Integrating Systems and Sectors Toward Obesity Solutions Proceedings of a Workshop (2021) / Chapter Skim
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4 Impacting Complex Systems That Can Influence Obesity
4 Impacting Complex Systems That Can Influence Obesity
Pages 53-68
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From page 53... ...
(Leah Frerichs) • The connections between education and health generally fall into three categories: direct relationships, which are the ways in which school environments and interactions in the school setting interactions can impact student health; indirect rela tionships, which are the ways in which educational outcomes relate to later health outcomes; and causal influences of health on educational outcomes.
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From page 54... ...
The second session in Part II of the workshop explored how complex systems may influence obesity and considered opportunities for systems change as they relate to obesity solutions. Sara Czaja, professor of gerontol ogy and director of the Center on Aging and Behavioral Research at Weill Cornell Medicine and emeritus professor of psychiatry and behavioral sci ences at the University of Miami, moderated the first half of the session, during which two speakers discussed the participatory nature of interven tions and education.
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From page 55... ...
She first displayed process flow diagrams that resulted from engaging health care providers from several community health centers in systems science work focused on processes for colorectal cancer screening. The resulting diagrams help identify health-related decision points, responsible parties for various processes, and potential gaps or bottlenecks.
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From page 56... ...
A SYSTEMS SCIENCE APPROACH TO EDUCATION AND HEALTH Matt Kasman, assistant research director at the Brookings Institution Center on Social Dynamics and Policy, discussed the use of systems sci ence approaches to explore links between education and health. He began by highlighting two prominent efforts that situate obesity in the context of broader systems of social life: the UK Foresight Group's obesity sys tems map depicting the web of interconnected causal factors that affect the prevalence of obesity (see Figure 2-1 in Chapter 2)
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From page 57... ...
Kasman explained that the first category, direct relationships, includes the ways in which school environments and interactions in the school set ting can impact student health, such as through access to healthy school meals and appropriate physical activity options. During the past decade or two, he remarked, many health-related systems science approaches have focused on or incorporated direct educational influences.
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From page 58... ...
He suggested that these feedback loops could be critical intervention points for improving population health outcomes and reducing disparities, adding that systems science approaches could help illuminate key dynamics, disentangle interconnected causal mechanisms, and identify promising policies and interventions to promote improved outcomes. Kasman ended his presentation by suggesting three actions to facilitate the use of systems science approaches to help understand the complex, dynamic relationships among health, educational activities, and outcomes.
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From page 59... ...
The education stakeholders provided valuable data and helped shape the research questions, he explained, noting that had his research involved a public health question, he would have needed to in volve public health stakeholders to provide another layer of buy-in, content e xpertise, and data. Finally, Czaja asked the two speakers for thoughts on integrating their approaches.
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From page 60... ...
Cultivating Diverse Skill Sets to Succeed with Systems Science Approaches A workshop participant commented on the emerging challenge of an implied need for systems science researchers to have a range of skills, such as robust mathematics and computation abilities, as well as strengths in understanding people, including themselves. These are classically siloed skill sets, Czaja pointed out, and she asked Frerichs and Kasman to suggest solutions for overcoming unintended consequences of classic disciplinary boundaries.
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From page 61... ...
Kasman urged remaining alert to unintended consequences of virtual programs that could exacerbate existing disparities, referencing emerging evidence of a growing divide in educational progress and academic achievement due to widespread remote schooling amid the coronavirus disease 2019 (COVID-19) pandemic.
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From page 62... ...
Health coaches also have tools to help people monitor their activities, he noted, and can make adjustments based on how people respond. Control systems use a technique called system identification to build dynamic models based on data from an actual person or other unit of in terest, Hekler continued, and the models feed into simulations of how the person will respond in future scenarios.
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From page 63... ...
. OBESITY-RELATED OPPORTUNITIES FOR SYSTEMS CHANGE IN COMMUNITIES Erin Hennessy, assistant professor in the Friedman School of Nutrition Science and Policy at Tufts University, discussed the use of systems think ing and systems science approaches to advance community-level obesity prevention.
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From page 64... ...
Hennessy next turned to discussing the promise of whole-of-commu nity approaches for effecting systems changes to prevent obesity. These approaches are multilevel, multifaceted, and implemented holistically throughout an entire community, she explained, and target multiple levels of influence and behaviors through policy, practice, and resource flows.
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From page 65... ...
. This realization helped articulate a new theory called stakeholder-driven community diffusion, she explained, which posits that community coalitions drive successful interventions by leveraging social network structures to diffuse their knowledge and engage ment with the public health prevention effort across the broader commu nity.
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From page 66... ...
Community-based system dynamics and group model building have been employed as intervention strategies, Hennessy continued, to guide multisector community coalitions through a process of extracting mental models, build ing collective understanding of a complex problem, and committing to ac tions to address the problem. She explained that her team's agent-based model defines agents as community coalition stakeholders who possess knowledge, engagement, and position in a social network, which Hennessy said allows for a quantitative, computational strategy for understanding longitudinal change in these key metrics.
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From page 67... ...
AUDIENCE DISCUSSION Next, Hekler and Hennessy responded to workshop participants' ques tions about immutable versus evolving factors in systems, similarities and differences across communities as observed in experiences with communityengaged efforts to address obesity, and fusion and defusion skills. Immutable Versus Evolving Factors in Systems In response to a question about how researchers applying systems sci ence approaches handle immutable factors, Hekler confirmed that some factors truly cannot be changed, but urged careful thought about the dis tinction between truly immutable and evolving factors.
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From page 68... ...
She also pointed to one similarity across communities -- the abil ity to do powerful, dynamic work without substantial financial resources, instead leveraging relationships and resource flows to diffuse evidencebased interventions -- while acknowledging that different contextual factors, such as political dynamics, certainly exist, and communities sometimes conceptualize problems differently. Fusion and Defusion Skills Another workshop participant asked Hekler to elaborate on his sug gestion that scientists cultivate the skills of fusion and defusion.
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