TABLE 1—

Participants’ Ratings of Practical Challenges to Effective Systems Thinking and Modeling in Public Health

Cluster and Challenge	Rating
Expand Cross-Category Funding (average: 3.86)
Identify and develop funding sources that will encourage systems approaches to public health	4.13
Develop funding for demonstration projects that validate systems approaches to public health	4.09
Increase funding for transdisciplinary and interagency collaborative projects with a systems focus	4.06
Support Dynamic and Diverse Networks (average: 3.50)
Encourage collaborations between researchers and practitioners by clarifying the link of systems thinking and modeling to everyday practice in public health	3.74
Use participatory action approaches to partner with communities to co-define public health problems, challenges, needs, assets, and resources	3.74
Sustain multidisciplinary teams from a broad range of health and science backgrounds and thinking (e.g., deductive/inductive, research/practice)	3.65
Use Systems Measures and Models (average: 3.39)
Development of methods and tools that encourage systems approaches in research and evaluation	3.93
Develop new evaluation approaches that will help demonstrate the value of systems approaches, such as syndemics, in public health	3.78
Identify priority public health issues (e.g., tobacco, HIV, obesity) as possible tipping points for early examples of systems thinking and modeling	3.46
Inspire Integrative Learning (average: 3.38)
Identify and disseminate examples of “best practices” or “what works” in systems thinking inside and outside of public health	3.93
A critical mass of practitioners who are able to approach public health from a nonlinear perspective	3.72
Training and education in systems research techniques for public health professionals	3.70
Explore Systems Paradigms and Perspectives (average: 3.26)
Recognize the importance of a systems paradigm to public health (e.g., ecological, systemic, holistic, participatory, multidimensional, constructivist, adaptive, complex, and nonlinear frameworks)	4.00
Recognize the limitations of the dominant paradigm in public health (e.g., linear causality, reductionism, positivism, objectivism, the medical model, logic models, program-focused, disease-focused frameworks)	3.57
Getting government and public health officials at state and federal levels to appreciate the value of community-based approaches and highlight citizenship and local governance in public health	3.54
Show Potential of Systems Approaches (average: 3.25)
Rigorous research that demonstrates the value of systems thinking, methods, approaches, and research	3.76
Set priorities by analyzing system-wide issues rather than simply ranking by disease burden or attributable risk	3.74
Connect systems thinking and modeling to the series of recent Institute of Medicine reports (e.g., bridging the quality chasm, reducing health care errors, eliminating health and health care disparities)	3.63
Foster Systems Planning and Evaluation (average: 3.20)
Integrate organizational planning and evaluation functions around a systems approach	3.72
Apply systems thinking to physical and mental health problems affecting individuals, families, and communities throughout the human life cycle	3.65
Develop a unified mission/vision across sectors (e.g., public health, education, public safety, behavioral health) and between layers (e.g., national, state, community) regarding the systems approach	3.50
Utilize System Incentives (average: 3.05)
Provide incentives that encourage systems thinking	3.56
Reduce the overemphasis on immediate positive program impacts by taking a longer term view	3.54
Address issues of politics and bureaucracy that hinder systems thinking (e.g., politicians’ ignorance of how their systems work, public employee unions that avoid employee accountability, civil service systems that encourage stagnation)	3.35

Note. Shown are the 3 challenges in each cluster with the highest average importance ratings.