Recently I was discussing what I do with someone relatively unfamiliar to my research, yet in the same field and I described my interest in systems thinking, knowledge translation, and eHealth and how they go together. Somehow in the conversation the term “sexy” was used to describe these fields along with “hot” and “upcoming”. It’s nice to be at the forefront of a field — or three — but it also has some downsides.
One of the downsides is that rigor often gets displaced by enthusiasm. Even fields like knowledge translation, which first emerged in the mid 1990’s (and far earlier than that if you’re willing to consider different terms), is just now evolved to the point where it is widely accepted and supported as a legitimate area of research. There is still much work that calls itself KT that is really just dissemination with a different name, but the concept of KT at least has some respect.
So too, does the idea of systems thinking. With recent special issues in respected journals like the American Journal of Preventive Medicine and American Journal of Public Health and full monographs from the National Cancer Institute, the idea of transmitting systems science from the backwaters of public health to the forefront is close to reality.
eHealth was sexy too, but too much investment matched with too little patience for good evidence quickly burned through much of the potential that consumer-directed eHealth had for making transformative differences on a broad scale. No worry, mHealth is here and that is quickly proving to be as “hot” as eHealth was ten years ago.
The problem is that “hot” and “sexy” terms often presage their demise in respected discourse before too long. I was once told by a senior official with a large health NGO that he’d given up on eHealth because he knew it didn’t work. This was 2002. Most of the best evidence hadn’t been generated yet and already people had thrown in the towel.
Knowledge translation is having its problems too, because the evidence of a shortening from “evidence to effect” is hard to generate. Often, KT requires systems level changes and systems thinking to create the conditions to generate effective KT practice. That suddenly transforms something that is “sexy” into something difficult and much less so in the eyes of those who are responsible for implementation of KT plans.
Systems science as it is applied to health is in greater danger because the scale and scope of change required to generate good evidence is often at a scale that is prohibitive. Take gambling as one potential public health problem. Governments are now deriving enormous revenue from gambling, while the social costs seem to rise with it. So important is gambling to provincial government revenues in most Canadian provinces that the only way to really change is to change the system as a whole. Diabetes care, mental health, and public nutrition and food security are other issues that are complex and of a scope that requires a true systems-level intervention to effectively address. Suddenly, when you speak of connecting the private sector to the public sector, changing regulations, building true KT systems within these areas, supporting public health education and practice, and tackling the social inequalities that are propped up by a current system of organization, systems don’t seem as sexy.
Furthermore, in the case of systems, KT, or eHealth, acknowledging complexity in the way we handle things, and considering problems from a systems perspective, means hard work, different time horizons, and truly working collaboratively across disciplines and settings. That is hard stuff and it sure isn’t sexy.
There are lots of areas within the health system that are not sexy, but few are seen less interesting than issues that were once viewed as sexy, but now not so much. That’s the danger with systems, knowledge translation and eHealth.
Cameron:
As public health practitioners, our end users are most frequently the general public, and our messages are just part of the tsunami of information and images hurtling past them every day. In our podcast interview with Bill Novelli, he talked about his work with the Campaign for Tobacco-Free Kids. Using his marketing skills and the enormous web of personal and professional contacts he had developed in Washington, DC, the Campaign achieved, and continues to achieve, a level of influence and credibility all out of proportion to its short history and relatively small funding base. And yet, Novelli said, we barely scratched the surface.
Novelli said the key, which is frequently forgotten, is sustainability. Not just a year, not just a decade, but maybe a generation of sustained effort will be required to achieve lasting change.
Your points about systems complexity are well taken. Not only is this work complex, not only is complexity unsexy, but it takes time.
Oh, and also, thank you for your kind words about KTExchange.org.