Shifting the Paradigm for Chronic Disease Prevention: from simple solutions to system approaches Diane T. Finegood, PhD Professor, Biomedical Physiology and Kinesiology, Simon Fraser University Executive Director, The CAPTURE Project @DTFinegood BC Dairy Foundation, June 8, 2011
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Shifting the Paradigm for Chronic Disease Prevention:
from simple solutions to system approaches
Diane T. Finegood, PhD
Professor, Biomedical Physiology and Kinesiology, Simon Fraser University
Executive Director, The CAPTURE Project
@DTFinegood
BC Dairy Foundation, June 8, 2011
Take Home Messages
• Chronic disease prevention is complex (not simple or even complicated).
• Accepting complexity does not mean we should give up, but we must turn to solutions appropriate for complex problems.
• Interactions between: levels, capacity & complexity, competition & cooperation, and networks are places to look for solutions.
O
ITY
PREVALE
INDIVIDUAL
Energy
Expenditure
POPULATION
%
OBESE
OR
UNDERWT
Food
intake :
Nutrient
density
FACTORS
INTERNATIONAL
Development
Globalization
of
markets
School
Food &
Activity
WORK/
SCHOOL/
HOME
Infections
Labour
Worksite
Food &
Activity
Leisure
Activity/
Facilities
Agriculture/
Gardens/
Local markets
COMMUNITY
LOCALITY
Health
Care
System
Public
Safety
Public
Transport
Manufactured/
Imported Food
Sanitation
NATIONAL/
REGIONAL
Food &
Nutrition
Urbanization
Education
Health
Social Security
Transport
Family &
Home
National
perspective
Media &
CultureMedia
programs
& advertising
Source: see Kumanyika Ann Rev Pub Health 2001; 22:293-308
“Causal Web”
Obesity System Map
http://kim.foresight.gov.uk/Obesity/Obesity.html
Characteristics of Systems
Simple or Complicated Systems Complex Systems
Homogeneous Heterogeneous
Linear Nonlinear
Deterministic Stochastic
Static Dynamic
Independent Interdependent
No feedback Feedback
Not adaptive or self-organizing Adaptive and self organizing
No connection between levels or
subsystemsEmergence
Common Responses to Complex Problems
• Retreat
• Despair
• Believe the problem is beyond hope
• Assign blame, figure out who is responsible
• Simple solutions
• Galvanize our collective efforts and invest significant resources
Bar-Yam, Y. Making Things Work, 2004.
Places to Look for Solutions to Complex Problems
• In the interaction between levels
• In the relationship between an individual’s (or organization’s) capacity to deal with the complexity of it’s tasks
• In the interdependence between competition and cooperation
• By influencing emergence
Levels Relevant to Obesity & Chronic Disease
• International
• National
• Regional / Municipal
• Worksites / Schools
• Home / Family
• Individuals
• Organ / Metabolic Systems
• Proteins
• Genes
O
ITY
PREVALE
INDIVIDUAL
EnergyExpenditure
POPULATION
%
OBESE
OR
UNDERWTFood
intake :Nutrient density
FACTORS
INTERNATIONAL
Development
Globalizationof
markets
SchoolFood &Activity
WORK/
SCHOOL/
HOME
Infections
Labour
Worksite Food & Activity
LeisureActivity/Facilities
Agriculture/Gardens/Local markets
COMMUNITYLOCALITY
Health Care
System
PublicSafety
PublicTransport
Manufactured/Imported Food
Sanitation
NATIONAL/
REGIONAL
Food & Nutrition
Urbanization
Education
Health
Social Security
Transport
Family &Home
Nationalperspective
Media &CultureMedia
programs& advertising
Source: see Kumanyika Ann Rev Pub Health 2001; 22:293-308
“Causal Web”
Scale and Complexity of Diets
• Accumulated dietary intake
• Daily dietary intake
• Meals
• Whole foods
• Nutrients
Increasin
g # of p
ossib
le co
mb
inatio
ns
Different paradigms driving complexity
“Eat food, not too much,mostly plants”
Michael Pollen
Places to Intervene in a complex system
1. The power to transcend paradigms
2. The paradigm that the system arises out of
3. The goal of the system
4. The power to add, change, evolve, or self-organize system structure
5. The rules of the system
6. The structure of information flow
7. The gain around driving positive feedback loops
8. The strength of negative feedback loops
9. The length of delays
10. The structure of material stocks and flows
11. The size of buffers and other stabilizing stocks
12. Constants, parameters, numbers
Effe
ctiv
enes
s
Dif
ficu
lty
D. Meadows. Thinking in Systems, A Primer, Chelsea Green, 2009.
One Approach to Scale:
Intervention Level Framework
Effe
ctiv
enes
s
Dif
ficu
lty
Level Definition
Paradigm Deepest held beliefs
Goals What trying to achieve
Structure Information flows, connectivity, trust
Feedback &delays
Self-regulation, reinforcement & adaptation
Structural elements
Subsystems, actors, operating parameters
Finegood, DT. The Complex System Science of Obesity. In: The SocialScience of Obesity, Ed. J Cawley. Oxford University Press, 2011