Is public health ready for complexity?

Guest post by Brian Castellani, Professor of Sociology at Durham University

Public health, presently, is at a difficult crossroads. Its massive success in making the world a healthier place has led to a global embrace of its incredible insights; but still, the challenges currently faced have not given in so easily, as they are deeply entrenched complex problems - or, alternatively, what are more generally referred to as wicked problems!  The global spread of infectious disease; an exponentially growing (or, alternatively, greying) population throughout many parts of the world; the negative impact ecological upset is having on climate and health; urbanisation and the development of mega cities and metropolitan regions; the increasing costs of health and healthcare; air pollution; the opioid epidemic; and so forth.

Still, despite this increasing complexity, public health has been rather resistant to making the shift, falling back on tried-and-true ways of thinking about and modelling public health issues. This is particularly true when it comes to the harsh realities of getting funded or published!  This needs to change! The challenge, however, is how?

Here are, in my mind, six things that public health researchers and practitioners can do to make more effective use of the complexity sciences and advance the use of these ideas across the field:

Six ways to advance the study of complexity in public health

1. Public health is in a difficult position: it realises its work is more complex, but it is struggling to embrace the tools and concepts of complexity science and computational modelling, as it means doing things differently.

• This is particularly problematic in terms of funding streams and publishing in journals.
• The only way forward, then, is to get on with it and actually start funding and publishing such work. High risk can lead to high reward! 

2. Related, the best way forward is for public health to employ a mixed-methods approach, as most public health issues require more than one method, including computational modelling.

• This includes embracing the old and the new, particularly in terms of complex networks, machine intelligence, participatory systems mapping, qualitative comparative analysis (QCA), and agent-based modelling.

3. Public health needs to adopt a critical approach to complexity, as not all methods or theories are equally useful. In other words, the advance of complexity thinking in public health has to be more than the simple application of hard science methods.

• For example, while complex network analysis is powerful, it has significant limits.

4. Public health also needs to develop its theoretical and conceptual understanding of public health topics as complex. This is also true in terms of policy evaluation.

• Not all topics, for example, need to be modelled as overly complex. And there are different ways of modelling complexity.  For an excellent examples, visit the Centre for the Evaluation of Complexity Across the Nexus (CECAN).

5. Public health needs to recognise the important role it plays - both in terms of theory and practical experience - in the development of the complexity sciences, as most of these scholars are trained in other fields. Practitioner expertise, combined with the latest advances in computational methods, will go a long way to improving health. It cannot, however, just be one or the other.

6. Finally, public health needs to adopt a case-based approach to modelling its various complex topics, as health (be it an individual or population) is about cases.

• In turn, it needs to move away from the strict study of variables and variable-based statistics.
• Statistics remains very important for complexity modelling; but variables need to be attached to context and cases and their various path-dependent trajectories.
• Related, the field needs to shift to modelling multiple case-based trajectories, rather than designing a single model.

I want to thank Fuse for the opportunity to present a brief overview of the value of the complexity sciences for public health (and, in turn the value of public health for complexity science!) on 14 February 2019 at Newcastle University.  For those interested, here is a link to the presentation.

Coral Triangle Day

Posted by Duika Burges Watson

June 9th is Coral Triangle Day. The Coral Triangle is a region in South East Asia that covers just 1% of the world’s surface but contains 30% of its coral reefs, 76% of coral reef-building fish species, 9 of the 10 species of giant clam and is home to 100 million people. Celebrating Coral Triangle Day might not sound like an important public health issue for people in the UK, but my reading tells me it is fundamental. I am fortunate to have the opportunity to demonstrate how, as recipient of the 2012 Neville Schulman Challenge Award (with Dr Johanna Wadsley), through our Indonesian research exchange and expedition, Hugging the Coast.



Sometimes topics in public health leap out at you because you are motivated by an issue or concern that really grabs you. Hugging the Coast is a title that resonates on so many levels, and it is one that clearly touched not just us but the many supporters and sponsors that have provided gear, money, expertise, and time to help make the expedition possible.

In August 2012, our international team of six women sea-kayakers and social scientists will traverse the 250km length of the volcanic islands that reach from the northern tip of Sulawesi, Indonesia, to Sangihe in the Celebes Sea - at the edge of the Coral Triangle. We will be documenting and engaging with life in one of the world’s ‘liminal zones’, confronting key contemporary public health issues in relation to climate change and sea level rise, food security and ecology, and how what we ‘do’ at home is not isolated from what happens in other parts of the world.

Our project resonates with the major challenge to public health that is presented in Lang and Raynor’s recent publication Ecological Public Health: Reshaping the Conditions for Good Health. At its core, they argue that public health needs a major overhaul, we need to transform relationships between people, circumstances and the biological world of nature and bodies. They stress that we need better ways to understand and account for major transitions – be they demographic, epidemiological, urban, energy related, economic, nutritional, biological, cultural or political; any conditions involving interactions between human eco-systems and health.

Scenarios developed for the Coral Triangle suggest that in the next century the biological diversity of this ‘Amazon of the seas’ may be destroyed, the resilience of coastal environments will deteriorate and food security – already an issue with climate change and El Nino events – will force migration, urbanisation and even greater depletion of environmental resources. In Hugging the Coast we will confront the lived experience of transitions related to climate change.

But part of the Coral Triangle Initiative, and what Coral Triangle day is there to celebrate, is that there are opportunities to avoid this worst-case scenario – reducing greenhouse gas emissions and building resilience back in with new approaches to agriculture and aquaculture; international investment to ensure that economic growth, food security and natural environments are maintained. On this, a key focus for our expedition and research is the role that seaweed farming might play as an exemplar of ‘climate smart’ agriculture: as an alternative livelihood, reducing fisheries pressures and for carbon sequestration.

The seaweed farmed in the Coral Triangle, is not used there. The product ‘carrageenan’ is extracted from the seaweed and, amongst other uses, is employed in processed foods and fat-reduced products, in toothpaste, as an active ingredient in HIV/AIDs prevention technologies, as an anti-viral agent to protect against HPV and swine flu, and to encapsulate important drugs (for example for novel diabetes drugs). In many applications, public health is a driver of use. In Hugging the Coast we will be exploring a ‘liminal’ zone between land and sea, but also one between the global East and West.

Hugging the Coast offers us an opportunity to map out interactions between human eco-systems and health; to ‘test drive’ an ecological public health approach. It will inevitably be a complex picture, and one that you can follow and contribute to on our blog or on twitter @hugindo