Crielaard Loes, Nicolaou Mary, Brown Andrew D, Dijkstra S Coosje, Ter Ellen Fleur, Elsenburg Leonie K, Luna Pinzon Angie, Waterlander Wilma E, Stronks Karien
Amsterdam UMC, Department Public and Occupational Health, University of Amsterdam, Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands.
Faculty of Health, Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, Deakin University, 221 Burwood Highway Burwood VIC 3125, Geelong, VIC, Australia.
Int J Behav Nutr Phys Act. 2025 Jun 12;22(1):74. doi: 10.1186/s12966-025-01766-z.
Systems approaches are increasingly adopted in public health, commonly operationalised using system dynamics (SD). In public health, systems approaches have prioritised understanding the current system by describing the causes of a complex problem - e.g. obesity - as a system. It remains challenging to advance from understanding the current system producing undesired outcomes, towards responses to improve outcomes. Rather than creating models of the (entire) system, SD traditionally emphasises specific models to support policy development. While core concepts from SD have effectively been adopted in public health, there may be more to learn from SD when it comes to designing systems approaches that can fulfil the purpose of informing problem responses.
We reviewed seminal SD literature for clues on how to refine the focus of systems approaches, so that they lead to specific models supporting policy development. We conducted a narrative review, seeking a strategy that can be leveraged in systems approaches in public health. We concentrated on SD's problem framing strategy, leading to two insights.
Insight 1: Alongside the complex problem at stake (e.g. obesity), consider the intended result of the systems approach (coordination, learning, analysis or transformation). This helps recognise which system components are relevant to problem responses and make methodological decisions accordingly. Insight 2: If investigation of the current system reveals that only radical change can lead to improved outcomes, then proceed to envisioning how the system could be fundamentally transformed to support those desired outcomes. This next step helps to anticipate policy resistance, unintended consequences and counterintuitive behaviour by contemplating how the system would react due to proposed problem responses.
Applying a problem framing strategy, as is commonly done in SD, could make systems approaches in public health better positioned to inform problem responses. Problem framing stimulates the contribution of systems approaches to health policy, prioritising system components relevant to problem responses (Insight 1), which may not be part of the system (Insight 2).
系统方法在公共卫生领域的应用日益广泛，通常采用系统动力学（SD）来实施。在公共卫生中，系统方法优先通过将复杂问题（如肥胖症）的成因描述为一个系统来理解当前系统。从理解产生不良后果的当前系统转向采取改善后果的应对措施仍然具有挑战性。传统上，系统动力学并非创建（整个）系统的模型，而是强调使用特定模型来支持政策制定。虽然系统动力学的核心概念已在公共卫生领域得到有效应用，但在设计能够实现为问题应对提供信息这一目的的系统方法方面，可能还有更多可从系统动力学中学到的东西。
我们回顾了系统动力学的开创性文献，以寻找如何优化系统方法重点的线索，从而使其产生支持政策制定的特定模型。我们进行了一项叙述性综述，寻求一种可在公共卫生系统方法中利用的策略。我们专注于系统动力学的问题构建策略，得出了两点见解。
见解1：除了关注所涉及的复杂问题（如肥胖症）之外，还要考虑系统方法的预期结果（协调、学习、分析或变革）。这有助于识别哪些系统组件与问题应对相关，并据此做出方法学决策。见解2：如果对当前系统的调查表明只有根本性变革才能带来更好的结果，那么接着要设想如何对系统进行根本性变革以支持那些期望的结果。这下一步有助于通过思考系统对提议的问题应对措施会如何反应来预测政策阻力、意外后果和反直觉行为。
像系统动力学中通常所做的那样应用问题构建策略，可以使公共卫生领域的系统方法更有能力为问题应对提供信息。问题构建促进了系统方法对卫生政策的贡献，将与问题应对相关的系统组件（见解1）作为优先事项，而这些组件可能并非系统的一部分（见解2）。
