Accelerating systems thinking in health: Perspectives from the region of the Americas.

Introduction: The Systems Thinking Accelerator (SYSTAC) is a community to engage, connect and collaborate to elevate the field of systems thinking with a focus on low- and middle-income countries, highlighting the need to identify existing capacities within research and at the practice level. The study aimed to explore if there is a perceived need for and benefit from the application of Systems Thinking tools for analysis and diagnosis of problem-solving within Healthcare in the Region of the Americas in 2021 and the existing capabilities. Methods: The identification and deconstruction of the needs, demands, and opportunities regarding systems thinking in the Americas were approached by: (i) adapting the tools and Systems Thinking definition to reflect regional nuances, (ii) identifying stakeholder exercise, (iii) needs assessment survey distribution, (iv) stakeholder mapping analysis, (v) workshop. More information on the adaptation and execution of each tool can be found below. Results: 123 stakeholders were identified, of which 40 participated in the needs assessment survey. 72% of respondents indicated little knowledge of the tools and approaches of systems thinking but a high interest in developing them, as stated by 87% of respondents. Qualitative tools were most frequently used, such as brainstorming, problem trees, and stakeholder mapping. Systems thinking is mainly used when conducting research, implementing, and evaluating projects. A clear need and want for training and developing capacities in health systems thinking were identified. However, in practice, systems thinking faces challenges like resistance to change and to the transformation of health processes, barriers at the institutional level, and other administrative disincentives that hinder its application, being institutional transparency, political will, and the articulation of the actors the main challenges. Discussion: Strengthening and building personal and institutional capacities in systems thinking theory and practice requires overcoming challenges such as lack of transparency and inter-institutional cooperation, the low political will to implement it, and difficult stakeholders' integration. As a first step, it is crucial to understand further the stakeholder network and the capacity needs of the region, gain buy-in from strategic players to establish the use of system thinking as a priority, and develop a roadmap.

A systematic review on whether regenerative agriculture improves animal welfare: A qualitative analysis with a One Welfare perspective.

The welfare of animals in food-production systems is a cause of concern to the public. Regenerative agriculture was first used by the Rodale Institute and proposes to regenerate degraded components of ecosystems, aiming to be more than just sustainable. However, despite animal welfare being pushed to be part of the SDG agenda for 2030, there is no clarity on how regenerative agriculture impacts animal welfare. It is challenging to determine regenerative agriculture impacts on animal welfare, since it is not entirely defined. One Welfare could help define entry points for future research by studying animal welfare in connection with human welfare and environmental conservation. We aimed to analyse the extent to which positive animal welfare outcomes characterise regenerative agriculture systems in peer-reviewed articles and whether the narratives of such articles support that regenerative agriculture promotes animal welfare directly or indirectly by improving human welfare and environmental conservation. We searched papers including 'regenerative agriculture' using PRISMA-P, selecting animal welfare, human welfare, environment conservation terms, developed themes, and carried out analysis using Atlas.Ti8 and Causal Loop Diagram. We found that papers mainly linked animal welfare to animal health, human welfare to financial farm status and farmer's self-awareness, and environmental conservation to soil improvement. Causal Loop Diagram indicated that regenerative agriculture had the potential to improve the health and nutrition components of animal welfare by enhancing financial farmers' status/self-awareness (human welfare), and the soil (environmental conservation), reflecting that the processes that affect human welfare and environmental conservation could also affect animal welfare. However, information in papers remains insufficient to determine how regenerative agriculture impacts on animal welfare and research into regenerative agriculture needs to extend its focus on animal welfare and elucidate the regenerative agriculture principles leading to animal welfare.

Promoting knowledge to policy translation for urban health using community-based system dynamics in Brazil.

BACKGROUND: Effectively bridging the knowledge-policy gap to support the development of evidence-based policies that promote health and well-being remains a challenge for both the research and policy communities. Community-based system dynamics (CBSD) is a participatory modelling approach that aims to build stakeholders' capacity to learn and address complex problems collaboratively. However, limited evidence is available about the contributions of CBSD to knowledge-generating and policy processes across sectors and policy spheres. In the context of a multi-country research project focused on creating an evidence base to inform urban health policies across Latin America, a series of CBSD workshops convened stakeholders from research, policy-making, and other backgrounds working in food and transportation systems. Diverse participants were selected aiming to incorporate multiple perspectives relevant to understanding complex urban systems linked to food and transportation. This study focuses on one of these workshops, whose avenue was São Paulo, Brazil, assembling country-based participants representing local, regional, national, and international institutions with multidisciplinary backgrounds linked to food and transportation systems. OBJECTIVE: The aim of this case study is to explore the perceived influence of one of these workshops on attendees' understandings of food and transportation systems and their relationship to healthy urban environments, with attention to the role of the workshop in supporting knowledge to policy translation for urban health. METHODS: We conducted 18 semi-structured qualitative interviews with attendees one year after their participation in a CBSD workshop held in São Paulo, Brazil. A framework method approach was used to code participants' responses and identify emerging themes. RESULTS: Participants reported that the workshop's group model-building activities influenced their understanding of the knowledge-policy process as it relates to food and transport systems. Workshop contributed to participants' (1) abilities to engage with multisectoral stakeholders, (2) construct a shared language and understanding of urban challenges, (3) improve understanding of the interconnectedness across food and transportation systems, (4) facilitate dialogue across sectors, and (5) apply a systems thinking approach within their sector and professional context. Participants continued to draw on the tools developed during the workshop, and to apply systems thinking to their research and policy-making activities. CONCLUSIONS: CBSD may offer valuable opportunities to connect the research sector to the policy-making process. This possibility may contribute to knowledge to policy translation in the interconnection between the urban context, food and transportation systems, and health.

Engaging with complexity to improve the health of indigenous people: a call for the use of systems thinking to tackle health inequity.

The 400 million indigenous people worldwide represent a wealth of linguistic and cultural diversity, as well as traditional knowledge and sustainable practices that are invaluable resources for human development. However, indigenous people remain on the margins of society in high, middle and low-income countries, and they bear a disproportionate burden of poverty, disease, and mortality compared to the general population. These inequalities have persisted, and in some countries have even worsened, despite the overall improvements in health indicators in relation to the 15-year push to meet the Millennium Development Goals. As we enter the Sustainable Development Goals (SDGs) era, there is growing consensus that efforts to achieve Universal Health Coverage (UHC) and promote sustainable development should be guided by the moral imperative to improve equity. To achieve this, we need to move beyond the reductionist tendency to frame indigenous health as a problem of poor health indicators to be solved through targeted service delivery tactics and move towards holistic, integrated approaches that address the causes of inequalities both inside and outside the health sector. To meet the challenge of engaging with the conditions underlying inequalities and promoting transformational change, equity-oriented research and practice in the field of indigenous health requires: engaging power, context-adapted strategies to improve service delivery, and mobilizing networks of collective action. The application of systems thinking approaches offers a pathway for the evolution of equity-oriented research and practice in collaborative, politically informed and mutually enhancing efforts to understand and transform the systems that generate and reproduce inequities in indigenous health. These approaches hold the potential to strengthen practice through the development of more nuanced, context-sensitive strategies for redressing power imbalances, reshaping the service delivery environment and fostering the dynamics of collective action for political reform.

The Mexican Dietary and Physical Activity Guidelines: Moving Public Nutrition Forward in a Globalized World.

The objective of this article is to explain the process of the development of and to assess the Mexican food-based dietary and physical activity guidelines (FBDGs). The FBDGs were developed by an intersectoral and interdisciplinary committee of 11 national experts with input from 11 external advisors. The sectors represented were research and academic institutions, the Ministry of Health, and a nongovernmental organization. The evidence-based process included the following: literature reviews of local, national, and international evidence; review of dietary patterns of the Mexican population; key national and international recommendations; and review of FBDGs and visual icons from other countries. The guidelines' report follows the life-course socioecological model rooted in a deep understanding of the epidemiology and underlying causes of malnutrition in Mexico. The guidelines are summarized in 10 pretested main recommendations that include, and go beyond, simply promoting the consumption of a healthy and varied diet that includes fresh fruits, vegetables, legumes, and whole grains and staying within caloric needs and staying active. The guidelines strongly emphasize healthy cooking habits, enjoyable meals with family and friends, drinking water, and avoiding the consumption of sweetened beverages, grain-based desserts, and highly processed foods. Detailed guidelines specific to different groups (on the basis of age and physiologic status) are also included. An innovative aspect of the Mexican FBDGs is the inclusion of dietary guidance of children <2 y of age. Future editions of these guidelines should consider removing their emphasis on dietary cholesterol and total dietary fat and placing more attention on the substitution of saturated and trans fats with healthy oils. The process of national agenda setting, policy articulation, and implementation of the Mexican FBDGs in the context of addressing the national obesity epidemic deserves to be initiated and formally assessed through the lens of evidence-based, public nutrition complex adaptive systems.

Safety inspections in construction sites: A systems thinking perspective.

Although safety inspections carried out by government officers are important for the prevention of accidents, there is little in-depth knowledge on their outcomes and processes leading to these. This research deals with this gap by using systems thinking (ST) as a lens for obtaining insights into safety inspections in construction sites. Thirteen case studies of sites with prohibited works were carried out, discussing how four attributes of ST were used in the inspections. The studies were undertaken over 6 years, and sources of evidence involved participant observation, direct observations, analysis of documents and interviews. Two complementary ways for obtaining insights into inspections, based on ST, were identified: (i) the design of the study itself needs to be in line with ST; and (ii) data collection and analysis should focus on the agents involved in the inspections, the interactions between agents, the constraints and opportunities faced by agents, the outcomes of interactions, and the recommendations for influencing interactions.

As origens do pensamento sistêmico: das partes para o todo / The origins of the systemic thinking: from the parts to the whole

O Pensamento Sistêmico foi reformulado ao longo dos anos, tendo sua base epistemológica modificada. O presente artigo objetiva apresentar os aspectos históricos e epistemológicos que constituem o Pensamento Sistêmico, entendendo-se que esta compreensão teórica é fundamental para a prática dos terapeutas sistêmicos nos mais diversos contextos. Reforçam-se as ideias de que pensar sistemicamente implica reconhecer o sujeito em seu contexto, de que os fatos não são previsíveis e de que o terapeuta/pesquisador faz parte do sistema no qual intervém/estuda. Assim, ao fazer uso do Pensamento Sistêmico, o profissional amplia seu olhar sobre a situação, questiona a problemática apresentada, e trabalha com as pessoas envolvidas alternativas de modos mais funcionais de relacionamento.(AU)

The Systemic Thinking has been reformulated over the years and its epistemological basis has been modified. This theoretical paper aims to present the historical and epistemological aspects of the Systems Thinking, as well as this theoretical understanding is important for the practice of systemic therapists in various contexts. The paper reinforces the idea that thinking systemically involves recognizing the person in a context, that the facts are not predictable and that the therapist/researcher is part of the system in which he/she intervenes or studies. Thus, to make use of systems thinking, the professional expands the vision of the situation, questions the problematic presented, and works more functional modes of relationship with other people involved.(AU)