Integrating Systems and Sectors Toward Obesity Solutions Proceedings of a Workshop (2021) / Chapter Skim
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2 Overview of Systems Science Theories, Approaches, and Applications
2 Overview of Systems Science Theories, Approaches, and Applications
Pages 5-30
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Systems science approaches can complement observational and experimental techniques to simulate the counterfactual scenarios in which one variable is changed while all others are held constant, thereby advancing understanding of strategies for improving population health. (Sandro Galea)
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Rivera, professor of chemical engineering and program director of the Control Systems Engineering Laboratory at Arizona State University. S peakers in this session introduced the concepts of complex systems and systems thinking as they apply to population health issues and broadly described systems science approaches (i.e., methodologies or tools)
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Actors are also adaptive, Hammond added, elaborating that differences may exist between their short- and long-term behavioral responses to environmental and policy changes. Hammond described a third characteristic of complex systems by stress ing the importance of detailed information with regard to the context and timing of various exposures as people move through their environments.
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United Kingdom Government Office for Science, 2007.
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Public health has advanced from using systems thinking, he explained, to adopting specific systems science tools, both qualitative and quantitative. Hammond briefly mentioned causal loop diagrams and systems maps as examples of qualitative tools, and then reviewed quantitative tools in more detail.
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Tools also differ in the relative emphasis they place on data inputs versus theoretical inputs, Hammond added, as well as their field of origin and the training required to use them. He noted that NIH's initial investment and training in systems science approaches focused on system dynamics modeling, social network models, and agent-based modeling, which remain among the most common types of methods used in public health and obesity.
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Hammond shifted his exposition of systems science history to describe how obesity research has been informed by systems science approaches. Publications first appeared in this area around 2009, he remarked, and these initial publications explained why systems science approaches are apt for studying obesity and designing interventions to address it, reviewed potential applications of specific systems science methods and tools to obe sity, and suggested potential data requirements and obstacles (Hammond, 2009)
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(IOM and NRC, 2015) SYSTEMS THINKING TO UNDERSTAND AND IMPROVE POPULATION HEALTH Sandro Galea, dean and the Robert A
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According to Galea, the map makes it abundantly clear that the only rational way to address obesity is to ap proach it as a complex system. Galea shifted to expound on the compatibility of population health with systems thinking by reviewing three of nine principles that have been advanced as foundations of population health science (Keyes and Galea, 2016)
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FIGURE 2-3 Percentage distribution of serum cholesterol levels (milligram/deciliter) in men aged 50–62 who did or did not subsequently develop coronary heart disease (CHD)
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He maintained that these books fail to sufficiently consider broader, ubiquitous environmental factors, such as increasing portion sizes of packaged and restaurant foods, which influence and can undermine individual behavior changes. Differ ences in food environments can help explain heterogeneity in the prevalence of obesity across adjoining communities, he added, and he called for the application of systems science approaches to understand both the individual drivers and the ubiquitous forces that affect population health.
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To overcome this difficulty, Galea suggested, systems science approaches can complement observational and experimental techniques to simulate the counterfactual, and although all approaches have imperfections, together they can contribute to a better understanding of strategies for improving population health (Marshall and Galea, 2015)
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Louis, provided an overview of applications of systems science. Systems science approaches are benefi cial for chronic disease prevention and policy implementation, he began, echoing Hammond's and Galea's statements about the complexity of public health problems.
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18 FIGURE 2-4 The complex tobacco landscape. SOURCES: Presented by Douglas Luke, April 6, 2020.
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An under lying assumption in such a model, he explained, is the average number of contacts per person per unit time, which assumes random mixing and ignores social structures. Nonetheless, this traditional model with its simpli fying assumption worked until the 1980s, Luke recounted, when the AIDS epidemic elevated the role of social context in disease transmission.
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Tobacco Town, which uses the systems science approach of agent-based modeling, is a policy laboratory used to explore potential impacts of various retail poli cies across contexts and populations. Luke explained that Tobacco Town is based on evidence indicating that people who live in neighborhoods with a high density of tobacco retailers are more likely to start smoking and
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Different communities take different actions at different times, he explained, and clarity is lacking about how density reduction would work in practice. Luke's research team developed a "mechanism metaphor," he recounted, starting with the assumption of a simple linear relationship whereby a high density of tobacco retailers lowers the time and monetary costs of obtaining tobacco products (see Figure 2-7)
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Researchers collaborate with community stakeholders to tailor models to specific com munities, he elaborated, so they can test the impact of policies prioritized by community members and disseminate the results. Luke reviewed examples of Tobacco Town in action to show that it confirmed the nonlinearity between retailer density and the costs of pro curing tobacco products.
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, he elaborated, and the Tobacco Town dashboard illustrated how various policies would potentially affect retailer density across these different types of communities. He noted that as policies became stronger, to include restricting tobacco sales at pharmacies and requiring buffers between retailers, retailer density dropped consider ably in all communities, and disparities in density diminished across com munities of varying urbanicity and income levels.
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PANEL DISCUSSION Rivera moderated a panel discussion with the three session speakers following their presentations. Topics addressed included the importance of applyng systems science approaches to obesity solutions and potential i metrics of success; examples of communicating systems science concepts to academics, policy makers, and the public; the role of leadership and the alignment of multisector action in systems science approaches; the types of training and collaboration that can help prepare stakeholders to undertake systems modeling efforts; and funding opportunities for systems science approaches.
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Luke concurred, urging researchers to be "appropriately skeptical" about a model's capabilities when they discuss using modeled results to plan action with community stakeholders. The Role of Leadership and Alignment of Multisector Action Rivera asked the speakers to discuss the role of leadership and the alignment of multisector action based on systems science approaches.
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Training and Collaboration Rivera asked the speakers to elaborate on the types of training and collaboration that can help prepare stakeholders to undertake systems modeling efforts. Hammond underscored that substantial training and experience are essential to the appropriate use of systems science tools.
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He also emphasized the importance of participating in transdisciplinary teams so that population health stakeholders can engage with expert modelers. Luke concurred with the value of a team-based approach, noting that all members need not be expert modelers.
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According to Hammond, participatory group model building is a quali tative systems science approach that can engage community members and stakeholders in articulating their lived experiences in systems. Tapping into community members' perspectives and experiences can help researchers b etter understand and visualize systems structures, he explained, adding that the translation of these qualitative inputs into quantitative models must be done carefully.
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Luke explained that his group developed its Tobacco Town models in close consultation with a variety of community and policy partners to increase the models' potential for community impact. He highlighted the value of working with legal experts to help shape how potential tobacco control policies are presented, given that they may be contested in court over First Amendment or other constitutional challenges.
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He cautioned against charging physicians with solving the com plex systems problems that ultimately shape population health, noting that their primary role is to provide clinical care, which is only one component of broader systems. Hammond agreed, and added that systems science ap proaches can be used to study and make changes in the health care system.
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