1 A Systems Approach A Systems Approach to Childhood Obesity Prevention to Childhood Obesity Prevention Outline Outline 1. What is systems thinking? 2. Applications to obesity 3. Two examples of research and practice 4 Final thoughts and a few useful resources 4. Final thoughts and a few useful resources
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A Systems Approach A Systems Approach to Childhood Obesity Preventionto Childhood Obesity Prevention
OutlineOutline
1. What is systems thinking?
2. Applications to obesity
3. Two examples of research and practice
4 Final thoughts and a few useful resources4. Final thoughts and a few useful resources
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1. 1. What does it mean to What does it mean to think in systems?think in systems?
U.K Foresight Programme, 2007www.foresight.gov.uk
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U.K Foresight Programme, 2007www.foresight.gov.uk
Key Characteristics of Complex SystemsKey Characteristics of Complex Systems
Heterogeneous
Each actor and sector in society matters
Dynamically interactive
Feedback loops; learning; adaptation
Emergent phenomena possibleEmergent phenomena possible
Tipping
Non-equilibrium
Opposite of reductionism (whole is greater than sum of parts)
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What is systems thinking?What is systems thinking?
Constructing mental models and representing relationshipsConstructing mental models and representing relationships
How do we ensure sustained interventions and intervention effects?
How do we diffuse and scale-up effective interventions? Interventions often only attain cost-effectiveness when they achieve economy of scale.y
How do we ensure different communities all benefit from interventions?
Huang et al.,Children’s Healthcare, 2011
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Knowledge Transfer LoopKnowledge Transfer Loop
Evidence-Based
Practice
Evidence-Based
Practice
Practice-Based
Evidence
Practice-Based
Evidence
External Validity
Eva
luat
ion
Mo
del
ing
PracticePractice EvidenceEvidence
Internal ValidityE M
Systems Thinking Helps Avoid Common Pitfalls Systems Thinking Helps Avoid Common Pitfalls Stemming from LaundryStemming from Laundry--List CauseList Cause--andand--Effect ThinkingEffect Thinking
Independent effects (from causal factors)
One-way causality (feedbacks)
Linearity of effects (dynamically variable over time)
Instantaneous effects (delays are everywhere)
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What Systems Science Is NotWhat Systems Science Is Not
Crystal ball to predict the future Crystal ball to predict the future
Guessing game of what solutions are for a given problem
Free of theoretical and data considerations
Replacement of existing toolbox
All models are wrong; some are useful. (George Box)
From individual From individual approaches…approaches…
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To an environmental and To an environmental and policy focus…policy focus…
H d hi li H d hi li How do we achieve policy How do we achieve policy adoption and implementation?adoption and implementation?
If we build it, will they come?If we build it, will they come?If we build it, will they come?If we build it, will they come?
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Food deserts in the U.S.Food deserts in the U.S.
Active communitiesActive communities
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New ventures…New ventures…How to bring the human factor and the How to bring the human factor and the
environment togetherenvironment together
3. 3. Two Examples of Two Examples of Research and PracticeResearch and Practice
How to intervene on both the supply of and demand for health, healthy products, healthy places and healthy policies?
How to create social movements and shift social norms?
Can culture be changed or realigned?
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Designer Schools: Designer Schools: Buckingham, VirginiaBuckingham, Virginia
Team:
UNMC (T. Huang)UVA (M. Trowbridge)VMDO Architects
Gorman et al, Obesity, 2007Huang et al., Prev Chronic Dis, in press Supported in Part: UVA Youth-NEX
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Institutional dining hallInstitutional dining hall
Student-Led Guided Tour (in collaboration with USGBC)
Series of Workshops with School & Community Stakeholders
Technical Assistance (e.g., Experience Food Project/Chef Tom French)
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Latino Health Movement through Youth Latino Health Movement through Youth ggAdvocacy, Social Marketing & PartnershipsAdvocacy, Social Marketing & Partnerships
Support: RWJF/Active Living ResearchNebraska Research Initiative
Initiative FrameworkInitiative Framework
• Designed to develop youth activists to enhance g p ycommunity readiness to address childhood obesity in Omaha’s Latino community.
• Empower families to make healthy choices and create an environment that is conducive to health lifest leshealthy lifestyles.
• It is youth driven and community participatory. Community ownership and sustainability of change are key.
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Art and ScienceArt and Science
Marriage of art media and science Marriage of art, media, and science.http://www.youtube.com/watch?v=YCTgcUTSH6E
The goal is to catalyze a social movement about Latino health.
The founding youth advocate cohort designed
and developed the logo and developed the logo, brand, and containers for
generating a Latino health movement
SaludableOmahaSaludableOmaha
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SaludableOmaha Logic ModelSaludableOmaha Logic Model
Integrated Integrated Model for Model for Generating Generating Social Social M tM tMovementMovement
Frerichs et al, 2012
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4. Final Thoughts4. Final Thoughts
Solution-oriented approach, paradigm shift, convergence of fields
Systems thinking compels us to ask different questions and come up with non-linear solutions
Multicomponent ≠ Multilevel ≠ Systems Science
I i l hi k f Important to involve systems thinkers at outset of program design
Complements traditional toolbox
Blending the individual, social Blending the individual, social & environmental…& environmental…
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Some Useful ResourcesSome Useful Resources
Donella Meadows: Thinking in Systems: A Primer
Tarek Hamid: Thinking in Circles about Obesity
Joy Richmond el al (eds): Tracing Connections: Voices of Systems Thinkers
Di Fi d Th l i f b i Diane Finegood: The complex systems science of obesity. In: John Cawley (ed.): The Oxford Handbook of the Social Science of Obesity