文章基本信息

标题：Systemic Intervention for Public Health
本地全文：下载
作者：Gerald Midgley
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2006
卷号：96
期号：3
页码：466-472
DOI：10.2105/AJPH.2005.067660
语种：English
出版社：American Public Health Association
摘要：Many calls have been made for a systems approach to public health. My response is to offer a methodology for systemic intervention that (1) emphasizes the need to explore stakeholder values and boundaries for analysis, (2) challenges marginalization, and (3) draws upon a wide range of methods (from the systems literature and beyond) to create a flexible and responsive systems practice. I present and discuss several well-tested methods with a view to identifying their potential for supporting systemic intervention for public health. BECAUSE OF THE COMPLEXITY of many public health issues, where numerous interacting variables need to be accounted for and multiple agencies and groups bring different values and concerns to bear, it is not uncommon for people to call for a systems approach. 1 ^– 5 This should not be surprising, as the whole concept of public health is founded on the insight that health and illness have causes or conditions that go beyond the biology and behavior of the individual human being. If I can give an overly simplistic definition of systems thinking as “looking at things in terms of the bigger picture” (not a definition I would want to defend in a rigorous academic fashion, but adequate for my purposes), then it should be immediately apparent that public health is already founded on a systemic insight. Because many public health professionals are calling for a systems approach, I offer a set of methodological concepts that I have found useful in my own practice to frame systemic inquiry. Of course, many different systems methodologies have been developed over the years. There are far too many to list, let alone review (see Midgley 6 for a wider set of readings). However, the methodology I want to introduce here, which I have called systemic intervention (more detailed information can be found elsewhere 7 ), has the advantage of taking a pluralistic approach to the design of methods. It provides a rationale for creatively mixing methods from a variety of sources, yielding a more flexible and responsive approach than might be possible with a more limited set of tools. I will outline this methodology before reviewing a selection of other systems approaches that have been designed for different purposes. We can borrow some useful methods from these approaches, which can then be woven into systemic intervention practice (and more traditional scientific methods plus methods from other sources can be drawn upon in the same way). Two brief practical examples of systemic intervention illustrate my argument.