Systems Thinking, eHealth and Changing Public Health

Tomorrow is my last class in CHL 5804: Health Behaviour Change for the 2010 year. Like every year, it was filled with the expected, unexpected and everything in between. I love teaching the course and interacting with about 30 graduate students from different disciplines, research backgrounds and educational levels. And while we often don’t admit it to our peers, one of the biggest reasons to teach is that we learn a lot, maybe more, than the students in our courses.

This year I was quite surprised by the interest in two areas: systems thinking and eHealth. Now these are my areas of interest so this is not a surprise on the surface, but then I’ve had these interests for a few years and are about equally passionate today than in past years. Another argument is that I am a better teacher today, which I suppose is possible, but as I look more into my own teaching practice I can’t imagine that the quality of teaching is significantly different than in past years.

I am taking this as a sign of maturity of both fields relative to public health. Both of these fields are relatively new. Depending on your definitions — of which there are many — eHealth has been around for about 15 years, evolving with the World Wide Web. Systems thinking and public health is a little younger, with its rise beginning less than 10 years ago. The publication of the US National Cancer Institute’s monograph on systems thinking and tobacco control, Greater than the Sum, published a couple years ago and the special issue of the American Journal of Preventive Medicine and the American Journal of Public Health, both signaled the rise of systems thinking and public health.

As we know from work in knowledge translation, it can take a long time to get knowledge into practice and this year I think the knowledge about the potential of tools like social media, mobile technologies and consumer-oriented databases has translated into action. My students do presentations each year pitching a hypothetical version of a Framework Convention similar to the one on tobacco control. This year, to my surprise (and with no coaching, particularly given that my eHealth “lectures” are all delivered electronically) most of the groups included some type of eHealth or mHealth intervention in their plans.

These were not just ideas aimed at impressing the professor, rather they represented some remarkably creative ideas on how to use technology to support health promotion, disease prevention, and public eHealth all around.

Attached to this idea of technology aiding the development of interventions for change was the idea that these eHealth tools exist within a larger system. When you speak of social networks or systems dynamics, you are in the realm of systems thinking. The idea that things are connected and intertwined is an idea that seems to hold a lot of appeal for many students and this is growing, particularly as more of my students have real world experience each year. This is important because once you’ve spent time dealing with problems at anything other than a theoretical level, you begin to see the breakdown in linear approaches to problem solving and the need for thinking in systems.

At the same time, as you spend time in that world you also see the problems and costs associated with relying solely on face-to-face methods of intervening. There simply isn’t enough funds, people or other resources to sustain a model that relies exclusively on physical, one-to-one care and prevention efforts. eHealth provides an avenue to consider ways of doing things at a distance and, for some conditions, this translates into interest in doing things that can reach more people for less money, hence the interest in eHealth.

This makes me quite pleased.

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