We believe that systems thinking and complexity science can be transformational in global health by increasing local capacity and shared learning, and minimizing unintended consequences.
This Blog Post is Based on a Series of 4 Lectures by Dr. Henry Mosley, Emeritus Professor at the Johns Hopkins Bloomberg School of Public Health. Click here to see and hear Dr. Mosley’s Lectures in full.
In the past century, we have made great strides in public health. New treatments and cures are constantly being discovered, and many lives have been saved due to this progress and innovation. However, we still see many inequities and inefficiencies in our health systems, and millions die each year of curable diseases. Despite magnificent discoveries and improvements, we can do much better in providing health worldwide. The way that we currently deliver health is inefficient and inequitable. Transformational change is needed.
To address the need for transformational change, we strongly believe systems thinking provides a lens to recognize and apply a new paradigm in health. Systems thinking is a way of looking at the world, based on the idea that we can better understand the nature of a problem by considering all participants and their interactions, than we can when viewing each part in isolation. Such an approach means that when addressing health issues we must consider economic, political, social and other factors that might seem unrelated to health, but may be contributing to the outcomes. Health challenges are complex and solutions differ depending on time and place making it impossible to impose effective “one-size-fits-all” plans of action, which is often the strategy of today’s health leaders.
Viewing health through a systems thinking lens led to a new paradigm for Dr. Henry Moseley: households are central to health systems, and therefore health interventions that incorporate building the capacity of households can lead to system-wide health improvement.
Our current mental model in health is that physicians and other health practitioners are the predominant producers of health. However households – dwellings and all those living therein – actually provide roughly 70-90% of all health treatment, making households the primary providers of health. As such, these units are central components to our current health systems and thus, in this paradigm, households must be the major focus of policies and programs aimed at improving health, especially in low-income countries.
As the primary producers of health, it is important that the family has the capacity to deliver healthcare treatments within the home. Mothers are the primary managers and implementers of health within households; therefore programs and policies that include the education and instruction of women as an emphasis can make a greater impact. Many social studies have shown that the biggest impact in health can be made through building capacity of mothers and women, as women manage the most fundamental unit in a health system: the family.
From Blueprints to Systems
Health programs and policies worldwide are being implemented based on the blueprint model. In this model, plans and policies are developed by leaders at the top and are implemented by front-line workers and communities. The blueprint model generally follows the outline:
However, this blueprint model disconnects learning from action. Managers and policy makers learn, while households and communities are recipients of health programs. This leads to dependence and decreased capacity of the local work force.
When approaching health policymaking and planning from a systems perspective, households and communities are involved in the decision making process. When using a systems lens, context is crucial. David C. Aron said that, “there is no such thing as a best practice independent of the context in which it is being conducted (1).” When planning for health interventions, listening and learning to understand local context will allow for adaptation to meet specific needs of a community and specifically, households, where the majority of health is being produced. This type of planning increases the capacity of those being affected by the plans by allowing them to participate in shared learning and action.
Developing a Shared Vision
An important role of today’s health leaders is the development of a shared vision. When applying solutions and interventions with local context in mind, having a vision that is shared among all stakeholders in the health system including practitioners, policy makers, and local leaders promotes increased participation and adaptation to meet health needs and goals. Because households are the primary providers of health, their participation and investment in a vision for health will promote action to reach such a vision at the most fundamental level. A shared vision encourages synergistic collaboration in order to promote equitable health, rather than the implementation of short-term, disease-specific programs and policies that lead to unintended consequences. When striving to improve health for all, all participants in the health systems must be included and invested in the effort.
While this paradigm of the household production of health that Henry Moseley has described can be incredibly beneficial to our health systems, there may be other paradigms that emerge when a systems thinking lens is applied. We may not know right now what they are, but a systems thinking lens applied to health allows for adaptation and emergence around effective practices in health. As we seek to improve the health systems of the world, applying a systems lens that incorporates a holistic perspective of the problems we face will help us address the complex problems of the world and create equitable health systems.
(1) Aron, David. “Moving Telemedicine from “Research Research ” to “Just the Way Just the Way We Do Business”.” Research Development: Improving Veterans’ Lives. Veteran Health Administration. Cleveland, Ohio. 17 May 2011. Address.