A Brief History of Dynamic Systems Thinking in Health

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Dynamic systems views of health are found throughout history and across civilizations, including Chinese, Indian and Greek writings. Modern scientific concepts in body physiology include Harvey’s description of the motion of the heart and circulation and Cannon’s concept of homeostasis, where the internal “milieu” or state of the body is maintained at stable levels by feedback control mechanisms. More quantitative models were developed in both physiology and epidemics by the 1930s. Around that time, Ludwig von Bertalanffy, a biologist and philosopher, the founder of General System Theory, proposed the theory of organized open systems to explain living organisms. He advocated a mixed scientific and humanistic approach, using both analysis and synthesis to address modern social and technical problems using multiple discipline perspectives. A major motivation was to oppose the mechanistic image of man as a robot, a GST view that influenced American Psychiatry. The Society for General Systems Research was founded in 1954 and it became a part of systems science. Meanwhile, engineering approaches to feedback control had existed in mechanical devices from antiquity and were applied to projectile guidance during wartime. “Other more specific system sciences included cybernetics, information theory, communication theory, systems engineering, operations research, computer science, management science game theory and decision theory. This was stimulated by Weiner and Shannon and Weaver, together with the urgent engineering demands created by increasingly complex production processes.” Forrester developed the System Dynamics engineering method at MIT in the 1950s and applied it to social systems including industrial, urban and world dynamics. The controversial limits to growth Club of Rome model helped focus the international community on the need for environmental reform.

Early applications of SD in health included hospital management and medical technology, human services delivery and narcotic addiction, body system models, diffusion of medical technologies and capacity planning. With the advent of microcomputer SD software the application of system dynamics to health has expanded across the world since the early 1990s. More recently there has been activity in public health, chronic disease, tobacco policy, polio eradication, as well as some process-centric simulation addressing patient flows. Learning environments and serious games for health have become more widespread and online community learning environments using interactive web-based simulations are now available for science education and climate change

Simulation and modeling is now firmly established in public health, systems biology, infectious diseases, physiology and clinical skills training. Recent events include special issues of the American Journal of Public Health on systems thinking and modeling and tobacco control, seminars, videocasts and an annual Institute on Systems Science and Health by CDC NIH including system dynamics with a number of other behavioural and social sciences methods. There is growing use of SD in mental health and other UK NHS and Canadian planning and clinical activities and other worldwide activities publicized and encouraged by the Health Policy SIG of the System Dynamics Society since 2003. Climate change and environmental modeling and systems biology, including the physiome project, continue to accelerate the development of virtual experiments in a variety of health and health care problems.

There has been some strengthening of systems approaches in traditional disciplines, including the areas of health policy and health economics, complex interventions in complex systems, program evaluation using critical realism frameworks (realistic evaluation), process and systems improvement in quality and safety led by Don Berwick’s IHI, Systems frameworks for health care performance and the social determinants of health in the WHO and funded activities in emergency preparedness and bio-security. Systems science is now recognised as a requirement for the education of the future medical professional. Technical skills and tools are available but System Dynamics in general remains a foreign language of engineers. Here we apply the combination of concept maps and system dynamics modeling to simple health problems to reduce this strangeness. The focus is on health practitioners interested in the dynamics of systems jointly solving chronic persistent or complex dynamic problems.


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