Systems Thinking for Capacity in Health (ST4C Health) recently released a video in an attempt to start a revolution in global health. Dr. Chad Swanson narrates the video and begins with a personal story about his mission to Mozambique 12 years ago to understand “how people suffer and die on a personal level.” From his experiences on the trip, he concluded:
- Global health interventions need to take into account all the associated contextual factors and underlying causes in order to change health systems
- The current structure of global health approaches is inadequate and requires a systems thinking approach to make a real, lasting difference
On their website, ST4C Health defines systems thinking as “a novel, transformational way of thinking about and approaching health […] based on the idea that when all stakeholders and their interactions are considered as a whole, we can better understand health problems than we can when only viewing each part in isolation. Such an approach means that we must consider economic, political, and social factors – factors that might seem unrelated to health. Also, since health challenges are complex, and solutions differ depending on time and place, we cannot impose a top-down plan of action and expect predictable, positive results all the time.”
I don’t believe systems thinking is a novel idea. Rather, I believe this idea is generally understood and accepted in the global health field, however it’s definitely challenging to turn it into action. It’s much easier to focus solely on one disease or population at time. In fact, that’s how funding is distributed.
With limitations on time, human resources, finances and more, how can we stay focused on the big picture and supplement our current siloed efforts? What do you think it will take to make this revolution a reality?
IH CONNECT 
Thank you so much for your candid review of our new video. We appreciate the response and thoughtful comments.
In your review, you seem to make 2 claims or assumptions: that systems thinking is not novel, and that it is resource intensive. We address each below:
We describe systems thinking as novel because it has not been widely applied, and because some concepts and methods are unknown to most in health.
First, while some of the core ideas related to systems thinking are not new (such as a comprehensive or holistic approach to health; see here:
http://st4chealth.com/2009/07/15/gonzalez-would-no-doubt-be-thoroughly-dismayed/), its application in health has been very limited. Published reports and data strongly suggest that health curricula, funding mechanisms (as you mentioned), and the very way that we think are still deeply rooted in reductionism. As such, for most in health, the application of systems thinking is novel.
Second, some of the concepts and methods of systems thinking and complexity – such as emergence, self-organization, and dynamic modeling – are novel to most in health. Donors, politicians, practitioners, community leaders, and the general public could apply these concepts as a lens through which we can better understand the world, and apply the methods to better enable us to develop solutions to complex, dynamic problems such as universal health coverage and obesity.
We contend that systems thinking is neutral with respect to the amount of resources that it would require
Systems thinking provides the theory, language, concepts, and methods to approach complex social problems such as those faced in health. It is a lens through which we can view the world. As such, the specific interventions that are chosen are very context-dependent and neutral with respect to the resources that would be required.
Thanks again for engaging in this important conversation. We hope to clarify some of these points further in future videos.