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Possibilities for Better Integrating System Dynamics Into Public Health

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Possibilities for Better Integrating System Dynamics Into Public Health Bobby Milstein 21st International Conference of the System Dynamics Society – PowerPoint PPT presentation

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Title: Possibilities for Better Integrating System Dynamics Into Public Health


1
Possibilities for Better Integrating System
Dynamics Into Public Health
Bobby Milstein 21st International Conference of
the System Dynamics Society New York, 2003
2
Seeing Beyond the Probable
Most organizations plan around what is most
likely. In so doing they reinforce what is, even
though they want something very
different. -- Ciement Bezold
  • PossibleWhat may happen?
  • PlausibleWhat could happen?
  • ProbableWhat will likely happen?
  • PreferableWhat do we want to have happen?

Bezold C, Hancock T. An overview of the health
futures field. Geneva WHO Health Futures
Consultation 1983 July 19-23.
3
Smallpox EradicationOur Greatest (Temporary)
Victory

4
A Glimpse Into 2020
Murray CJL, Lopez AD. The global burden of
disease summary. Cambridge, MA Harvard
University Press, 1996.
5
Starting Assumptions
  • Most public health agencies act as if each
    affliction can be prevented individually by
    understanding its unique causes and developing
    targeted interventions
  • This compartmentalized approach is ingrained in
    financial structures, problem solving frameworks,
    statistical models, and criteria for professional
    prestige

6
Need A Complementary Science of Relationships
  • Problem, problem solver, response
  • Coordination of multiple problems, problem
    solvers, and responses

7
Diseases of Disarray
  • Hardening of the categories
  • Tension headache between treatment and prevention
  • Hypocommitment to training
  • Cultural incompetence
  • Political phobia
  • Input obsession

Wiesner PJ. Four disease of disarray in public
health. Annals of Epidemiology.
19933(2)196-8. Chambers LW. The new public
health do local public health agencies need a
booster (or organizational "fix") to combat the
diseases of disarray? Canadian Journal of Public
Health 199283(5)326-8.
8
Spectrum of Prevention
Time Horizon for Observing Effects on Population
Health Status
SHORTmonths-years
LONGdecades-centuries
INTERMEDIATEyears-decades
Effects on outcomes other than population
health status (e.g., risk/protective behaviors,
change agents, or system changes) can be observed
in shorter time intervals
9
Public Health Goals Are Accumulating and Becoming
More Systemic
The perfection of means and confusion of goals
characterizes our age. -- Albert Einstein
  • Prevent disease and injury (1850 -- present)
  • Promote health and human development (1974 --
    present)
  • Assure the conditions in which people can be
    healthy (1988 -- present)

10
Virtually Unstoppable Trends in Prevention
Science
  • Systems-oriented
  • Politically engaged
  • Philosophically conscious

11
What Is Not Happening
  • Integration
  • Dynamic hypotheses of health states and rates
  • Testing through simulation
  • Searching for polices that can be effective
  • Rehearsing policy implementation
  • Learning about dynamic complexity

12
Brief History of Causal TheoryWhat accounts for
poor community health?
  • Gods will
  • Humors, miasma, ether
  • Poor living conditions, immorality (sanitation)
  • Single disease, single cause (germ theory)
  • Single disease, multiple causes (heart disease)
  • Single cause, multiple diseases (tobacco)
  • Multiple causes, multiple diseases (but no
    feedback dynamics) (social epidemiology)
  • Dynamic feedback among afflictions, living
    conditions, and community capacity (syndemic)

1840
1880
1950
1960
1980
2000
13
Roles for System Modelingin Public Health
  • Cost-effectiveness analysis simulating patterns
    of disease dynamics, prevention activities, and
    resources
  • Program dynamics simulating system-wide impacts
    of comprehensive programs with interacting
    components
  • Community dynamics simulating the mediating
    effects of local conditions, capabilities, and
    constraints
  • Group model building providing more structure
    and insight to the participatory planning process
  • Game-based learning improving intuition,
    foresight, commitment, and agility in navigating
    change
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