System Perspectives on Prevention

1. System Perspectives on Prevention Samantha Hobson Bushfire 2000 Lockhardt River Professor Andrew Wilson Menzies Centre for Health Policy School of Public Health

2. Outline • The Value of Prevention • System Perspectives

3. Components of projected $161 billion increase in total health system and aged care expenditure, Australia 2003 to 2033 10 prevention = small impact on health care costs Qld CHO Report 2010

4. Costs growing even where rates falling

5. Big Growth, Limited ability to prevent

6. Annual Growth of Health Expenditure and GDP, Constant Prices 2001-02 to 2010-11 Health > GDP AIHW Aust Health Expenditure 2010-11

7. Opportunities for Better Care without Higher Cost? ? Importance in cost containment

8. Systems Perspectives on Prevention

9. Systems Perspectives • What is a Prevention System? • Health Systems Perspective on Prevention • Systems Thinking about doing Prevention • Modeling • Action Systems

10. Prevention Systems (s)

13. Weaknesses Current Prevention ‘System’ • Reflects the broader health system • Fragmented • Loosely coordinated • Multiple and discontinuous funding sources • Largely communicable disease focussed • Largely health system focussed • Poor Continuity of Effort

14. Current Prevention ‘System’ Strengths • Committed Individuals • Existing infrastructure • Strong NGO sector • Flexibility thru necessity • History of Creativity

15. National Preventative Health Taskforce 2010 General Strategies • Shared responsibility – developing strategic partnerships • Act early and throughout life • Engage communities • Influence markets and develop connected and coherent policies • Reduce inequity through targeting disadvantage • Indigenous Australians – contribute to ‘Close the Gap’ • Refocus primary healthcare towards prevention

16. SUPPORTING INFRASTRUCTURE • Social marketing • Data, surveillance and monitoring • National research infrastructure • Workforce development • Future funding models for prevention National Preventative Health Taskforce 2010

17. Prevention System What else is needed? • New Capacities • New Partnerships • Different Ways of Thinking • New Knowledge • Dementia • Musculoskeletal Disease

18. Health Systems Perspective on Prevention

19. Health System and Prevention • What can the health system do to better prevent disease and promote health? • Questions of Effectiveness and Efficiency in Health System Prevention Action • Individual, Group, Community, Population focus • How much Health $$ should be spent on Prevention? • What does Health control and regulate?

20. Critical Components Impact Up Stream Scalability Sustainability Effectiveness Longer Term Short Term Downsteam

21. Systems Thinking and Prevention – Better Understanding Complex Systems

22. Huang TT et al, PrevChronic Dis 2009;6(3):A82.

23. Butland B et al. Foresight Tackling Obesities: Future Choices –Project report 2007.

24. Scenario Testing Interventions for Obesity • An individualistic, market-driven society that adopts a more long-term and sustainable view. • A society where social responsibilities are prioritised, and communities and Government implement plans to meet long-term challenges. • Asociety where communities take the lead and focus on tackling difficulties as they arise. • An individualistic, market-driven society that reacts to problems when and where they occur. Butland B et al. Foresight Tackling Obesities: Future Choices –Project Report 2007.

25. Butland B et al. Foresight Tackling Obesities: Future Choices –Project report 2007.

26. Butland B et al. Foresight Tackling Obesities: Future Choices –Project report 2007.

27. Systems Thinking about doing Prevention

28. Complex Systems and Wicked Problems • No easy fix, no one strategy. • Likely to be lots of “failures”, need to learn from failures as well successes. • Need systematic and systemic approaches. • Need persistence – how do we institutionalise ongoing action? • Need to assess and minimise the potential for harm along the way.

29. The Ways of a Systems Thinker • Sees the whole picture • Changes perspectives to see new leverage points in complex systems • Looks for interdependencies • Considers how mental models create our futures • Pays attention and gives voice to the long-term • “Goes wide” (uses peripheral vision) to see complex cause and effect relationships • Finds where unanticipated consequences emerge • Sees oneself as part of, not outside, the system Source: “Systems Thinking Playbook” by Linda Booth Sweeney and Dennis Meadows

30. What does this mean? • Understand the Problem and Context (Diagnostic) • Identify Intervention Points and Options • Identify Potential Impact • (Effectiveness, Risks, Equity, Benefit-Cost) • Identify Potential Achievability under Different Settings • (Political, Investment Level, Scaling, Dose) • Understand the Players and Interactions • Implement, Learn, Change • (understanding, action, outcomes)

31. Research Opportunities • The Value of Prevention • How do we value prevention rather then health care avoidance? • How do we communicate that value to the community and decision makers? • System Perspectives • How can we better implement what we know works in prevention? Learning from Doing. • Why doesn’t it work they way we think it should in real life?

32. Research Opportunities • The Prevention System • What are the elements of successful prevention system(s)? • What are the options for prevention – individual, community, population – programs, regulation, legislation? • Driving Change • How do we become more effective influencers? • Consumerism, choice and the prevention paradox?

33. Thank-you Questions Lena Nyadbi 2013 “Dayiwul Lirlmim” (Barramundi Scales). Musee du quai Branly, Paris.