Description
Chapter 14 discusses moving from solving single solutions to a more broad based systems thinking defined as One Health. Answer the following questions in regards to the One Health Initiative:
– Define and discuss what the one health initiative is? How can it impact human health?
– Discuss the 3 three components that make up the educational framework of one health (microbiological influences on health and disease; ecosystem health/physical environment; and human-animal interaction) and the role they play.
– How does the one health initiative improve global health and how can we get countries to partner in these efforts? Give an example of how the global community has partnered on a one health initiative (i.e. Paris Climate Accord Agreement)
– How does social work practice align with the One Health initiative?
Lastly, thinking about the overall course, what are your biggest takeaways about public health and social work practice? What was most helpful to learn about?
Unformatted Attachment Preview
Chapter 14
Systems Thinking:
From Single
Solutions to One
Health
Learning Objectives (1 of 2)
• Explain how systems thinking differs from
reductionist thinking
• Identify characteristics of a system
• Identify the steps in systems analysis using systems
diagrams
• Explain the meaning of interactions between factors
Learning Objectives (2 of 2)
• Explain the meaning of bottlenecks and leverage
points
• Identify and explain uses of systems thinking in
public health
• Discuss One Health as an example of systems
thinking
Vignette 1
• You are pregnant and have a 10-year history of
cigarette smoking. You are surprised that at your first
prenatal visit, there is a big sticker on your chart
saying “Smoker.” Everyone in the doctor’s office asks
you what they can do to help, and they quickly enroll
you in special services for smoking cessation for
which you were not eligible before you got pregnant.
When you ask why so much time, attention, and
money is now coming your way, they tell you
pregnancy is a leverage point for stopping smoking.
• You ask: What do they mean by “leverage point”?
Vignette 2
• A patient with active TB is reported by the local
hospital laboratory to the health department. The
health department quickly connects with the patient
to determine his close personal contacts. They also
ask him if they can test him for HIV. He turns out to
be HIV positive, and permission is then requested to
get in touch with his sexual contacts.
• You consider how you would describe the
relationship between TB and HIV, and wonder how
knowledge of this relationship can be used to reduce
the risks of both TB and HIV.
Vignette 3
• You hear that motor vehicle injuries, especially those
due to automobile collisions, have been dramatically
reduced in recent years.
• Was there a magic bullet that accomplished this, you
wonder, or was this reduction accomplished through
a more complicated process?
Vignette 4
• You love rare hamburgers. “Just wave them over the
flame,” you like to say. Recently, you have heard that
ground beef is a high-risk food—even a health
hazard.
• You ask: What does that mean and what is being
done about it?
Vignette 5
• You hear that a new RNA virus is rapidly spreading
and will likely soon reach the United States. Public
health officials are rapidly mobilizing efforts to
control the disease and respond to an outbreak but
see little chance of stopping the disease from
reaching the United States.
• Is this a common event, you wonder, or an
emergency?
Questions-to-Ask (1 of 4)
• What makes systems thinking different?
• What is a system?
• What are the initial steps in systems analysis?
• What additional steps are needed to complete a
system analysis?
• How can we use a systems analysis to better
understand a problem such as coronary artery
disease?
Questions-to-Ask (2 of 4)
• How can we use systems diagrams to display the
working of a system?
• How can we apply systems thinking to population
health issues?
• How can systems thinking help us incorporate
interactions between factors to better understand
the etiology of disease?
• How can systems thinking help take into account the
interactions between diseases?
Questions-to-Ask (3 of 4)
• How can systems thinking help identify bottlenecks
and leverage points that can be used to improve
population health?
• How can systems thinking help us develop strategies
for multiple simultaneous interventions?
• How can systems thinking help us look at processes
as a whole to plan short-term and long-term
intervention strategies?
Questions-to-Ask (4 of 4)
• What is meant by One Health?
• What is the One Health Initiative and the One Health
Educational Framework?
What Makes Systems Thinking Different?
• Traditional thinking in public health, like most sciencebased disciples, has used mostly reductionist thinking
– Looks at one factor or variable at a time
• Systems thinking looks at the impacts of multiple
factors and how they work together as parts of a
system
– Often utilizes data derived from reductionist thinking but
goes beyond to look at multiple factors that cause disease
and disease outcomes
What is a System?
• A system is an interacting group of items forming a
unified whole
– A system changes if you take away or add pieces
– Parts are connected to each other and work together, and the
arrangement is crucial
– Behavior of a system depends on its overall structure
• May be used to describe complex biological
relationships, organizations’ relationships or processes,
or the working of factors/influences that bring about
disease and the outcome of disease
What Are the Initial Steps in
Systems Analysis?
1. Identify the key influences or interventions on an
outcome such as disease of the outcome of disease
2. Indicate the relative strength of the impact of each
of the influences or interventions
3. Identify how these influences or interventions
interact
–
How they work together or interfere with each other
What Additional Steps Are Needed to
Complete A System Analysis?
4. Identify the dynamic changes that may occur in a
system by identifying the feedback loops that occur
in the system
5. Identify bottlenecks that limit the effectiveness of
the system
6. Identify leverage points that provide opportunities
to greatly improve outcomes
How Can We Use a Systems Analysis to
Better Understand a Problem Such as
Coronary Artery Disease?
• Table 14-1 illustrates how we can better understand
a health problem through utilizing the six steps of
systems analysis
Table 14.1: Steps and Their Meaning in
Systems Analysis (1 of 3)
• Identify influences
– Identify factors or determinants that are thought to affect
or influence the probability of occurrence or outcome of a
disease
• Estimate the relative strength of influences
– Estimate the relative risks of each of the influences, or at
least the relative strength, such as weak, moderate, or
strong
Table 14-1: Steps and Their Meaning in
Systems Analysis (2 of 3)
• Examine the interactions between factors
– How is the occurrence of disease or the outcome of
disease affected when two or more influences are
present? Do the impacts of the influences add together,
does one influence protect against another influence?
• Identify feedback loops
– Identify ways that an influence increases or decreases the
impact of other factor(s) over time.
Table 14-1: Steps and Their Meaning in
Systems Analysis (3 of 3)
• Identify bottlenecks
– Identify points in the system or constraints that need to be
addressed in order for the other factors or influences to
have their potential impacts
• Identify leverage points
– Identify points in the system that present opportunities for
interventions to have greater than otherwise expected
impacts
How Can We Use Systems Diagrams to
Display the Workings of a System? (1 of 3)
• The development of systems diagrams begins with
identifying the key factors that will be included in the
systems
• For each factor, we need to:
– Indicate the direction in which it operates (which way the
arrow points)
– Indicate whether the factor operates to reinforce or
increase another factor/outcome (+) or operates to
dampen or decrease another factor/outcome (-)
Figure 14.1: Positive and Negative
Impacts
How Can We Use Systems Diagrams to
Display the Workings of a System? (2 of 3)
• For each factor, we need to:
– Indicate the strength or magnitude of the impact with the
width of the arrow used
• The thicker the arrow, the greater the impact
Figure 14.2: Strength of Response
How Can We Use Systems Diagrams to
Display the Workings of a System? (3 of 3)
• There are different types of feedback loops
– Positive feedback loop: One factor reinforces another to
magnify its impact
• Product of the signs is positive
– Negative feedback loop: One factor reinforces another
factor, which dampens yet another factor
• Product of the signs is negative
Figure 14.3: Positive Feedback Loop
Figure 14.4: Negative Feedback Loop
Figure 14.5: Basic System Diagram
Figure 14.6: Additional Negative
Influences
Figure 14.7: Additional Positive
Influences
Figure 14.8: Systems Diagram
How Can We Apply Systems Thinking to
Population Health Issues?
• Systems thinking can help:
– Incorporate interactions between factors and between
diseases
– Identify bottlenecks and leverage points
– Develop ideas for multiple simultaneous interventions and
look at processes as a whole to plan short and long term
intervention strategies
How Can Systems Thinking Help Us
Incorporate Interactions Between Factors to
Understand the Etiology of Disease?
• Recognition of interactions that multiply or greatly
increase the risk of a certain disease have become an
important tool for:
– Setting priorities
– Developing approaches to risk reduction
• Example: Cigarette smoking, radon, and lung cancer
How Can Systems Thinking Help Take into
Account the Interactions Between Diseases?
• Syndemic is the occurrence together of two or more
diseases that interact to magnify the occurrence
and/or burden of disease
• Syndromes
– Some diseases predispose to other diseases
– Patterns of risk factors/symptoms that tend to occur
together
• Example: HIV
How Can Systems Thinking Help Identify
Bottlenecks and Leverage Points Used to
Improve Population Health?
• Bottleneck: A point at which events are slowed,
presenting obstacles to the success of an intervention
• Leverage point: A point in the system in which
successful interventions produce better than
expected outcomes
• Example: Motor vehicle injuries and the golden hour,
cigarette smoking and pregnant women
How Can Systems Thinking Help Us
Develop Strategies for Multiple
Simultaneous Interventions?
• Previously, interventions were studied and applied one
intervention at a time
– Little thought was given to how they interact or how they
could be used in combination to produce the best results
• Systems thinking creates a coordinated strategy of
utilizing primary, secondary, and tertiary interventions
– Highly successful population health strategy
How Can Systems Thinking Help Us Look at
Processes as a Whole to Plan Short Term and
Long Term Intervention Strategies?
• “Health in All Policies” approach
– Efforts to see the entire processes rather than pieces of
the pie have become key to planning interventions
• Example: Food safety and Hazard Analysis and
Critical Control Points (HACCP)
What is Meant by One Health?
• Human health is dependent on animal health and
the health of the ecosystem
• Connections among human, animal and ecosystem
health
Figure 14.9: The Relationships between
Human Health, Animal Health and
Ecoystem Health are Central to One Health
What is the One Health Initiative?
• Developed by the veterinary medicine community
• “The collaborative effort of multiple health science
professions, together with their related disciplines
and institutions – working locally, nationally, and
globally – to attain optimal health for people,
domestic animals, wildlife, plants, and our
environment.”
Source: One Health Initiative. About the one health initiative. http://www.onehealthinitiative.com/about.php. Accessed July 25, 2017.
Figure 14.10: The One Health Umbrella
Indicating the Need for Broad Collaboration
to Achieve the Goals of One Health
What is the One Health Educational
Framework?
• Developed by the One Health Interprofessional
Education Working Group
• Three components:
– Microbiological influences on health and disease
– Ecosystem health/physical environment
– Human–animal interaction
Top 10 Emerging RNA Viruses
• AIDS/HIV
• Chikungunya
• Dengue
• Ebola
• Hantavirus
• Influenza A
• Middle Eastern
Respiratory
Syndrome
• SARS
• West Nile Virus
• Zika
Ecosystem Factors with Major Impacts
on Human Health
• Global movement of populations
• Agriculture changes and changes in food distribution
• Ecological changes in land and resource use
• Climate change
Human Health Benefits of
Human–Animal Bond
• Reduced blood pressure
• Reduced cholesterol and triglycerides
• Reduced feelings of loneliness
• Increased opportunities for exercise, outdoor
activities, and socialization
Human Health Risks of
Human–Animal Bond
• Toxoplasmosis
• Cat-scratch disease
• Toxocariasis
• Monkeypox
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