Abstract
BackgroundIn the design of public health policy, a broader understanding of risk factors for disease across the life course, and an increasing awareness of the social determinants of health, has led to the development of more comprehensive, cross-sectoral strategies to tackle complex problems. However, comprehensive strategies may not represent the most efficient or effective approach to reducing disease burden at the population level. Rather, they may act to spread finite resources less intensively over a greater number of programs and initiatives, diluting the potential impact of the investment. While analytic tools are available that use research evidence to help identify and prioritise disease risk factors for public health action, they are inadequate to support more targeted and effective policy responses for complex public health problems.DiscussionThis paper discusses the limitations of analytic tools that are commonly used to support evidence-informed policy decisions for complex problems. It proposes an alternative policy analysis tool which can integrate diverse evidence sources and provide a platform for virtual testing of policy alternatives in order to design solutions that are efficient, effective, and equitable. The case of suicide prevention in Australia is presented to demonstrate the limitations of current tools to adequately inform prevention policy and discusses the utility of the new policy analysis tool.SummaryIn contrast to popular belief, a systems approach takes a step beyond comprehensive thinking and seeks to identify where best to target public health action and resources for optimal impact. It is concerned primarily with what can be reasonably left out of strategies for prevention and can be used to explore where disinvestment may occur without adversely affecting population health (or equity). Simulation modelling used for policy analysis offers promise in being able to better operationalise research evidence to support decision making for complex problems, improve targeting of public health policy, and offers a foundation for strengthening relationships between policy makers, stakeholders, and researchers.
Highlights
In the design of public health policy, a broader understanding of risk factors for disease across the life course, and an increasing awareness of the social determinants of health, has led to the development of more comprehensive, cross-sectoral strategies to tackle complex problems
Summary: In contrast to popular belief, a systems approach takes a step beyond comprehensive thinking and seeks to identify where best to target public health action and resources for optimal impact
It is concerned primarily with what can be reasonably left out of strategies for prevention and can be used to explore where disinvestment may occur without adversely affecting population health
Summary
The complex problem of suicide Suicide remains the leading cause of death in adult males aged under 44 years and women under 34 years [6] despite significant declines in young adult males since the 1990s [7], and represents significant economic and health service costs to Australia [8]. The potential utility of these systems science methods lie in their ability to systematically and quantitatively analyse a range of intervention and policy options and identify leverage points in the system (places to intervene) where small inputs might result in large impacts [60] This alternative approach should be considered to support decision making for future strategies to address complex problems such as suicide prevention, when substantial investments in a ‘comprehensive approach’ over many years has failed to yield significant impacts. The Partnership Centre is working towards developing stronger national networks of researchers, policy, and program practitioners This provides a valuable opportunity for co-production of simulation models to better inform policy responses for complex public health problems. Author details 1Research Fellow, The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, Sydney NSW 1240, Australia. 2Professor of Public Health, School of Science and Health, University of Western Sydney, Campbelltown Campus, Penrith NSW 2571, Australia. 3Deputy CEO, Sax Institute, PO Box K617, Haymarket, Sydney NSW 1240, Australia. 4School of Public Health, University of Sydney, Edward Ford Building (A27), Camperdown NSW 2059, Australia. 5Director, The Australian Prevention Partnership Centre, Sax Institute, PO Box K617, Haymarket, Sydney NSW 1240, Australia
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