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Beyond Methodolgoical Technique Systems Science in Service of Social Change

Beyond Methodolgoical Technique Systems Science in Service of Social Change. Bobby Milstein Institute on Systems Science and Health Ann Arbor, MI May 3-8, 2009. Troubling Extremes. Over-reliance on Models. Under-reliance on Models. Imperatives for Protecting Health.

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Beyond Methodolgoical Technique Systems Science in Service of Social Change

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  1. Beyond Methodolgoical TechniqueSystems Science in Service of Social Change Bobby Milstein Institute on Systems Science and Health Ann Arbor, MI May 3-8, 2009

  2. Troubling Extremes Over-reliance on Models Under-reliance on Models

  3. Imperatives for Protecting Health Typical Current State“Static view of problems that are studied in isolation” Proposed Future State“Dynamic systems and syndemic approaches” “Currently, application of complex systems theories or syndemic science to health protection challenges is in its infancy.” -- Julie Gerberding Gerberding JL. Protecting health: the new research imperative. Journal of the American Medical Association 2005;294(11):1403-1406.

  4. A Growing Portfolio of CDC Efforts areIncorporating System Sciences (e.g., SNA, SD, ABM) • Infection dynamicsSmallpox, anthrax, HIV, STD, TB, polio, SARS, influenza, etc. • Chronic diseases and risksDiabetes, obesity, hypertension, cardiovascular disease, oral health, tobacco, diet, physical activity, stress, alcohol, sleep, etc. • Environmental healthAir, water, soil, heat, climate change, etc. • PreparednessBiological, radiological, chemical, environmental, etc. • Violence and InjuryChild maltreatment, sexual assault, etc. • Grantmaking ScenariosTiming and sequence of outside assistance • Upstream-Downstream EffortBalancing disease treatment with prevention/protection • Health System PerformanceRelationships among cost, quality, equity, and health status

  5. Changing (and Accumulating) Views of Population HealthWhat Accounts for Poor Population Health? 1840 1880 1950 1960 1980 2000 • God’s will • Humors, miasma, ether • Poor living conditions, immorality (e.g., sanitation) • Single disease, single cause (e.g., germ theory) • Single disease, multiple causes (e.g., heart disease) • Single cause, multiple diseases (e.g., tobacco) • Multiple causes, multiple diseases (but no feedback dynamics) (e.g., multi-causality) • Dynamic feedback among afflictions, living conditions, and public strength (e.g., syndemic orientation) Milstein B. Hygeia's constellation: navigating health futures in a dynamic and democratic world [Doctoral Dissertation]. Cincinnati, OH: Union Institute & University; 2006. Richardson GP. Feedback thought in social science and systems theory. Philadelphia, PA: University of Pennsylvania Press, 1991.

  6. Incorporating a Systems Orientation Into Public Health Work UNDERSTANDING CHANGESystems Science GOVERNING MOVEMENT Social Navigation • What causes population health problems? • How are efforts to protect the public’s health organized? • How and when do health systems change (or resist change)? Directing Change • Who does the work? • By what means? • According to whose values? Charting Progress • How are conditions changing? • In which directions? SETTING DIRECTIONPublic Health What are health leaderstrying to accomplish? PUBLIC HEALTH WORK InnovativeHealth Ventures

  7. Expanding Public Health Science Syndemic Orientation Governing Dynamics CausalMapping Dynamic Modeling Problems/OpportunitiesAmong People inPlaces Over Time Plausible Futures Boundary Critique DemocraticPublic Work Navigational Freedoms “Public health imagination involves using science to expand the boundaries of what is possible.” -- Michael Resnick EpidemicOrientation

  8. Aligning Concepts and Methods Syndemic Orientation Where are we going? What links to what? What influences what? Public Work, Civic Agency Connections Leverage Navigational View Network View Dynamic View Directional Data Proximity Data Causal Data

  9. A Model Is… They help us understand, explain, anticipate, and make decisions An inexact representation of the real thing “All models are wrong, some are useful.” -- George Box Sterman JD. All models are wrong: reflections on becoming a systems scientist. System Dynamics Review 2002;18(4):501-531. Available at <http://web.mit.edu/jsterman/www/All_Models.html> Sterman J. A sketpic's guide to computer models. In: Barney GO, editor. Managing a Nation: the Microcomputer Software Catalog. Boulder, CO: Westview Press; 1991. p. 209-229. <http://web.mit.edu/jsterman/www/Skeptic%27s_Guide.html>

  10. Boundary Critique Creating a new theory is not like destroying an old barn and erecting a skyscraper in its place. It is rather like climbing a mountain, gaining new and wider views, discovering unexpected connections between our starting point and its rich environment. -- Albert Einstein Ulrich W. Boundary critique. In: Daellenbach HG, Flood RL, editors. The Informed Student Guide to Management Science. London: Thomson; 2002. p. 41-42. <http://www.geocities.com/csh_home/downloads/ulrich_2002a.pdf>. Ulrich W. Reflective practice in the civil society: the contribution of critically systemic thinking. Reflective Practice 2000;1(2):247-268. http://www.geocities.com/csh_home/downloads/ulrich_2000a.pdf Midgley G. The sacred and profane in critical systems thinking. Systems Practice 1992;5:5-16.

  11. Boundary CritiqueEqualizing Experts and Ordinary Citizens • “Professional expertise does not protect against the need for making boundary judgements…nor does it provide an objective basis for defining boundary judgements. It’s exactly the other way round: boundary judgements stand for the inevitable selectivity and thus partiality of our propositions. • It follows that experts cannot justify their boundary judgements (as against those of ordinary citizens) by referring to an advantage of theoretical knowledge and expertise. • When it comes to the problem of boundary judgements, experts have no natural advantage of competence over lay people.” -- Werner Ulrich Ulrich W. Reflective practice in the civil society: the contribution of critically systemic thinking. Reflective Practice 2000;1(2):247-268.

  12. Defining Keywords • PoliticalThe action of diverse people negotiating their differences for common governance, from the Greek, politikos, “of the citizen” • PartisanFervent, sometimes militant support for a party, cause, faction, person, or idea, from Middle French, part, “faction” Crick BR. In defense of politics. 4th ed Chicago, IL: University of Chicago Press, 1993. Boyte HC. Everyday politics: reconnecting citizens and public life. Philadelphia, PA: University of Pennsylvania Press, 2004.

  13. Boundary Critique Ulrich W. Reflective practice in the civil society: the contribution of critically systemic thinking. Reflective Practice 2000;1(2):247-268. http://www.geocities.com/csh_home/downloads/ulrich_2000a.pdf

  14. Conversations Around the Model are Critical STRATEGIC DIALOGUE Local implementation opportunities Local implementation strengths and success Downstream interventions and costs SYSTEM DYNAMICS MODEL Other chronic disease endpoints Political will Health inequities Ability to engage all stakeholders Local leadership capacity Borderline conditions Implementation actions and costs • What measures of improvement ought to be included? • What else is missing? • Who else is missing? • What would be helpful to you?

  15. Navigating Change in Dynamic and Democratic Systems Dynamic Hypothesis (Causal Structure) Plausible Futures (Policy Experiments) Multi-stakeholder Interactions Morecroft JDW, Sterman J. Modeling for learning organizations. Portland, OR: Productivity Press, 2000. Sterman JD. Business dynamics: systems thinking and modeling for a complex world. Boston, MA: Irwin McGraw-Hill, 2000.

  16. Beware of Superficial Understanding “Academics and pundits love to throw around the term ‘social capital’ and debate its nuances, but most of them couldn’t organize a block party.” -- Ed Chambers Chambers ET, Cowan MA. Roots for radicals. New York: Continuum, 2003., p. 65.

  17. Power Has to be Organized Loose groupings of interested individuals don’t have a prayer of addressing major crises–housing, crime, schools, jobs, and others. Each crisis is, at bottom, a power crisis. The power of the mob, the power of drug lords, the power of corrupt borough machines, and the inertia of the police bureaucracy could only be challenged by another, deeper institutional power. -- Michael Gecan Gecan M. Going public. Boston: Beacon Press, 2002.

  18. Is Anyone Really an Outsider? Boyte HC. Doctoral education for the 21st century: reframing scholarship in mass communications. Civic Engagement News 2004;5.

  19. Innovation, Pragmatism, and the Promise of “What If…” Thinking Positivism • Begins with a theory about the world • Learning through observation and falsification • Asks, “Is this theory true?” Pragmatism • Begins with a response to a perplexity or injustice in the world • Learning through action and reflection (even simulated action can be illuminating) • Asks, “How does this work make a difference?” "Grant an idea or belief to be true…what concrete difference will its being true make in anyone's actual life? -- William James These are conceptual, methodological, and moral orientations, which shape how we think, how we act, how we learn, and what we value Shook J. The pragmatism cybrary. 2006. Available at <http://www.pragmatism.org/>. Addams J. Democracy and social ethics. Urbana, IL: University of Illinois Press, 2002. West C. The American evasion of philosophy: a genealogy of pragmatism. Madison, WI: University of Wisconsin Press, 1989.

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