haye shared examples of intervention approaches designed to leverage or change social networks as part of obesity solutions. She highlighted segmentation as one common strategy for local social networks, an approach that targets at-risk social groups (e.g., family or peer groups)
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From page 39... ...
. As a second strategy she cited alteration, in which an intervention aims to change people's social networks by building new, adjacent health networks that can increase access to posi tive social influences, norms, and support (Valente, 2012)
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Finally, she sug gested that the most powerful insights into social networks and their future role in obesity solutions will be drawn from the strengths of community partnerships, survey and interview data, and emerging sources of big data and secondary data. PANEL DISCUSSION Moderating a panel discussion following the presentations by Ford and de la Haye, Kumanyika began by asking the two speakers to com ment on the direct relationship between the operation of racism and the operation of social networks and how both issues could be interrupted or restructured.
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From page 41... ...
With respect to inequities and the concentration of health risks among certain populations, she added, these factors contribute to the social clustering and allocation of resources, to the segregation of certain populations in broader social networks, and to exposures to different types of social environments. Ford postulated that critical race theorists would suggest considering the differences or similarities between stigmatization ties to racialization and stigmatization ties to obesity.
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From page 42... ...
AUDIENCE DISCUSSION Following the panel discussion, Ford and de la Haye addressed work shop participants' questions about promoting breastfeeding as a strategy for preventing obesity, countering homophily to address obesity and other health concerns, measuring race as a social construct, addressing systemic bias favoring biological causes, and addressing structural racism while influencing systems. Promoting Breastfeeding as a Strategy for Preventing Obesity A workshop participant asked about promoting breastfeeding as a strategy for preventing obesity and incorporating race and racism in breastfeeding interventions.
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Addressing Structural Racism While Influencing Systems A workshop participant asked for examples of methods that organiza tions like the Roundtable on Obesity Solutions can use to address structural racism when attempting to influence complex systems. In response, de la
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She encouraged ex amination of how researchers understand structural racism and how that understanding manifests in their work, as well as how structural racism operates in society and relationships. Kumanyika stated that the process of calling out racism and under standing potentially counterproductive characteristics of social networks involves both people who are in positions of power and people who are not.
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From page 45... ...
In the face of this complexity, Diez Roux continued, interest abounds in applying systems science approaches, particularly agent-based modeling, to neighborhood effects research. According to Diez Roux and her col leagues, one reason these approaches are suitable for this research is their utility for better understanding the bidirectional person–environment rela tions that occur in neighborhoods, such as selection and endogeneity (e.g., understanding whether neighborhood physical activity levels increased be cause of local zoning and land use changes, or physically active people were more likely to move to the neighborhood because the changes made it more activity-friendly)
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From page 46... ...
She pointed out, for example, that people shop based on distance and prices, and stores react to the volume of shoppers. To address the first of the above questions, Diez Roux continued, the model compared income differentials in diet under various spatial segregation scenarios, assuming no differences between healthy and unhealthy foods in either price or pref erences.
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From page 47... ...
Diez Roux moved on to describe how systems science approaches prompt users to rethink their research questions. This may be the most valuable aspect of a systems science approach, she speculated, and she shared an example of transforming a relatively limited research question into a more nuanced, policy-relevant question: Original question: Are neighborhood characteristics independently asso ciated with health after accounting for individual-level socioconomic e status?
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From page 48... ...
Diex Roux ended her presentation with a quote from epidemiologist Raoul Stallones: "If we consider disease to be embedded in a complex net work in which biologic, social, and physical factors all interact, then we are impelled to develop new models and adopt different analytic methods." INTERSECTION OF POLICY AND SYSTEMS SCIENCE MODELING TO EXAMINE SOCIAL DETERMINANTS OF PHYSICAL ACTIVITY AND OBESITY Tiffany M Powell-Wiley, Earl Stadtman tenure-track investigator at the National Institutes of Health and chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory, discussed the intersection of policy and systems science modeling in the context of social determi nants of physical activity and obesity.
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Powell-Wiley highlighted the assessment's use of principles of community-based participatory research, describing how researchers gath ered data at community sites and used mixed methods to evaluate environ mental and psychosocial factors related to cardiovascular risk and potential intervention tools. The assessment found that physical activity could serve as a target for improving cardiovascular health in the city's Wards 5, 7, and 8, Powell-Wiley reported, and showed the feasibility of using mobile health technology to develop a physical activity intervention.
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Those questions addressed the impact of policing on community safety and physical activity, the study of systems of advantage in highly segregated White communities, and the use of models to examine the dynamics of structural racism.
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From page 51... ...
Systems thinking is critical for understanding drivers of health inequities, she maintained, and for understanding how structural racism affects health. Using Models to Examine Dynamics of Structural Racism Powell-Wiley shared an example of her team's thinking about dis crimination and segregation and their relationship to decision making about physical activity.
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