Advertisement

Systems thinking and ethics in public health: a necessary and mutually beneficial partnership

  • Diego S. Silva
  • Maxwell J. Smith
  • Cameron D. Norman
Original Article

Abstract

Systems thinking has emerged as a means of conceptualizing and addressing complex public health problems, thereby challenging more commonplace understanding of problems and corresponding solutions as straightforward explanations of cause and effect. Systems thinking tries to address the complexity of problems through qualitative and quantitative modeling based on a variety of systems theories, each with their own assumptions and, more importantly, implicit and unexamined values. To date, however, there has been little engagement between systems scientists and those working in bioethics and public health ethics. The goal of this paper is to begin to consider what it might mean to combine systems thinking with public health ethics to solve public health challenges. We argue that there is a role for ethics in systems thinking in public health as a means of elucidating implicit assumptions and facilitating ethics debate and dialogue with key stakeholders.

Keywords

Public health ethics Social networks Systems dynamimcs Systems thinking 

Notes

Acknowledgements

We would like to thank James Wilson for his important and helpful comments on an earlier version of this manuscript. We would also like to thank the Fondation Brocher; Diego Silva and Maxwell Smith were fellows there when much of the conceptualization of this paper occurred.

References

  1. Battle-Fisher, M. 2015. Application of Systems Thinking to Health Policy and Public Health Ethics. New York: Springer.CrossRefGoogle Scholar
  2. Castillo-Chavez, C., and Z. Feng. 1997. To treat or not to treat: the case of tuberculosis. Journal of Mathematical Biology 35: 629–656.CrossRefGoogle Scholar
  3. Castillo-Chavez, C., and B. Song. 2004. Dynamical models of tuberculosis and their applications. Mathematical Biosciences and Engineering 1 (2): 361–404.CrossRefGoogle Scholar
  4. Forrester, J.W. 1969. Urban Dynamics. Cambridge: MIT Press.Google Scholar
  5. Goldberg, D.S. 2012. Social justice, health inequalities and methodological individualism in US health promotion. Public Health Ethics 5 (2): 104–115.CrossRefGoogle Scholar
  6. Hyder, A.A., A. Rattani, C. Krubiner, et al. 2014. Ethical review of health systems research in low- and middle-income countries: a conceptual exploration. American Journal of Bioethics 14 (2): 28–37.CrossRefGoogle Scholar
  7. Jackson, M.C. 2003. Systems Thinking: Creative Holism for Managers. West Sussex, UK: Wiley.Google Scholar
  8. Kaufman, L., and A. Karpati. 2007. Understanding the sociocultural roots of childhood obesity: Food practices among latino families of Bushwick, Brooklyn. Social Science and Medicine 64: 2177–2188.CrossRefGoogle Scholar
  9. Lange, C., I. Abubakar, J.W. Alffenaar, et al. 2014. Management of patients with multidrug-resistant/extensively drug-resistant tuberculosis in Europe: A TBNET consensus statement. European Respiratory Journal 44 (1): 23–63.CrossRefGoogle Scholar
  10. Leischow, S.J., and B. Milstein. 2006. Systems Thinking and Modeling for Public Health Practice. American Journal of Public Health 96 (3): 403–405.CrossRefGoogle Scholar
  11. Leischow, S.J., A. Best, W.M. Trochim, et al. 2008. Systems thinking to improve the public’s health. American Journal of Preventive Medicine 35 (2 SUPPL): 196–203.CrossRefGoogle Scholar
  12. Malik, A., C. Willis, S. Hamid, et al. 2014. Advancing the application of systems thinking in health: Advice seeking behavior among primary health care physicians in Pakistan. Health Research Policy and Systems.  https://doi.org/10.1186/1478-4505-12-43.Google Scholar
  13. Mabry, P.L., S.E. Marcus, P.I. Clark, et al. 2010. Systems science: A revolution in public health policy research. American Journal of Public Health 100 (7): 1161–1163.CrossRefGoogle Scholar
  14. McRae, S.K., E. Fox, and A. Slowther. 2008. Clinical ethics and systems thinking. In The Cambridge Textbook of Bioethics, ed. P.A. Singer and A.M. Viens, 313–321. Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
  15. Midgley, G. 2006. Systemic intervention for public health. American Journal of Public Health 96 (3): 466–472.CrossRefGoogle Scholar
  16. Mulvaney-Day, N., and C. Womack. 2009. Obesity, identity and community: Leveraging social networks for behavior change in public health. Public Health Ethics 2 (3): 250–260.CrossRefGoogle Scholar
  17. Plsek, P.E. (2003) Complexity and the Adoption of Innovation in Health Care. Washington, D.C.: The National Institute for Health Care Management Foundation and the National Committee for Quality Health Care. Retrieved November 6, 2017. http://www.nihcm.org/pdf/Plsek.pdf.
  18. Plsek, P.E., and T. Greenhalgh. 2001. The challenge of complexity in health care. BMJ 323: 625–628.CrossRefGoogle Scholar
  19. Powers, M., and R. Faden. 2006. Social Justice: The Moral Foundations of Public Health and Health Policy. Oxford, UK: Oxford University Press.Google Scholar
  20. Pruyt, E., and Kwakkel, J. (2007) Combining system dynamics and ethics: towards more science?” System Dynamics Society. Retrieved November 6, 2017. http://www.systemdynamics.org/conferences/2007/proceed/papers/PRUYT232.pdf.
  21. Rittel, H.W.J., and M.M. Webber. 1973. Dilemmas in a general theory of planning. Policy Sciences 4: 155–169.CrossRefGoogle Scholar
  22. Roberts, J.S., J. Maienschein, and M.D. Laubichler. 2006. Systems bioethics and stem cell biology. Journal of Bioethical Inquiry 3: 19.CrossRefGoogle Scholar
  23. Silva, D.S. 2011. Smoking bans and persons with schizophrenia: a straightforward use of the harm principle? Public Health Ethics 4(2): 143–148.CrossRefGoogle Scholar
  24. Silva, D.S., M.J. Smith, and R.E.G. Upshur. 2013. Disadvantaging the disadvantaged: when public health policies and practices negatively affect marginalized populations. Canadian Journal of Public Health 104(5): 410–412.CrossRefGoogle Scholar
  25. Silva, D.S., J.L. Gibson, A. Robertson, et al. 2012. Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public’s perspectives. BMC: Public Health 12: 241.Google Scholar
  26. Smith, M.J., and D.S. Silva. 2015. Ethics for pandemics beyond influenza: ebola, drug-resistant tuberculosis, and anticipating future ethical challenges in pandemic preparedness and response. Monash Bioethics Review 33(2–3): 130–147.CrossRefGoogle Scholar
  27. Smith, M.J., C. Bensimon, D. Perez, et al. 2012. Restrictive measures in an influenza pandemic: a qualitative study of public perspectives. Canadian Journal of Public Health 103(5): e348–e352.Google Scholar
  28. Snowden, D.J. 2005. Multi-ontology sense making: a new simplicity in decision making. Informatics in Primary Care 13: 45–53.Google Scholar
  29. Sterman, J.D. 2006. Learning from evidence in a complex world. American Journal of Public Health 96 (3): 505–514.CrossRefGoogle Scholar
  30. Trochim, W.M., D.A. Cabrera, and B. Milstein. 2006. Practical challenges of systems thinking and modeling in public health. American Journal of Public Health 96 (3): 538–546.CrossRefGoogle Scholar
  31. Ulrich, W., and M. Reynolds. 2010. Critical systems heuristics. In Systems Approaches to Managing Change: A Practical Guide, ed. M. Reynolds and S. Holwell, 243–292. London: Springer.CrossRefGoogle Scholar
  32. Upshur, R.E.G. 2002. Principles for the justification of public health intervention. Canadian Journal of Public Health 93 (2): 101–103.Google Scholar
  33. Williams, B., and S. Hof. 2016. Wicked Solutions: A Complex Approach to Complex Problems. North Carolina: Lulu.com.Google Scholar
  34. Wilson, J. 2009. Towards a normative framework for public health ethics and policy. Public Health Ethics 2 (2): 184–194.CrossRefGoogle Scholar
  35. Wilson, J. 2014. Embracing complexity: Theory, cases and the future of bioethics. Monash Bioethics Review 32: 3–21.CrossRefGoogle Scholar

Copyright information

© Monash University 2018

Authors and Affiliations

  • Diego S. Silva
    • 1
  • Maxwell J. Smith
    • 2
    • 3
  • Cameron D. Norman
    • 3
    • 4
  1. 1.Faculty of Health ScienceSimon Fraser UniversityBurnabyCanada
  2. 2.School of Health Studies, Faculty of Health Sciences, Western UniversityLondon, OntarioCanada
  3. 3.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  4. 4.CENSE Research + DesignTorontoCanada

Personalised recommendations