Achieving a Systemic Understanding of Health Equity: Complex Health, Systemic Analysis, and Wicked Issues

Abstract

Problem:

Science is interpreted and validated, albeit from different analytical and theoretical orientations. Causal inference and analysis are more often expected in public health science. Public health science and its knowledge generation are expressed in a vernacular meant to describe wicked, value-laden structural health outcomes, divergent health statuses, and unpredictable health behaviors. Deviation from scientific expectations of reductionism can invite scrutiny and disregard. A taxonomy of public health establishes a shared, communal reality and imbues it with the perception of immutable, ordered certainty, while health remains a persistent uncertainty. Science shapes scientific conceptualization and analysis, and vice versa. When a narrow orientation to science leads exclusively to linear thinking, the opportunity to uncover the complexity of public health issues is missed. The gravity of health inequity leaves no room for missed public health opportunities or overly simplistic, restrictive reasoning.

Rationale:

Strict reliance on discrete measurement and reductionism cannot provide a complete picture of the complex health disparities that undermine health equity. A hallmark of scientific research is a shared vocabulary and a respected scientific orientation. Systems thinking is not new, but its adoption in public health has been slow. Finding a shared, complexity-sensitive vernacular in public health equity that crosses disciplines and systems methods has been elusive.

Methodology:

As with the adoption of causal inference, systems theories and methods have been rigorously applied with success in other fields and hold promise for innovation in public health. The importance of shared meaning in systemic health is explained using a novel network-based framework for health equity: the health-restricting and health-flourishing subsystems, as applied to health in under-resourced communities.

Results/Conclusion:

Systemic frameworks enable reformed focus on health equity within health systems. Wicked reasoning provides a fundamental foundation, employing shared nomenclature and a holistic understanding to support health.