Above: Authors of the study, Nova Scholar Kurt Stange, MD, PhD, and Fellow Heidi Gullet, MD, MPH.
August 23, 2023
Racism is increasingly recognized as a public health crisis throughout the United States. This powerful upstream determinant contributes to serious health inequities and adverse health outcomes for historically marginalized communities nationwide.
Such complex public health issues as racism call for innovative, integrative approaches. Nova Fellow Heidi Gullet and Scholar Kurt Stange’s “Using Community-Based System Dynamics to Address Public Health Disparities,” published in the Journal of Public Health Management and Practice, explores how Community-Based System Dynamics and systems science methods can be used to tackle challenging, deeply entrenched health disparities exacerbated by structural racism and demonstrates how to identify solutions. The authors highlight how this framework can be used to foster healthier communities and broader health equity through change in policy and practice.
Community-Based System Dynamics (CBSD) is a “participatory method for engaging and empowering diverse communities in systems thinking and action.” It employs a modeling approach that illuminates the intricate web of relationships within a system and their evolving patterns over time. It enables researchers and policymakers to visualize and understand complex relationships, feedback loops, and unintended consequences that perpetuate health disparities. It also offers decision makers the ability to simulate the effects of different strategies and gauge their potential impact, ensuring resources are channeled into initiatives with the highest likelihood for positive change.
Key Strengths of CBSD Identified in this Study
- CBSD is a robust, innovative tool to comprehensively and visually model and address structural racism
- CBSD engages those most impacted by structural racism to design and steer solutions and builds community capacity to understand complex systems and drive systemic change
- Participatory methods such as CBSD offer promising foundations for community engagement and sustainable collective action and solutions
- Simulation models of leverage points and possible solutions allow decision makers to measure potential impact and channel resources into solutions with highest likelihood of success
In this paper, Gullet and Stange explore the application of CBSD through initiatives formed in Cuyahoga County, Ohio. Community members and groups organized under the nationwide Place Matters initiative in 2009, and in 2013, carried out the first community health status assessment, which underscored how the historical impact of racism affects health outcomes today. In 2014, Health Improvement Partnership-Cuyahoga (HIP-Cuyahoga) was formed as a cross-sectoral, county-wide health improvement collaborative and declared eliminating structural racism as a key priority to uplifting community health.
Historically, interventions to such complex problems were developed in individual siloes, often missing large pieces of the puzzle and not involving community members. The CBSD model uses systems science and community engagement to identify the many, complex factors of health and present them visually in their dynamic relationships.
In the early Group Model Building (GMB) sessions of this study, “the core modeling team identified racial trauma and healing as missing elements of the larger system map and developed a causal loop diagram showing the feedback mechanism resulting from racial trauma and from healing at multiple levels.” The project team involved community members throughout the process in a series of online workshops fostering community capacity and trust and developing a shared picture of racism in Cuyahoga County. This also allowed the modeling team to honor and incorporate the lived experiences and knowledge of community members and co-create a representation of racism based on the community’s first hand involvement.
The core modeling team created an initial working system map of structural racism and identified leverage points and possible policy and community-driven solutions to catalyze change, including efforts to address equity and access to housing, education, food, healthcare, and much more. Further GMB sessions revealed sub-systems, findings were reflected in subsequent causal loop diagrams, and simulation models built from these data will be used to test possible solutions and measure potential outcomes. These maps, diagrams, and models, and the trust and relationships built through the process, provide a framework for achieving policy change, capacity building, and racial equity.
Dismantling structural racism and realizing racial equity is critical for public health. This study underscores how systems science and community partnerships can unravel complex relationships and drive equitable, sustainable solutions ranging from community initiatives to policy change. Embracing such robust, cross-sectoral methodologies could help pave the way for a brighter and healthier future for everyone.