Using Systems Applications to Inform Obesity Solutions Proceedings of a Workshop (2021) / Chapter Skim
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3 Exploring the Usefulness of Systems Science Approaches for Stakeholders in Different Sectors
3 Exploring the Usefulness of Systems Science Approaches for Stakeholders in Different Sectors
Pages 13-46
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From page 13... ...
Another simple calculator has been used to calculate how individual parks contribute to property values, health care savings, in formed decisions on environmental and public spending, and job creation in the community. These modeling outputs have supported billions of dollars in public investment in sport and recreation assets and helped unlock or shape more than $55 million in foundation and corporate grants to support healthy communities through sport.
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From page 14... ...
obesity epidemic by P building healthy communities through sport. Tom Farrey, executive director of The Aspen Institute's Sports & S ociety Program, reported that Project Play began with a conversation about how the space of sport activity (a component of the realm of physical activity)
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From page 15... ...
During the remainder of his presentation, he described three steps that the initiative has taken in pursuit of that aim. The first step, Farrey said, was to compile and organize existing research on the individual- and community-level benefits of physical activity and participation in sports.
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Figure used with permission of The Aspen Institute's Project Play.
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Figure used with permission of The Aspen Institute's Project Play.
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He explained that this strategy emerged to address parents' concern about their children sustaining physical and emotional injuries from participating in sport. Recognizing that barrier to participation led Project Play to realize that it should give parents the confidence that sport can be a health-building experience.
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From page 19... ...
Surgeon General Vivek Murthy issued a call to action on the value of youth sport for promoting physical activity and public health. Since then, Farrey recalled, Project Play has conducted "state of play" audits that help communities assess where they are and how they could design investments and policies that would mobilize stakeholders to activate and improve the quality of play in their communities.
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Labs (developed by PHICOR) , highlighting their utility for helping decision makers grapple with the complexity of problems related to diet or physical activity and their potential solutions.
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recommended physical activity levels among 100 percent of youth is "not unachievable" because the activity level threshold is not high, and achieving this goal could result in averting $51.5 billion in direct medical costs, $69 billion in productivity losses, and saving 37.5 million years of life (Lee et al., 2017)
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From page 22... ...
Pathik added that the work of his organiza tion is a good example of how practitioners can react to a systems science approach. He noted that the organization has revised its approaches as a result of its engagement in the work of Project Play and the systems science modeling described earlier in the presentation by Lee.
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From page 23... ...
But without the programming previously offered by parks and recreation departments, he explained, facilities that may still be well maintained are now more expensive for people to use. He argued that the loss of public commitment to funding sport and recreation at the programmatic level results in a system oriented toward capitalism, which provides a place to play but lacks the programmatic structure to help youth develop competence and confidence to engage in physical activity for a lifetime.
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PANEL AND AUDIENCE DISCUSSION Following their presentations, Farrey, Lee, and Pathik addressed a participant's question about using systems science modeling to help avoid exacerbating disparities in access to sports and shared examples of increasing access to sports in underresourced communities. Addressing Disparities in Access to Sports Pathik mentioned that the number of children who receive free or reduced-price lunches is a metric used by the Sports Facilities Companies as a proxy to determine how many children need help accessing opportunities for sport in a given community.
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From page 25... ...
He noted that prior systems science modeling data assessing the conditions and needs in that census tract were instrumental in the event center's placement in an area of high need. COMMUNITIES: BALTIMORE, MARYLAND In the second panel, three speakers discussed the use of systems science modeling in communities -- specifically in Baltimore, Maryland -- offering
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From page 26... ...
According to Lee, the project's goal was to apply different systems science approaches to understand all of the complexities involved in Baltimore City's food system, as well as to use new systems science approaches such as systems mapping and systems science modeling. Buzogany then discussed Baltimore's food system and food policy landscape and highlighted the benefits of the city's partnership with Johns Hopkins University and the Global Obesity Prevention Center.
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From page 27... ...
By collaborating on systems science modeling efforts, she added, the initiative was able to understand how it could best implement strategies for improving the food environment within the focus areas of its healthy food environment strategy. Gittelsohn discussed B'More Healthy Communities for Kids, a multi level program implemented by the Global Obesity Prevention Center to improve access to, demand for, and consumption of healthier foods and beverages in low-income neighborhoods of Baltimore.
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From page 28... ...
She observed that policies such as the urban agriculture tax credit were created to help put the city's vacant land to productive use and to support ownership by urban farmers without burdening them with large property tax bills. Gittelsohn elaborated on the urban agriculture tax credit, recounting that city Councilman Pete Welch approached the Global Obesity Preven tion Center about his proposed bill to provide a 90 percent tax reduction for owners of vacant lots who converted them to urban farms (i.e., the urban tax credit)
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Lee recounted that the Baltimore City Health Department periodically contacted the Global Obesity Prevention Center to share potential policy interventions, such as placing warning labels on sugar-sweetened beverages in different combinations of grocery stores, corner stores, schools, and other settings where the beverages are available. The VPOP model forecasted the potential effect of the labels on purchasing and consumption of sugar-sweetened beverages.
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From page 30... ...
This figure summarizes the sensitivity analyses used to investigate how varying different unknown factors affects the change in obesity prevalence for Baltimore City. Each factor analyzed is represented by a horizontal bar, where the width of each bar represents the range of impact on obesity prevalence across a range of values for that factor (listed above the bar)
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From page 31... ...
The group partnered with Gittelsohn to develop a systems science dynamics model to simulate the effects of a staple foods ordinance, which she highlighted as an exemplar of government, community, and academia co-contributing to a shared vision. Gittelsohn elaborated on the systems science dynamics model, which he said enabled the group to simulate the inclusion of different foods and beverages in differing amounts in a potential Baltimore staple foods ordinance and then use the model to recommend modifications to the ordinance.
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PANEL AND AUDIENCE DISCUSSION Following the second panel's presentations, Lee, Buzogany, and ittelsohn commented on how dynamic systems components influence G systems science modeling efforts and answered participants' questions about validation of models, strategies for communities that want to get started with modeling, training and education to prepare decision makers for systems science modeling, and support for urban agriculture tax credit recipients. The Influence of Dynamic Systems Components on Systems Science Modeling Efforts Lee explained that one of the reasons for developing an explicit model that represents all of the processes, components, and mechanisms of a system is that changes in policies and priorities may occur.
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He stressed that the validation process never stops because although a model cannot achieve 100 percent validation, it is still important to continue to generate evidence to increase confidence that it is representing what it is intended to represent. Getting Communities Started with Systems Science Modeling Gittelsohn discussed the groundwork involved in building relationships within Baltimore, explaining that the Johns Hopkins team has been working in Baltimore communities for at least 15 years toward the goal of improving the food environment and that the team's modeling efforts began 5 or 6 years ago.
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From page 34... ...
Lee reiterated Gittelsohn's point that systems science modeling is an iterative process, and added that stakeholders can begin by developing a relatively simple model. There is value in developing an initial, smaller conceptual model to help give people a better sense of the topic of interest, he elaborated, even though this initial model may lack certain data and not provide a perfect representation of every factor involved.
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From page 35... ...
Diez Roux cited the study's three goals: to create an evidence base for making Latin American (and other) cities healthier, more equitable, and environmentally sustainable; to engage policy makers and the public in a new dialogue about urban health and urban sustainability and implications for societal action; and to create a platform and network that will ensure continued learning and translation.
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From page 36... ...
She added that both areas have high policy relevance globally and regionally, and have strong health–environment links that may operate in both directions, which means that the effects of policies will likely involve reinforcing or buffering loops or dependencies. Diez Roux emphasized the uniqueness of the policy maker engagement component of the study's fourth aim, suggesting that its purpose is to ensure the study's policy relevance, as well as to promote new ways of thinking among policy actors and other stakeholders about the drivers of urban health and the types of policies and interventions that could improve health and sustainability in cities.
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From page 37... ...
The outcomes of interest were healthy eating and mobility/transport in Latin American cities, Langellier continued, and the objectives were to engage policy stakeholders in SALURBAL, introduce systems thinking by explaining such concepts as feedback loops and describing how to depict complex systems, describe the structure and function of complex systems that drive both healthy eating and transport and explore their overlap, explore multisector influences on urban health, and identify policy solutions that recognize complex system influences on health outcomes. According to Langellier, a critical component of the workshops was scripted activities to introduce systems thinking and work toward mapping systems by facilitating the transfer of participants' mental models to a more explicit form.
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From page 38... ...
Langellier shifted to a review of SALURBAL's two agent-based simulation models of urban policy, one focused on ultraprocessed food purchasing policy and the other on urban transport and mobility policy. He prefaced this discussion by noting that the stakeholder insights and action ideas generated during the group model-building workshops were important
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From page 39... ...
The first was how food labeling, advertising, and taxes can be combined most effectively to reduce purchasing of ultraprocessed food in Latin American cities. Langellier observed that there is currently much policy action on taxation, labeling, and advertising policies in numerous Latin American cities and countries.
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From page 40... ...
He underscored that both models effectively integrate health aspects with outcomes of interest to policy makers in multiple sectors. Felipe Montes Jimenez, associate professor in the Department of Industrial Engineering at the Universidad de Los Andes, shared a case study of an effort called TransMiCable that implemented cable car transport in a lowincome, densely populated area of Bogotá.
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The updated diagram, he said, conveyed that social dynamics favor both physical activity promotion and the dynamics of transport that could influence mental health and leisure activities. He cited as a second aspect social and economic development, denoting social dynamics that could affect mobility, interurban displacement, and quality of life.
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. SOURCES: Presented by Felipe Montes Jimenez, September 16, 2020; Sarmiento et al., 2020.
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As the Urban Health Network grew and added members in different Latin American countries, she continued, an opportunity arose to apply for funding from the Wellcome Trust, which was interested in funding an international collaboration that involved policy maker engagement. That funding was critical, Diez Roux noted, for creating the Network's infrastructure and a platform for collaborating and generating evidence to support public policy.
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From page 44... ...
Use of Agent-Based Models to Simulate Intervention Impact Langellier responded to a participant's question about the use of agent-based versus system dynamics models to simulate impacts of the SALURBAL intervention. He noted that SALURBAL collaborators are in the process of developing system dynamics models of obesity transitions in Latin American countries, but explained that agent-based models were chosen for the ultraprocessed food model for purposes of flexibility and for utility in addressing future research questions.
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From page 45... ...
According to Diez Roux, feedback from these exercises indicated that participants had begun to apply systems thinking to their conceptualization of problems, and that they went away from the exercises with the intention of conducting similar activities at their own worksites. She asserted that this shift in participants' mindsets is extremely valuable, suggesting that this outcome may be even more valuable than the results generated from the formal simulation models.
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