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Complexity and Dynamism from an Urban Health Perspective: a Rationale for a System Dynamics Approach

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Abstract

In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are relatively new approaches in public health, but ones that hold immense promise as methodologies to model and analyze the complexity underlying urban processes to effectively inform policy actions in dynamic environments. This conceptual essay reviews the utility of applying the concepts, principles, and methods of systems thinking to the study of complex urban health phenomena as a complementary approach to standard epidemiological methods using specific examples and provides recommendations on how to better incorporate systems thinking methods in urban health research and practice.

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References

  1. United Nations, Department of Economic and Social Affairs, Population Division. World urbanization prospects: the 2014 revision, Highlights 2014. ST/ESA/SER.A/352.New York: United Nations; 2014. http://esa.un.org/unpd/wup/Highlights/WUP2014-Highlights.pdf. Accessed 10 Jan 2015.

  2. McDonald RI, Douglas I, Revenga C, et al. Global urban growth and the geography of water availability, quality, and delivery. Ambio. 2011; 40(5): 437–446.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Cuthill M. Strengthening the ‘Social’ in sustainable development: developing a conceptual framework for social sustainability in a rapid urban growth region in Australia. Sustain Dev. 2010; 18(6): 362–373.

    Article  Google Scholar 

  4. Linard C, Gilbert M, Snow RW, Noor AM, Tatem AJ. Population distribution, settlement patterns and accessibility across Africa in 2010. Plos One. 2012;7(2):e31743.

  5. Vermeiren K, Van Rompaey A, Loopmans M, Serwajja E, Mukwaya P. Urban growth of Kampala, Uganda: pattern analysis and scenario development. Landsc Urban Plan. 2012; 106(2): 199–206.

    Article  Google Scholar 

  6. Galea S, Freudenberg N, Vlahov D. Cities and population health. Soc Sci Med. 2005; 60(5): 1017–1033.

    Article  PubMed  Google Scholar 

  7. Lawrence RJ. Urban health: an ecological perspective. Rev Environ Health. 1999; 14(1): 1–10.

    Article  CAS  PubMed  Google Scholar 

  8. Vlahov D, Agarwal SR, Buckley RM, et al. Roundtable on urban living environment research (RULER). J Urban Health. 2011; 88(5): 793–857.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Duhl LJ, Hancock T. Promoting health in the urban context. WHO Healthy Cities Papers, Copenhagen; 1988.

  10. Rydin Y, Bleahu A, Davies M, et al. Shaping cities for health: complexity and the planning of urban environments in the 21st century. Lancet. 2012; 379(9831): 2079–2108.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Bocquier P, Madise NJ, Zulu EM. Is there an urban advantage in child survival in Sub-Saharan Africa? evidence from 18 countries in the 1990s. Demography. 2011; 48(2): 531–558.

    Article  PubMed  Google Scholar 

  12. Matthews Z, Channon A, Neal S, Osrin D, Madise N, Stones W. Examining the “urban advantage” in maternal health care in developing countries. PLoS Med. 2010; 7(9): e1000327.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Goebel A, Dodson B, Hill T. Urban advantage or urban penalty? a case study of female-headed households in a south African city. Health Place. 2010; 16(3): 573–580.

    Article  PubMed  Google Scholar 

  14. Rice J, Rice JS. The concentration of disadvantage and the rise of an urban penalty: urban slum prevalence and the social production of health inequalities in the developing countries. Int J Health Serv. 2009; 39(4): 749–770.

    Article  PubMed  Google Scholar 

  15. Kearns G. The urban penalty and the decline in mortality in England and Wales, 1851–1900. Ann Demogr Hist (Paris). 1993;75–105.

  16. Wilson AG. Ecological and urban systems models: some explorations of similarities in the context of complexity theory. Environ Plan A. 2006; 38: 633–646.

    Article  Google Scholar 

  17. Batty M. The size, scale, and shape of cities. Science. 2008; 319(5864): 769–771.

    Article  CAS  PubMed  Google Scholar 

  18. Berry BJL. Cities as systems with systems of cities. Pap Reg Sci Assoc. 1964; 13: 147–163.

    Article  Google Scholar 

  19. Mandelbaum SJ. Thinking about cities as systems reflections on the history of an idea. J Urban Hist. 1985; 11(2): 139–150.

    Article  Google Scholar 

  20. Pareto V. Cours d’Economie politique. Geneva, Switzerland: Droz; 1896.

  21. Forrester JW. Urban dynamics. Cambridge, MA: MIT Press; 1969.

    Google Scholar 

  22. Hancock T, Duhl L. Healthy cities project: a guide to assessing healthy cities. Copenhagen, Denmark: FADL Publishers; 1998.

  23. Luke DA, Stamatakis KA. Systems science methods in public health: dynamics, networks, and agents. Annu Rev Public Health. 2012; 33: 357–376.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Chen C, Shao LG, Xu L, Shang JC. A case study predicting environmental impacts of urban transport planning in China. Environ Monit Assess. 2009; 157(1–4): 169–177.

    Article  CAS  PubMed  Google Scholar 

  25. Chen MC, Chang K. Reasoning the causality of city sprawl, traffic congestion, and green land disappearance in Taiwan using the CLD model. Int J Environ Res Public Health. 2014; 11(11): 11464–11480.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Macmillan A, Connor J, Witten K, Kearns R, Rees D, Woodward A. The societal costs and benefits of commuter bicycling: simulating the effects of specific policies using system dynamics modeling. Environ Health Perspect. 2014; 122(4): 335–344.

    PubMed Central  PubMed  Google Scholar 

  27. Wang S, Xu L, Yang F, Wang H. Assessment of water ecological carrying capacity under the two policies in Tieling City on the basis of the integrated system dynamics model. Sci Total Environ. 2014; 472: 1070–1081.

    Article  CAS  PubMed  Google Scholar 

  28. Rehan R, Knight MA, Unger AJ, Haas CT. Development of a system dynamics model for financially sustainable management of municipal watermain networks. Water Res. 2013; 47(20): 7184–7205.

    Article  CAS  PubMed  Google Scholar 

  29. Qi C, Chang NB. System dynamics modeling for municipal water demand estimation in an urban region under uncertain economic impacts. J Environ Manag. 2011; 92(6): 1628–1641.

    Article  Google Scholar 

  30. Stave KA. A system dynamics model to facilitate public understanding of water management options in Las Vegas, Nevada. J Environ Manag. 2003; 67(4): 303–313.

    Article  Google Scholar 

  31. Chaerul M, Tanaka M, Shekdar AV. A system dynamics approach for hospital waste management. Waste Manag. 2008; 28(2): 442–449.

    Article  PubMed  Google Scholar 

  32. Ciplak N, Barton JR. A system dynamics approach for healthcare waste management: a case study in Istanbul Metropolitan City, Turkey. Waste Manag Res. 2012; 30(6): 576–586.

    Article  PubMed  Google Scholar 

  33. Kollikkathara N, Feng H, Yu D. A system dynamic modeling approach for evaluating municipal solid waste generation, landfill capacity and related cost management issues. Waste Manag. 2010; 30(11): 2194–2203.

    Article  CAS  PubMed  Google Scholar 

  34. Sufian MA, Bala BK. Modeling of urban solid waste management system: the case of Dhaka city. Waste Manag. 2007; 27(7): 858–868.

    Article  CAS  PubMed  Google Scholar 

  35. Dyson B, Chang NB. Forecasting municipal solid waste generation in a fast-growing urban region with system dynamics modeling. Waste Manag. 2005; 25(7): 669–679.

    Article  PubMed  Google Scholar 

  36. Metcalf SS, Northridge ME, Widener MJ, Chakraborty B, Marshall SE, Lamster IB. Modeling social dimensions of oral health among older adults in urban environments. Health Educ Behav. 2013; 40(1 Suppl): 63S–73S.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Weeks MR, Li J, Liao S, et al. Multilevel dynamic systems affecting introduction of HIV/STI prevention innovations among Chinese women in sex work establishments. Health Educ Behav. 2013; 40(1 Suppl): 111s–122s.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Mahamoud A, Roche B, Homer J. Modelling the social determinants of health and simulating short-term and long-term intervention impacts for the city of Toronto, Canada. Soc Sci Med. 2013; 93: 247–255.

    Article  PubMed  Google Scholar 

  39. Proust K, Newell B, Brown H, et al. Human health and climate change: leverage points for adaptation in urban environments. Int J Environ Res Public Health. 2012; 9(6): 2134–2158.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Bridgewater K, Peterson S, McDevitt J, et al. A community-based systems learning approach to understanding youth violence in Boston. Prog Community Health Partnersh. 2011; 5(1): 67–75.

    Article  PubMed  Google Scholar 

  41. Fisher M, Milos D, Baum F, Friel S. Social determinants in an Australian urban region: a ‘complexity’ lens. Health Promot Int. 2014. doi:10.1093/heapro/dau071

  42. Mabry PL, Olster DH, Morgan GD, Abrams DB. Interdisciplinarity and systems science to improve population health: a view from the NIH office of behavioral and social sciences research. Am J Prev Med. 2008; 35(2 Suppl): S211–S224.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Barlas Y. System dynamics: systemic feedback modeling for policy analysis in knowledge for sustainable development—an insight into the encyclopedia of life support systems. Oxford, United Kingdom: UNESCO Publishing-EOLSS Publishers; 2002.

  44. Bai XM, Nath I, Capon A, Hasan N, Jaron D. Health and wellbeing in the changing urban environment: complex challenges, scientific responses, and the way forward. Curr Opin Environ Sustain. 2012; 4(4): 465–472.

    Article  Google Scholar 

  45. Vlahov D, Robertson AM, Strathdee SA. Prevention of HIV infection among injection drug users in resource-limited settings. Clin Infect Dis. 2010; 50(Suppl 3): S114–S121.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Barlas Y, Ozevin MG. Analysis of stock management gaming experiments and alternative ordering formulations. Syst Res Behav Sci. 2004; 21(4): 439–470.

    Article  Google Scholar 

  47. Sterman JD. Learning in and about complex-systems. Syst Dyn Rev. 1994; 10(2–3): 291–330.

    Article  Google Scholar 

  48. Diehl E, Sterman JD. Effects of feedback complexity on dynamic decision-making. Organ Behav Hum Decis Process. 1995; 62(2): 198–215.

    Article  Google Scholar 

  49. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston, MA: Irwin/McGraw-Hill; 2000.

  50. Richardson GP. The feedback concept in American social science with implications for system dynamics. Plenary paper. Proceedings of the 1983 International System Dynamics Conference. Chestnut Hill, MA; 1983.

  51. Richardson GP. Reflections on the foundations of system dynamics. Syst Dyn Rev. 2011; 27(3): 219–243.

    Article  Google Scholar 

  52. Vennix JAM. Group model-building: tackling messy problems. Syst Dyn Rev. 1999; 15(4): 379–401.

    Article  Google Scholar 

  53. Luna-Reyes LF, Andersen DL. Collecting and analyzing qualitative data for system dynamics: methods and models. Syst Dyn Rev. 2003; 19(4): 271–296.

    Article  Google Scholar 

  54. Cavana RY, Tobias M. Integrative system dynamics: analysis of policy options for tobacco control in New Zealand. Syst Res Behav Sci. 2008; 25(5): 675–694.

    Article  Google Scholar 

  55. National Science Foundation. NSF-08-508: human and social dynamics: competition for FY 2008 (HSD). http://www.nsf.gov/pubs/2008/nsf08508/nsf08508.pdf.2007. Accessed 30 July 2014.

  56. National Institutes of Health. PAR-08-224: using systems science methodologies to protect and improve population health (R21). https://grants.nih.gov/grants/guide/pa-files/PAR-08-224.html.2008. Accessed 30 July 2014.

  57. National Institutes of Health. RFA-RM-10-002: science of behavior change: finding mechanisms of change in the laboratory and the field (R01). https://grants.nih.gov/grants/guide/rfa-files/RFA-RM-10-002.html.2010. Accessed 30 July 2014.

  58. National Institutes of Health. PAR-11-315: systems science and health in the behavioral and social sciences (R21). https://grants.nih.gov/grants/guide/pa-files/PAR-11-315.html.2011. Accessed 30 July 2014.

  59. National Institutes of Health. PAR-11-314: systems science and health in the behavioral and social sciences (R01). https://grants.nih.gov/grants/guide/pa-files/PAR-11-314.html.2011. Accessed 30 July 2014.

  60. National Institutes of Health. RFA-GM-13-006: modeling social behavior (R01). http://grants.nih.gov/grants/guide/rfa-files/RFA-GM-13-006.html.2012. Accessed 30 July 2014.

  61. National Institutes of Health. PA-13-288: behavioral and social science research on understanding and reducing health disparities (R21). https://grants.nih.gov/grants/guide/pa-files/PA-13-288.html.2013. Accessed 30 July 2014.

  62. National Institutes of Health. PA-13-292: behavioral and social science research on understanding and reducing health disparities (R01). https://grants.nih.gov/grants/guide/pa-files/PA-13-292.html.2013. Accessed 30 July 2014.

  63. National Institutes of Health. PAR-13-374: modeling social behavior (R01). http://grants.nih.gov/grants/guide/pa-files/PAR-13-374.html.2013. Accessed 30 July 2014.

  64. National Institutes of Health, Centers for Disease Control and Prevention. RFA-TW-12-001: limited competition: planning grants for hubs of interdisciplinary research and training in global environmental and occupational health (GEOHealth) (P20). https://grants.nih.gov/grants/guide/rfa-files/RFA-TW-12-001.html.2011. Accessed 30 July 2014.

  65. Leischow SJ, Best A, Trochim WM, et al. Systems thinking to improve the public’s health. Am J Prev Med. 2008; 35(2 Suppl): S196–S203.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Harpham T. Urban health in developing countries: what do we know and where do we go? Health Place. 2009; 15(1): 107–116.

    Article  PubMed  Google Scholar 

  67. Frieden TR, Mostashari F, Kerker BD, Miller N, Hajat A, Frankel M. Adult tobacco use levels after intensive tobacco control measures: New York City, 2002–2003. Am J Public Health. 2005; 95(6): 1016–1023.

    Article  PubMed Central  PubMed  Google Scholar 

  68. Coady MH, Jasek J, Davis K, Kerker B, Kilgore EA, Perl SB. Changes in smoking prevalence and number of cigarettes smoked per day following the implementation of a comprehensive tobacco control plan in New York City. J Urban Health. 2012; 89(5): 802–808.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Coady MH, Chan CA, Sacks R, Mbamalu IG, Kansagra SM. The impact of cigarette excise tax increases on purchasing behaviors among New York City smokers. Am J Public Health. 2013; 103(6): e54–e60.

    Article  PubMed Central  PubMed  Google Scholar 

  70. Shelley D, Cantrell MJ, Moon-Howard J, Ramjohn DQ, VanDevanter N. The $5 man: the underground economic response to a large cigarette tax increase in New York City. Am J Public Health. 2007; 97(8): 1483–1488.

    Article  PubMed Central  PubMed  Google Scholar 

  71. Davis KC, Grimshaw V, Merriman D, et al. Cigarette trafficking in five northeastern US cities. Tob Control. 2014; 23(e1): e62–e68.

    Article  PubMed  Google Scholar 

  72. Farrelly MC, Nonnemaker JM, Watson KA. The consequences of high cigarette excise taxes for low-income smokers. PLoS One. 2012; 7(9), e43838.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  73. Forrester JW. Counterintuitive behavior of social systems. Technol Rev. 1971; 73(3): 52–68.

    Google Scholar 

  74. Gruebner O, Staffeld R, Khan MMH, Burkart K, Krämer A, Hostert P. Urban health in megacities: extending the framework for developing countries. IHDP Update. 2011; 1: 42–49.

    Google Scholar 

  75. World Health Organization Centre for Health Development. Our cities, our health, our future. Acting on social determinants for health equity in urban settings. Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings. Kobe, Japan; 2008.

  76. Mabry PL, Marcus SE, Clark PI, Leischow SJ, Mendez D. Systems science: a revolution in public health policy research. Am J Public Health. 2010; 100(7): 1161–1163.

    Article  PubMed Central  PubMed  Google Scholar 

  77. Livingood WC, Allegrante JP, Airhihenbuwa CO, et al. Applied social and behavioral science to address complex health problems. Am J Prev Med. 2011; 41(5): 525–531.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research has been supported by New York University Abu Dhabi’s Visiting Scholars Program. D.C.O. is funded in part by the Center for Drug Use and HIV Research (CDUHR - P30 DA011041).

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Correspondence to Danielle C. Ompad.

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Tozan, Y., Ompad, D.C. Complexity and Dynamism from an Urban Health Perspective: a Rationale for a System Dynamics Approach. J Urban Health 92, 490–501 (2015). https://doi.org/10.1007/s11524-015-9963-2

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