This weekend my wife and I had the pleasure to host one of my best friends in the world and his fiancee for a weekend visit to Toronto. It’s perhaps no surprise that we spent a lot of time talking and laughing over a meal. Last night we talked about the impact of our work and the focus we’ve chosen to take and it got me thinking about the challenge of finding balance between specialization and generalization in health promotion work relative to impact. My wife is a social worker who specializes in domestic violence issues. Although she is a trained psychoanalyst, she came to find her greatest opportunity to contribute to the world lay in tackling problems from a systems perspective. She builds multi-sector partnerships, collaborations and works to address the problem of domestic violence at its root and its consequences from multiple perspectives including treatment & prevention and policy & practice. It is a systems approach from the beginning to the end.
Readers of this blog will know that this is a similar approach I take to the problems that interest me like food systems change, tobacco control and gambling. These are often ‘wicked’ problems — those with no clear source or obvious solution requiring collaboration and broad stakeholder engagement to solve. I work and study in the field of health promotion, which is (I argue) a systems science and practice even if it doesn’t identify itself as such. It looks at the bigger picture and tries to use that lens as a means of understanding the world and solving social problems.
My friends are both quite attune to this and I would argue also apply systems thinking to their work, yet they do in a very different way. They are counseling psychologists and, for the most part, they work one-to-one or in small groups. What our conversation revealed was the myriad ways in which systems thinking can be applied to the big and small picture. Family systems therapy for example, is one way in which these ideas are applied to small groups or individuals. But there are many more.
This got me to thinking about the opportunities and challenges associated with promoting systems transformations at the macro and micro levels. The way my friends approach their work is fundamentally different even if it shares much of the same interests in systems change as the approach that I take. Yet, that difference has a huge impact on a few people (hundreds) rather than an almost imperceptible impact on thousands. In applying systems thinking outside of the clinical encounter, the problem they face is that they are not paid (that is, they are not reimbursed for clinical time) when they go beyond the one-to-one and small-group approach; so even if they wanted to do that work, they couldn’t unless it was on their own time. Health promotion is almost the opposite: we have become so good at working with large groups that we’ve stopped developing strategies that can help individuals that fit with the health promotion values. It’s true, that there is a season for each of these approaches. Health promotion has worked hard to escape the individual-focus that other fields like health education still use and psychology is pretty good at doing the individual thing. It just seems that there is room for both specialized and generalized systems thinking and action working together. I just haven’t figured out how. Any suggestions?