Powell Kenneth E, Kibbe Debra L, Ferencik Rachel, Soderquist Chris, Phillips Mary Ann, Vall Emily Anne, Minyard Karen J
1 Public Health and Epidemiology Consultant, Atlanta, GA, USA.
2 Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA.
Public Health Rep. 2017 Nov/Dec;132(2_suppl):33S-38S. doi: 10.1177/0033354917723601.
In 2007, 31.7% of Georgia adolescents in grades 9-12 were overweight or obese. Understanding the impact of policies and interventions on obesity prevalence among young people can help determine statewide public health and policy strategies. This article describes a systems model, originally launched in 2008 and updated in 2014, that simulates the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034.
In 2008, using information from peer-reviewed reports and quantitative estimates by experts in childhood obesity, physical activity, nutrition, and health economics and policy, a group of legislators, legislative staff members, and experts trained in systems thinking and system dynamics modeling constructed a model simulating the impact of policy interventions on the prevalence of childhood obesity in Georgia through 2034. Use of the 2008 model contributed to passage of a bill requiring annual fitness testing of schoolchildren and stricter enforcement of physical education requirements. We updated the model in 2014.
With no policy change, the updated model projects that the prevalence of obesity among children and adolescents aged ≤18 in Georgia would hold at 18% from 2014 through 2034. Mandating daily school physical education (which would reduce prevalence to 12%) and integrating moderate to vigorous physical activity into elementary classrooms (which would reduce prevalence to 10%) would have the largest projected impact. Enacting all policies simultaneously would lower the prevalence of childhood obesity from 18% to 3%.
Systems thinking, especially with simulation models, facilitates understanding of complex health policy problems. Using a simulation model to educate legislators, educators, and health experts about the policies that have the greatest short- and long-term impact should encourage strategic investment in low-cost, high-return policies.
2007年，佐治亚州9至12年级的青少年中有31.7%超重或肥胖。了解政策和干预措施对年轻人肥胖率的影响有助于确定全州范围的公共卫生和政策策略。本文介绍了一个系统模型，该模型最初于2008年推出，并于2014年更新，它模拟了政策干预措施对佐治亚州儿童肥胖率直至2034年的影响。
2008年，一组立法者、立法工作人员以及接受过系统思维和系统动力学建模培训的专家，利用同行评审报告中的信息以及儿童肥胖、体育活动、营养、健康经济学和政策领域专家的定量估计，构建了一个模型，以模拟政策干预措施对佐治亚州儿童肥胖率直至2034年的影响。2008年模型的使用推动了一项法案的通过，该法案要求对学童进行年度体能测试，并更严格地执行体育教育要求。我们在2014年对该模型进行了更新。
在政策无变化的情况下，更新后的模型预测，从2014年到2034年，佐治亚州18岁及以下儿童和青少年的肥胖率将保持在18%。强制要求学校每日开设体育课（这将使肥胖率降至12%）以及将中等至剧烈强度的体育活动纳入小学课堂（这将使肥胖率降至10%）预计产生的影响最大。同时实施所有政策将使儿童肥胖率从18%降至3%。
系统思维，尤其是借助模拟模型，有助于理解复杂的卫生政策问题。利用模拟模型向立法者、教育工作者和卫生专家介绍具有最大短期和长期影响的政策，应能鼓励对低成本、高回报政策进行战略投资。
