NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Institute of Developmental Sciences, University of Southampton, Southampton, UK.
Perspect Public Health. 2023 Nov;143(6):324-336. doi: 10.1177/17579139221106337. Epub 2022 Jul 7.
A whole systems approach to tackling obesity has been recommended by Public Health England for several years. This qualitative study aimed to investigate whether systems thinking is reflected in local authority plans and strategies to tackle obesity, using the leverage points for intervention in a complex system, as a framework.
We sought to identify obesity strategies/plans for Southampton and 19 other local authority comparators (based on children's services and Office for National Statistics data). A healthy weight strategy was available for 10 local authorities and a qualitative document analysis was undertaken. The policy actions proposed in the plans were coded against the leverage points for intervention in a complex system and themes were developed to characterise interventions in each category.
A majority of actions included in the plans were categorised as 'Numbers, Constants and Parameters' which reflect downstream measures. However, there were examples of actions that could act on higher leverage points. In addition, some local authority plans included interventions that could act on 10 of the 12 leverage points suggesting incorporation of systems thinking.
Some local authority plans to tackle obesity do reflect systems thinking when viewed through the lens of the leverage points for intervention in a complex system. Interventions at higher leverage points should be prioritised by public health decision-makers, especially in a climate of competing agendas and limited resources.
英国公共卫生署多年来一直建议采取整体系统方法来解决肥胖问题。本定性研究旨在使用复杂系统干预的杠杆点作为框架,调查地方当局解决肥胖问题的计划和策略中是否反映了系统思维。
我们试图确定南安普顿和其他 19 个地方当局比较者(基于儿童服务和国家统计局数据)的肥胖策略/计划。有 10 个地方当局提供了健康体重策略,并对其进行了定性文件分析。计划中提出的政策行动按照复杂系统干预的杠杆点进行编码,并针对每个类别中的干预措施开发了主题。
计划中包含的大多数行动都被归类为“数字、常量和参数”,反映了下游措施。然而,也有一些可以在更高的杠杆点上发挥作用的行动。此外,一些地方当局的计划包括可以针对 12 个杠杆点中的 10 个发挥作用的干预措施,这表明系统思维的融入。
从复杂系统干预的杠杆点的角度来看,一些地方当局解决肥胖问题的计划确实反映了系统思维。公共卫生决策者应优先考虑在更高杠杆点上的干预措施,特别是在竞争议程和资源有限的情况下。