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Report Applying System Thinking In Public Health
Applying Systems Thinking in Public health
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Author Note
Applying Systems Thinking in Public health
Executive Summary
The document aims to look into the increased rates of obesity all over the world and in the US and present the correlation of these increased rates to health and socioeconomic differences. It also presents the various other causes behind these increased rates. Additionally, the differences in the prevalence of obesity among different genders, age groups and communities have been discussed. The role of stakeholders and associated challenges have been debated towards the end. It is recommended to make efforts to reduce health and related inequalities, increase stakeholder's involvement, employ systems thinking strategies and model building plans to address the increased rates of obesity in the US.
Introduction
Obesity is a worldwide public health issue with all the countries facing the problem. According to recent figures, the number of obese people has increased from 857 million in 1980 to more than 2.1 billion in 2013 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PK6PHPcp","properties":{"formattedCitation":"(Wise, 2014)","plainCitation":"(Wise, 2014)","noteIndex":0},"citationItems":[{"id":117,"uris":["http://zotero.org/users/local/YjWHJPzk/items/IR98V48B"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/IR98V48B"],"itemData":{"id":117,"type":"article-journal","title":"Obesity rates rise substantially worldwide","container-title":"Bmj","page":"g3582","volume":"348","author":[{"family":"Wise","given":"Jacqui"}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Wise, 2014). The increase observed in children was around 1.5% higher compared to the rise witnessed among adults ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"e0n3lcCU","properties":{"formattedCitation":"(Wise, 2014)","plainCitation":"(Wise, 2014)","noteIndex":0},"citationItems":[{"id":117,"uris":["http://zotero.org/users/local/YjWHJPzk/items/IR98V48B"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/IR98V48B"],"itemData":{"id":117,"type":"article-journal","title":"Obesity rates rise substantially worldwide","container-title":"Bmj","page":"g3582","volume":"348","author":[{"family":"Wise","given":"Jacqui"}],"issued":{"date-parts":[["2014"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Wise, 2014). According to the Center for Disease Control and Prevention (CDC), from 2015 to 2016, about 39% of the adult population in the US suffered from obesity. It is interesting to note that the distribution patterns are different in different ethnic groups. Non-Hispanic black populations and Hispanics are most affected with a cumulative percentage of 97.8 whereas least affected are non-Hispanic Asians (CDC, 2018). Many different biological and socioeconomic causes of obesity have been suggested by researchers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"DlqKYOEJ","properties":{"formattedCitation":"(Haidar & Cosman, 2011)","plainCitation":"(Haidar & Cosman, 2011)","noteIndex":0},"citationItems":[{"id":118,"uris":["http://zotero.org/users/local/YjWHJPzk/items/D5G4CKEP"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/D5G4CKEP"],"itemData":{"id":118,"type":"article-journal","title":"Obesity epidemiology","container-title":"Clinics in colon and rectal surgery","page":"205–210","volume":"24","issue":"04","source":"Google Scholar","author":[{"family":"Haidar","given":"Yarah M."},{"family":"Cosman","given":"Bard C."}],"issued":{"date-parts":[["2011"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Haidar & Cosman, 2011). Biological causes include genetic abnormalities, metabolic disorders and digestive diseases. Socioeconomic factors include availability to healthy foods, lifestyle choices, income status, job type and exercise patterns ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"pAZXxboN","properties":{"formattedCitation":"(Haidar & Cosman, 2011)","plainCitation":"(Haidar & Cosman, 2011)","noteIndex":0},"citationItems":[{"id":118,"uris":["http://zotero.org/users/local/YjWHJPzk/items/D5G4CKEP"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/D5G4CKEP"],"itemData":{"id":118,"type":"article-journal","title":"Obesity epidemiology","container-title":"Clinics in colon and rectal surgery","page":"205–210","volume":"24","issue":"04","source":"Google Scholar","author":[{"family":"Haidar","given":"Yarah M."},{"family":"Cosman","given":"Bard C."}],"issued":{"date-parts":[["2011"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Haidar & Cosman, 2011).
The treatment of the disease lies almost entirely on prevention strategies. Prevention is surely better than the treatment especially to prevent childhood obesity ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PSGmj12S","properties":{"formattedCitation":"(Pandita et al., 2016)","plainCitation":"(Pandita et al., 2016)","noteIndex":0},"citationItems":[{"id":121,"uris":["http://zotero.org/users/local/YjWHJPzk/items/2I85YG83"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/2I85YG83"],"itemData":{"id":121,"type":"article-journal","title":"Childhood obesity: prevention is better than cure","container-title":"Diabetes, metabolic syndrome and obesity: targets and therapy","page":"83","volume":"9","author":[{"family":"Pandita","given":"Aakash"},{"family":"Sharma","given":"Deepak"},{"family":"Pandita","given":"Dharti"},{"family":"Pawar","given":"Smita"},{"family":"Tariq","given":"Mir"},{"family":"Kaul","given":"Avinash"}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Pandita et al., 2016). Awareness programs on the need and benefits of adopting healthy life choices and exercise are significantly helpful to reduce these ever-growing obesity rates ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"fL3S6dxs","properties":{"formattedCitation":"(Pandita et al., 2016)","plainCitation":"(Pandita et al., 2016)","noteIndex":0},"citationItems":[{"id":121,"uris":["http://zotero.org/users/local/YjWHJPzk/items/2I85YG83"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/2I85YG83"],"itemData":{"id":121,"type":"article-journal","title":"Childhood obesity: prevention is better than cure","container-title":"Diabetes, metabolic syndrome and obesity: targets and therapy","page":"83","volume":"9","author":[{"family":"Pandita","given":"Aakash"},{"family":"Sharma","given":"Deepak"},{"family":"Pandita","given":"Dharti"},{"family":"Pawar","given":"Smita"},{"family":"Tariq","given":"Mir"},{"family":"Kaul","given":"Avinash"}],"issued":{"date-parts":[["2016"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Pandita et al., 2016). To implement childhood obesity prevention strategies, it is important to keep the researchers and stakeholders engaged ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ek6keE3y","properties":{"formattedCitation":"(Williams & Fruhbeck, 2009)","plainCitation":"(Williams & Fruhbeck, 2009)","noteIndex":0},"citationItems":[{"id":122,"uris":["http://zotero.org/users/local/YjWHJPzk/items/HQFGZAX7"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/HQFGZAX7"],"itemData":{"id":122,"type":"book","title":"Obesity: Science to practice","publisher":"John Wiley & Sons","source":"Google Scholar","title-short":"Obesity","author":[{"family":"Williams","given":"Gareth"},{"family":"Fruhbeck","given":"Gema"}],"issued":{"date-parts":[["2009"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Williams & Fruhbeck, 2009).
Body
Obesity is a public health issue of concern in the US as it affects thousands of people on daily basis leading to several other including cardiovascular diseases, blood pressure, heart failure, anxiety and depression ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"PMCjh4s0","properties":{"formattedCitation":"(Hurt, Kulisek, Buchanan, & McClave, 2010)","plainCitation":"(Hurt, Kulisek, Buchanan, & McClave, 2010)","noteIndex":0},"citationItems":[{"id":125,"uris":["http://zotero.org/users/local/YjWHJPzk/items/T2QC5VQF"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/T2QC5VQF"],"itemData":{"id":125,"type":"article-journal","title":"The obesity epidemic: challenges, health initiatives, and implications for gastroenterologists","container-title":"Gastroenterology & hepatology","page":"780","volume":"6","issue":"12","author":[{"family":"Hurt","given":"Ryan T."},{"family":"Kulisek","given":"Christopher"},{"family":"Buchanan","given":"Laura A."},{"family":"McClave","given":"Stephen A."}],"issued":{"date-parts":[["2010"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hurt, Kulisek, Buchanan, & McClave, 2010). The amount of money spent on obesity and associated mortalities in the US crosses $150 billion. The number of obese including adults and children have been increasing and have reached to a total number of affected adults to 60 percent making it the biggest challenge in healthcare systems ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"r3enUg8W","properties":{"formattedCitation":"(Hurt et al., 2010)","plainCitation":"(Hurt et al., 2010)","noteIndex":0},"citationItems":[{"id":125,"uris":["http://zotero.org/users/local/YjWHJPzk/items/T2QC5VQF"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/T2QC5VQF"],"itemData":{"id":125,"type":"article-journal","title":"The obesity epidemic: challenges, health initiatives, and implications for gastroenterologists","container-title":"Gastroenterology & hepatology","page":"780","volume":"6","issue":"12","author":[{"family":"Hurt","given":"Ryan T."},{"family":"Kulisek","given":"Christopher"},{"family":"Buchanan","given":"Laura A."},{"family":"McClave","given":"Stephen A."}],"issued":{"date-parts":[["2010"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Hurt et al., 2010).
Role of stakeholders
The role of stakeholders is critical in obesity control programs. Many stakeholders have an interest in diet-related interventions in the workplace ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"qdGV0fMG","properties":{"formattedCitation":"(Griffiths, Maggs, & George, 2008)","plainCitation":"(Griffiths, Maggs, & George, 2008)","noteIndex":0},"citationItems":[{"id":126,"uris":["http://zotero.org/users/local/YjWHJPzk/items/GH4UNK5E"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/GH4UNK5E"],"itemData":{"id":126,"type":"article-journal","title":"Stakeholder Involvement’: Background paper prepared for the WHO/WEF joint event on Preventing Noncommunicable Diseases in the Workplace (Dalian/China, September 2007)","container-title":"World Health Organization","author":[{"family":"Griffiths","given":"John"},{"family":"Maggs","given":"Hayley"},{"family":"George","given":"Emma"}],"issued":{"date-parts":[["2008"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Griffiths, Maggs, & George, 2008). Some people and organizations like owners, workers, trades unions and ministries of health and labour are naturally taken as a stakeholder. Other than these, some other stakeholder groups should also be involved. These groups include private sector food producers, organisations in the agricultural industry, and food retailers ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"xPvsKSeD","properties":{"formattedCitation":"(Griffiths et al., 2008)","plainCitation":"(Griffiths et al., 2008)","noteIndex":0},"citationItems":[{"id":126,"uris":["http://zotero.org/users/local/YjWHJPzk/items/GH4UNK5E"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/GH4UNK5E"],"itemData":{"id":126,"type":"article-journal","title":"Stakeholder Involvement’: Background paper prepared for the WHO/WEF joint event on Preventing Noncommunicable Diseases in the Workplace (Dalian/China, September 2007)","container-title":"World Health Organization","author":[{"family":"Griffiths","given":"John"},{"family":"Maggs","given":"Hayley"},{"family":"George","given":"Emma"}],"issued":{"date-parts":[["2008"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Griffiths et al., 2008). The rationale provided for the involvement of stakeholders include personal choice; they do it because they think it is the right thing to do, investment; it a source of valuable interest. Additionally, the other two factors are compulsion and lost the opportunity. Compulsion means they are expected to do it with no choice and lost opportunity refers to getting involved because of competitors. Compulsion generates the lowest quality or minimal output as the organisation or the person is doing it forcefully without personal interest ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"mYXVNkhy","properties":{"formattedCitation":"(Griffiths et al., 2008)","plainCitation":"(Griffiths et al., 2008)","noteIndex":0},"citationItems":[{"id":126,"uris":["http://zotero.org/users/local/YjWHJPzk/items/GH4UNK5E"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/GH4UNK5E"],"itemData":{"id":126,"type":"article-journal","title":"Stakeholder Involvement’: Background paper prepared for the WHO/WEF joint event on Preventing Noncommunicable Diseases in the Workplace (Dalian/China, September 2007)","container-title":"World Health Organization","author":[{"family":"Griffiths","given":"John"},{"family":"Maggs","given":"Hayley"},{"family":"George","given":"Emma"}],"issued":{"date-parts":[["2008"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Griffiths et al., 2008).
Systems thinking approach and challenges
Systems thinking approach is a philosophy and can differ in meaning in different perspectives. It is opposite to traditional analysis approaches which analyse the systems by dividing into separate components ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"JFDyTYst","properties":{"formattedCitation":"(De Savigny & Adam, 2009)","plainCitation":"(De Savigny & Adam, 2009)","noteIndex":0},"citationItems":[{"id":127,"uris":["http://zotero.org/users/local/YjWHJPzk/items/DFJC878E"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/DFJC878E"],"itemData":{"id":127,"type":"book","title":"Systems thinking for health systems strengthening","publisher":"World Health Organization","ISBN":"92-4-156389-3","author":[{"family":"De Savigny","given":"Don"},{"family":"Adam","given":"Taghreed"}],"issued":{"date-parts":[["2009"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (De Savigny & Adam, 2009). The systems thinking approach, in contrast, suggests analysing the connections between different systems and how they interrelate to each other ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"QesoXiV6","properties":{"formattedCitation":"(De Savigny & Adam, 2009)","plainCitation":"(De Savigny & Adam, 2009)","noteIndex":0},"citationItems":[{"id":127,"uris":["http://zotero.org/users/local/YjWHJPzk/items/DFJC878E"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/DFJC878E"],"itemData":{"id":127,"type":"book","title":"Systems thinking for health systems strengthening","publisher":"World Health Organization","ISBN":"92-4-156389-3","author":[{"family":"De Savigny","given":"Don"},{"family":"Adam","given":"Taghreed"}],"issued":{"date-parts":[["2009"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (De Savigny & Adam, 2009). To address the issue of obesity, the systems-thinking approach provides new ways to mutually address this complicated societal issue ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"XOnsligY","properties":{"formattedCitation":"(Finegood, 2012)","plainCitation":"(Finegood, 2012)","noteIndex":0},"citationItems":[{"id":128,"uris":["http://zotero.org/users/local/YjWHJPzk/items/3LPVXWRQ"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/3LPVXWRQ"],"itemData":{"id":128,"type":"chapter","title":"The importance of systems thinking to address obesity","container-title":"Obesity Treatment and Prevention: New Directions","publisher":"Karger Publishers","page":"123-137","volume":"73","author":[{"family":"Finegood","given":"Diane T."}],"issued":{"date-parts":[["2012"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Finegood, 2012).
The systems thinking approach at multiple levels is helpful to analyse and control obesity. Studying the correlations between different systems working on obesity control brings out several challenges and obstacles. For example, smaller obesity control programs working at a school or organisation level are not connected to national programs working for the same cause. Combining this approach with group model-building strategies will aid the characterization of complex systems ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"nNM9qfiq","properties":{"formattedCitation":"(Brennan, Sabounchi, Kemner, & Hovmand, 2015)","plainCitation":"(Brennan, Sabounchi, Kemner, & Hovmand, 2015)","noteIndex":0},"citationItems":[{"id":129,"uris":["http://zotero.org/users/local/YjWHJPzk/items/ZU3PN6TA"],"uri":["http://zotero.org/users/local/YjWHJPzk/items/ZU3PN6TA"],"itemData":{"id":129,"type":"article-journal","title":"Systems thinking in 49 communities related to healthy eating, active living, and childhood obesity","container-title":"Journal of Public Health Management and Practice","page":"S55-S69","volume":"21","author":[{"family":"Brennan","given":"Laura K."},{"family":"Sabounchi","given":"Nasim S."},{"family":"Kemner","given":"Allison L."},{"family":"Hovmand","given":"Peter"}],"issued":{"date-parts":[["2015"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Brennan, Sabounchi, Kemner, & Hovmand, 2015).
Conclusion
To conclude, it can be said that obesity is one of the biggest challenges in America and other nations. Several factors increase its number and prevalence in different age and ethnic groups. Voluntary and non-voluntary stakeholders play a crucial role in prevention programs. It is the responsibility of policymakers and government organisations working in healthcare to ensure unbiased health facilities to all groups and in all areas. This will help to reduce these higher rates and related mortalities. Additionally, incorporating systems thinking approach with the model-building models will surely accelerate the process of obesity control.
Recommendation
To increase the efforts to minimise health-related and socioeconomic disparities.
To increase the number of stakeholders for obesity control programs.
To increase the engagement among stakeholders incorporating systems thinking approaches.
To employ model building plans with the systems thinking strategies.
References
ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Brennan, L. K., Sabounchi, N. S., Kemner, A. L., & Hovmand, P. (2015). Systems thinking in 49 communities related to healthy eating, active living, and childhood obesity. Journal of Public Health Management and Practice, 21, S55–S69.
De Savigny, D., & Adam, T. (2009). Systems thinking for health systems strengthening. World Health Organization.
Finegood, D. T. (2012). The importance of systems thinking to address obesity. In Obesity Treatment and Prevention: New Directions (Vol. 73, pp. 123–137). Karger Publishers.
Griffiths, J., Maggs, H., & George, E. (2008). Stakeholder Involvement’: Background paper prepared for the WHO/WEF joint event on Preventing Noncommunicable Diseases in the Workplace (Dalian/China, September 2007). World Health Organization.
Haidar, Y. M., & Cosman, B. C. (2011). Obesity epidemiology. Clinics in Colon and Rectal Surgery, 24(04), 205–210.
Hurt, R. T., Kulisek, C., Buchanan, L. A., & McClave, S. A. (2010). The obesity epidemic: Challenges, health initiatives, and implications for gastroenterologists. Gastroenterology & Hepatology, 6(12), 780.
Pandita, A., Sharma, D., Pandita, D., Pawar, S., Tariq, M., & Kaul, A. (2016). Childhood obesity: Prevention is better than cure. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 9, 83.
Williams, G., & Fruhbeck, G. (2009). Obesity: Science to practice. John Wiley & Sons.
Wise, J. (2014). Obesity rates rise substantially worldwide. BMJ, 348, g3582.
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