Seeing Simplicity / Seeing Complexity
We are on the cusp of what is known in public health circles as ‘flu season’. Unless you don’t get out much, you probably know that this year’s season has special significance because of the presence of a new relatively new, and powerful strain of influenza known as H1N1 (or ‘the swine flu’ to some). This week we saw the first large-scale roll-outs of vaccinations for H1N1 along with the annual drive to provide the public with flu shots. As is to be expected, there has been a lot of coverage of the flu and the efforts to provide a form of preventive medicine (a vaccine) in anticipation of what is expected to be a heavier-than-usual year of the flu. Judging by the waves of people I know reporting they and their loved ones are (or have been) sick in person, on Facebook or Twitter , I’d say we’re already off to a big year.
Vaccines provoke a lot of concern from people. After all, the basic tenets of a vaccine are to inject someone with either a dead or live version of the virus in tiny forms to boost the host’s immune system and it is natural to those without immunology or biology in their educational history to find this odd. Yet, we’ve nearly wiped out diseases like polio and smallpox because of these vaccines. Those successes have not translated into desire for more vaccines (despite their declared importance to public health), rather the opposite is happening. The current issue of Wired magazine focuses on this problem surrounding the link that some have drawn between Autism and vaccines. This link is possible because the diagnosis of autism often is made about the same time that the most common childhood vaccinations are administered. Despite there being considerable evidence to the contrary, a connection between two unrelated activities gets put together. Something simple is made complex.
This same example also illustrates the opposite. Vaccines and drugs are often developed by profit-making companies who hope to make money as well as profit health benefits. This profit motive can easily get translated into callous disregard for the public’s health and the inability to see the harm products cause: greed rules. Something complex is made simple.
The ability to shift between these two levels of abstraction is a critical challenge for public health. Unlike some areas of health practice, public health deals in the public realm, looking at issues that have importance to everyone, not just individual citizens. We are guided by public ethics, not private morals. But public health is messy for this very reason, because at its root are problems that are mostly complex ones — those with multiple causes and overlapping sets of consequences that cannot be fully predicted using simple methods or models. Complicated problems are ones that have a lot of components to them, but their organization and relationship to each other allows us to diagnose and prescribe a solution. Simple ones have few parts and very straightforward relationships. (A great illustration of these problems is here) .
Yet the impact of making problems at one level look like those at another cannot be understated. This is how myths develop and conspiracy theories take hold. In Canada, public health officials are trying to counteract the myths that the H1N1 vaccine (and flu shots in general) are being perpetuated. But in a social media ecology, that is hard to do, particularly when the myth-makers get so much attention and are motivated — by many conflicting reasons — to get their message out. Research has looked at the messaging behind anti-vaccination messages on YouTube and found it to be a source of a lot of contradictory messaging.
For public health, this is complexity in action and perhaps it is complexity — and social media — that might be the lens and tools to address these myths, otherwise they will continue to flourish. This isn’t such a problem when the consequences of doing something or not doing something has little impact on others. Vaccinations on the other hand impact us all – whether we take them or not — because compromised immunity for one, can lead to disease transmission to another. But things aren’t always what they seem. Once we believed that smoking was a simple choice, then we realized that it caused problems to the individual smokers’ health in myriad ways making it much more complicated, and now research has shown that cigarette smoking is having wide-scale complications to the health of others through second-hand smoke.
So is it simple or is it complex?