scholarly journals Ripple Effects Mapping: Capturing the Wider Impacts of Systems Change Efforts in Public Health

2021 ◽  
Author(s):  
James Nobles ◽  
Jessica Wheeler ◽  
Kirsty Dunleavy-Harris ◽  
Richard Holmes ◽  
Alan Inman-Ward ◽  
...  
Keyword(s):  
Public Health ◽  
Systems Approach ◽  
Data Gathering ◽  
Systems Change ◽  
Unintended Consequences ◽  
Temporal Dimension ◽  
Ripple Effects ◽  
Systems Approaches ◽  
Adaptive Nature ◽  
Change Efforts

Abstract Background: Systems approaches are currently being advocated and implemented to address complex challenges in Public Health. These approaches work by bringing multi-sectoral stakeholders together to develop a collective understanding of the system, and then to identify places where they can leverage change across the system. Systems approaches are unpredictable, where cause-and-effect cannot always be disentangled, and unintended consequences – positive and negative – frequently arise. Evaluating such approaches is difficult and new methods are warranted. Methods: Ripple Effects Mapping (REM) is a qualitative method which can capture the wider impacts, and adaptive nature, of a systems approach. Using a case study example from the evaluation of a physical activity systems approach in Gloucestershire, we: a) introduce the adapted REM method; b) describe how REM was applied in the example; c) explain how REM outputs were analysed; d) provide examples of how REM outputs were used; and e) describe the strengths, limitations, and future uses of REM based on our reflections. Results: Ripple Effects Mapping is a participatory method that requires the active input of programme stakeholders in data gathering workshops. It produces visual outputs (i.e., maps) of the programmes activities and impacts, which are mapped along a timeline to understand the temporal dimension of systems change efforts. The REM outputs from our example were created over several iterations, with data collected every 3-4 months, to build a picture of activities and impacts that have continued or ceased. Workshops took place both in person and online. An inductive content analysis was undertaken to describe and quantify the patterns within the REM outputs. Detailed guidance related to the preparation, delivery, and analysis of REM are included in this paper. Conclusion: REM may help to advance our understanding and evaluation of complex systems approaches, especially within the field of Public Health. We therefore invite other researchers, practitioners and policymakers to use REM and to continuously evolve the method to enhance its application and practical utility.

Promoting the Integration of Policy, Systems, and Environmental Change Interventions Through a Web-Based Professional Development Program

2021 ◽  
pp. 237337992110492
Author(s):  
Laura Bohen ◽  
Stephanie Heim ◽  
Laura Perdue ◽  
Anne Dybsetter
Keyword(s):  
Public Health ◽  
Systems Approach ◽  
Development Program ◽  
University Of Minnesota ◽  
Web Based ◽  
Healthy Communities ◽  
Systems Approaches ◽  
Public Health Professionals ◽  
Policy Systems ◽  
The University

In 2017, the University of Minnesota Extension launched an online program called “Systems Approaches to Healthy Communities” that targets public health professionals and health promotion advocates to address how policy, systems, and environment interact with their work. This program was developed through evaluation of existing programs and content to expand reach for Minnesota Extension. Through five modules (Frameworks for Healthy Communities, Taking a Systems Approach, Engaging with Communities, Knowing Your Community, Putting It All Together), participants are informed on their role in public health efforts, barriers to lasting change in communities, and how to coordinate their work with local partners they might not have otherwise. Systems Approaches to Healthy Communities was developed following a number of pilots and revisions, which will benefit others looking to develop novel online programming or translate existing curricula to new modalities.

scholarly journals Urban governance and the systems approaches to health-environment co-benefits in cities

2015 ◽  
Vol 31 (suppl 1) ◽  
pp. 25-38 ◽  
Author(s):  
Jose A. Puppim de Oliveira ◽  
Christopher N. H. Doll ◽  
José Siri ◽  
Magali Dreyfus ◽  
Hooman Farzaneh ◽  
...  
Keyword(s):  
Public Health ◽  
Environmental Impacts ◽  
Urban Governance ◽  
Systems Approach ◽  
Positive Outcomes ◽  
Sustainable Cities ◽  
Urban Context ◽  
Systems Approaches ◽  
Global Environmental ◽  
Sectoral Linkages

Abstract The term “co-benefits” refers to positive outcomes accruing from a policy beyond the intended outcome, often or usually in other sectors. In the urban context, policies implemented in particular sectors (such as transport, energy or waste) often generate multiple co-benefits in other areas. Such benefits may be related to the reduction of local or global environmental impacts and also extend into the area of public health. A key to identifying and realising co-benefits is the adoption of systems approaches to understand inter-sectoral linkages and, in particular, the translation of this understanding to improved sector-specific and city governance. This paper reviews a range of policies which can yield health and climate co-benefits across different urban sectors and illustrates, through a series of cases, how taking a systems approach can lead to innovations in urban governance which aid the development of healthy and sustainable cities.

Cases of social innovations implemented in the public health sector

2020 ◽  
Vol 16 (9) ◽  
pp. 1600-1621
Author(s):  
E.V. Molchanova
Keyword(s):  
Public Health ◽  
Systems Approach ◽  
Health Sector ◽  
Demographic Challenges ◽  
Disability Adjusted Life ◽  
The Social ◽  
Social Innovations ◽  
Demographic Processes ◽  
Disease Study ◽  
Disability Adjusted Life Year

Subject. The article discusses medical and demographic processes in Russia and Finland. Objectives. I evaluate cases of social innovations implemented for the preservation and strengthening of public health in Finland under the auspices of The Global Burden of Disease Study. Methods. Methodologically, the study relies upon the ideology of the GDB Project, which rests on the DALY (the Disability Adjusted Life Year). Results. I analyzed the morbidity and mortality rates, DALY in Russia and Finland, determined what mainly triggers the risk (environmental, behavioral, metabolic) fueling some public health degradation. The article provides the insight into the efficiency of some social innovations implemented in Finland and suggests what should be done to outline medical and demographic programs in Russia. Conclusions and Relevance. The medical and demographic situation in Russia requires new tools to find innovative solutions for the social policy and, inter alia, the use of the GBD technique, which proved to be effective. Referring to evidence from Finland, demographic challenges in Russian can be handled through a systems approach, i.e. socio-economic actions, improvement of the healthcare and social security, wellness propaganda.

scholarly journals A Review of Reductionist versus Systems Perspectives towards ‘Doing the Right Strategies Right’ for Circular Economy Implementation

Systems ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 38
Author(s):  
Raquel Balanay ◽  
Anthony Halog
Keyword(s):  
Circular Economy ◽  
Systems Approach ◽  
Holistic Approach ◽  
Comprehensive Analysis ◽  
Unintended Consequences ◽  
Review Reports ◽  
The Right ◽  
Business As Usual ◽  
Analytical Frameworks ◽  
Reductionist Approach

This systematic review examines the importance of a systems/holistic approach in analyzing and addressing the footprints/impacts of business-as-usual activities regarding the development of a circular economy (CE). Recent works on why current CE approaches have to be examined in terms of reductionist vs. systems perspectives are reviewed to tackle questions pertaining to the right or the wrong way of CE implementation. ‘Doing the right thing right’ is essential for sustainability—the ultimate goal of a CE, which must be viewed as a system to begin with. The limited reductionist approach overlooks and thus cannot prognosticate on the formidable unintended consequences that emerge from ‘doing the right things wrong’, consequences that become too costly to undo. The systems approach, being holistic, is complicated and difficult to pursue but open to exciting opportunities to integrate innovations in CE analysis and implementation. Complexity is an inherent downside of the systems approach. However, both approaches are complementary, as reductionist models can be combined to create a system of comprehensive analysis to correct the approach towards implementation of current CE initiatives. This review reports that advancements in systems analytical frameworks and tools are highly important for creating general guidelines on CE analysis and implementation.

scholarly journals Public health measures to reduce the risk of SARS-CoV-2 transmission in Canada during the early days of the COVID-19 pandemic: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046177
Author(s):  
Julie Polisena ◽  
Maria Ospina ◽  
Omolara Sanni ◽  
Brittany Matenchuk ◽  
Rachel Livergant ◽  
...  
Keyword(s):  
Public Health ◽  
Scoping Review ◽  
Health Agency ◽  
Unintended Consequences ◽  
Pandemic Preparedness ◽  
School Closures ◽  
Mass Gatherings ◽  
And Migration ◽  
Priority Populations ◽  
New Evidence

ObjectiveThe main objectives of this study were to synthesise and compare pandemic preparedness strategies issued by the federal and provincial/territorial (P/T) governments in Canada and to assess whether COVID-19 public health (PH) measures were tailored towards priority populations, as defined by relevant social determinants of health.MethodsThis scoping review searched federal and P/T websites on daily COVID-19 pandemic preparedness strategies between 30 January and 30 April 2020. The PROGRESS-Plus equity-lens framework was used to define priority populations. All definitions, policies and guidelines of PH strategies implemented by the federal and P/T governments to reduce risk of SARS-CoV-2 transmission were included. PH measures were classified using a modified Public Health Agency of Canada Framework for Canadian Pandemic Influenza Preparedness.ResultsA total of 722 COVID-19 PH measures were issued during the study period. Of these, home quarantine (voluntary) (n=13.0%; 94/722) and retail/commerce restrictions (10.9%; n=79/722) were the most common measures introduced. Many of the PH orders, including physical distancing, cancellation of mass gatherings, school closures or retail/commerce restrictions began to be introduced after 11 March 2020. Lifting of some of the PH orders in phases to reopen the economy began in April 2020 (6.5%; n=47/722). The majority (68%, n=491/722) of COVID-19 PH announcements were deemed mandatory, while 32% (n=231/722) were recommendations. Several PH measures (28.0%, n=202/722) targeted a variety of groups at risk of socially produced health inequalities, such as age, religion, occupation and migration status.ConclusionsMost PH measures centred on limiting contact between people who were not from the same household. PH measures were evolutionary in nature, reflecting new evidence that emerged throughout the pandemic. Although ~30% of all implemented COVID-19 PH measures were tailored towards priority groups, there were still unintended consequences on these populations.

Balancing benefits and potential risks of vaccination: the precautionary principle and the law of unintended consequences

2021 ◽  
pp. bmjebm-2021-111773
Author(s):  
David Robert Grimes
Keyword(s):  
Public Health ◽  
Precautionary Principle ◽  
Unintended Consequences ◽  
Vaccine Hesitancy ◽  
Public Health Issue ◽  
Public Confidence ◽  
The Precautionary Principle ◽  
Life Saving ◽  
Potential Risks ◽  
Risk And Benefit

Vaccination is a life-saving endeavour, yet risk and uncertainty are unavoidable in science and medicine. Vaccination remains contentious in the public mind, and vaccine hesitancy is a serious public health issue. This has recently been reignited in the discussion over potential side effects of COVID-19 vaccines, and the decision by several countries to suspend measures such as the AstraZeneca vaccine. In these instances, the precautionary principle has often been invoked as a rationale, yet such heuristics do not adequately weigh potential harms against real benefits. How we analyse, communicate and react to potential harms is absolutely paramount to ensure the best decisions and outcomes for societal health, and maintaining public confidence. While balancing benefits and risks is an essential undertaking, it cannot be achieved without due consideration of several other pertinent factors, especially in the context of vaccination, where misguided or exaggerated fears have in the past imperilled public health. While well meaning, over reactions to potential hazards of vaccination and other health interventions can have unintended consequences, and cause lingering damage to public trust. In this analysis, we explore the challenges of assessing risk and benefit, and the limitations of the precautionary principle in these endeavours. When risk is unclear, cautious vigilance might be a more pragmatic and useful policy than reactionary suspensions.

The Grammar of Leprosy: Temporal Politics and the Impossible Subject

2021 ◽  
Vol 8 (3) ◽  
pp. 1-26
Author(s):  
Laura A. Meek
Keyword(s):  
Public Health ◽  
Public Health Problem ◽  
Unintended Consequences ◽  
World Health ◽  
Test Results ◽  
Temporal Framing ◽  
The Past ◽  
Research Article ◽  
The World ◽  
Potential Problems

This research article critically interrogates the implications and unintended consequences of the World Health Organization’s purported elimination of leprosy as a public health problem. I explore how leprosy has been portrayed (for nearly a century) as something from the past, recalcitrantly lingering on into the present, but surely about to be gone—a temporal framing I call the ‘grammar of leprosy’. I recount the experiences of Daniel, my interlocutor in Tanzania, whose existence became a problem for his doctors. This problem they ultimately resolved by fabricating negative test results in order to record what they already knew: leprosy had been eliminated. I also analyse how researchers working for Novartis (the supplier of leprosy’s cure) continue to push for an always imminent ‘elimination’, while field researchers repeatedly caution about the potential problems of this approach. Finally, I reveal how the grammar of leprosy operates through a complex set of temporal politics, pulling into its orbit and being enabled by multiple interwoven temporalities. I conclude that—due to this grammar, the impossible subjects it produces, and the temporal politics through which it operates—leprosy elimination campaigns may have dire consequences for the lives of people with leprosy today, impeding rather than enabling treatment.

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