a systems approach to childhood obesity prevention - … · 1 a systems approach to childhood...

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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

30,000-ft thinking (big-picture, horizontal thinking)

Systems-as-cause thinking (self-generation phenomena, no “external forces)

Dynamic thinking (trajectories v. equilibrium points) Dynamic thinking (trajectories v. equilibrium points)

Operational thinking (stocks and flows)

Closed-loop thinking (feedbacks)

Source: B. Richmond

What is systems thinking?What is systems thinking?

Simulating mental modelsSimulating mental models

Scientific thinking (simulations, adaptive learning)

Communicating and diffusing models of complex systems

Empathic thinking (listening and communicating, responding to feedback on mental models)responding to feedback on mental models)

Generic thinking (transcending fields)

Source: B. Richmond

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A systems approach focuses on A systems approach focuses on the interconnections across the interconnections across

actors, factors and sectors that actors, factors and sectors that contribute to childhood obesitycontribute to childhood obesity

2 2 How can systems How can systems 2. 2. How can systems How can systems thinking be applied to thinking be applied to

childhood obesity?childhood obesity?

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Applications for ObesityApplications for Obesity

Cope with complexities of childhood obesityp p y

Understand interpersonal, community and intersectoral dynamics –not just traditional risk factors – for generating solutions

Create virtual laboratories for intervention design and testing sustainable solutions

Generate new hypotheses and identify gaps in empirical data

B i h l i l di i li & Bring together multiple disciplines & sectors

Integrate multiple data sources

Anticipate intended and unintended consequences

Unintended ConsequencesUnintended Consequences

The call for low-fat diets

Data: OECD

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The Perils of Unintended ConsequencesThe Perils of Unintended Consequences

The story of Lake Victoria

Developmental Connections

1 Intrauterine Programming1 Intrauterine Programming2 Breastfeeding, early food exposure, attachment stage

3 Childcare, habit formation, adiposity rebound4 Brain maturation, self-management, puberty, health behavior change, increased

salience of peer effects & school effects

5 Independence, increasing life stress6 Pre-conception parental health status, prenatal care

Esposito et al., PCD, 2009

Nader et al, Child Obes, 2012

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Social Networks in Contexts

Christakis & Fowler, NEJM, 2007

Local, State, and National Policies

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A Systems Framework of Childhood Obesity with Feedbacks betweenIndividuals and the Environment

Physical Environment SupportDesign of Childcare

Food AccessRegional &

Social Environment SupportPeer & Family Institutional

Culture

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Centers & Schools Food AccessUrban Planning Networks Norms

Culture

Health Care SystemPrevention & Treatment

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6Nader et al., Child Obes, 2012

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Local, State, and National PoliciesC

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A Systems Framework of Childhood Obesity with Feedbacks between Individuals and the Environment




Culture

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Policies related to urban planning, housing, transportation, parks & recreation, food availability, access, financing & marketing, and education.

Policies related to urban planning, housing, transportation, parks & recreation, food availability, access, financing & marketing, and education.

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Culture

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Policies on media and information, housing (e.g. segregation), industry practices, labor, individual incentives (tax, insurance, etc.).

Policies on media and information, housing (e.g. segregation), industry practices, labor, individual incentives (tax, insurance, etc.).

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Policies on health care infrastructure, financing, delivery mode.

Policies on health care infrastructure, financing, delivery mode.

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Interplay between social and physical environment.Interplay between social and physical environment.

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Culture

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Social and physical environments enable and/or constrain family & individual behavior. Individuals also shape their environment.

Social and physical environments enable and/or constrain family & individual behavior. Individuals also shape their environment.

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Preventive & curative services to families and individuals.

Preventive & curative services to families and individuals.

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Culture

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Health care providers and practices as advocates of social & environmental changes to promote healthy lifestyles.

Health care providers and practices as advocates of social & environmental changes to promote healthy lifestyles.

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Individual empowerment and community mobilization to effect policy change.

Individual empowerment and community mobilization to effect policy change.

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Sustainability, Scalability, ReachSustainability, Scalability, Reach

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

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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

Old kitchen & Old kitchen & serveryservery

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School in constructionSchool in construction

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CafeCafe

Food LabFood Lab

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Creating Food Smart YouthCreating Food Smart Youth

School GardenSchool Garden

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Design “Software”Design “Software”

To optimize the use of design features:p g

Operator’s Manual

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

a systems approach to childhood obesity prevention - … · 1 a systems approach to childhood...

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