Systems Change Science

Introductory Paragraph

The primary purpose of this article is to demystify systems change science. Anyone working to change social norms is, by definition, aspiring to change a variety of systems which support outlooks resistant or barriers to innovative solutions. Anyone involved in working across the continuum of care or doing multi-sectoral work is, by definition, breaking down silos (See the SAFE Solution article titled, “Activate Your Community.”) Systems change science simply highlights the most effective ways to make those changes happen.

The secondary purpose of this article is to introduce the relationships between the themes covered in greater detail in the other articles in this collection of article on system-building. For example, all of the articles of the Strategic Prevention Framework (SPF) incorporate data, whether it is in needs assessment, prioritization of implementation choices during planning, or in evaluating outcomes. Likewise, the process of advocacy (see “Advocate for Policy Change”) is dependent not only upon data but upon the effective communication of measurable outcomes (See “Build Education and Raise Awareness”).

Key Information

In keeping with the objective of demystifying systems change science, it may be useful to keep in mind the saying, “the whole is greater than the sum of the parts.” This comes from the systems approach, which is really just a way of thinking. It focuses on the big picture and on seeing the relationships between the component parts of the system. In a way it a bifocal vision — seeing both the forest and trees. It invites seeing patterns and underlying structures. Such a vantage point equips us to identify optimal courses of action to create change most effectively. For example, one motivated champion in a coalition may have more community impact than ten people who are members because of their departmental obligations, so finding three more comparable champions helps the coalition to leverage change more effectively than just focusing on growing the size of the coalition.

A systems approach also takes a deep view. It focuses on changing the source of conditions, rather than addressing symptoms. The prevention community has done a good job of promoting the need to balance “downstream” work with an “upstream” and proactive approach. Systems thinking goes further and looks at the groundwater. In many respects, a focus on protective factors creates a context for allies working in related fields, such as substance use prevention, suicide prevention, and the prevention of gun violence or domestic violence (See the SAFE Solution article titled, “Intersectionality.”) Likewise, the deep view of a systems approach encounters underlying values and worldviews that shape the landscape of the work we are doing around substance use.

Examples of System-Building

Any form of multi-sectoral collaboration is inherently systems work. Building coalition membership with representation from stakeholders who represent different agencies requires acting on a broad view. Bringing together health promotion and law enforcement agencies is a complex systems task because they tend to work on opposite ends of the upstream/downstream continuum. Likewise, fostering collaboration between the medical community and the faith community reveals the kind of language translation that is needed because one tends to speak of curing while the other operates in a healing modality. Community/Campus initiatives are also examples of systems work. Likewise, whenever we are working in two or more of the five zones of the social-ecological model (individual, family, peer, school, community) we are implementing a systems approach.

While system-building may seem complex at first, when the extent to which we are already engaged in working across multiple systems, it becomes much simpler. However, simple is not necessarily easy. One area of doing the hard work is in the community-wide norm change associated with stigma reduction (See the SAFE Solution article titled, “Reduce Stigma.”) Another example is work done to address social determinants of health. One cannot work very long in prevention, treatment, or recovery without encountering the “negative synergy” often caused by multiple concurrent barriers in transportation, housing, and employment systems (See the SAFE Solution article titled, “Apply a Health Equity Lens.”) Four more detailed examples are provided below:

Relevant Research

• Extensive work has been done in systems research in the physical and biological sciences, but less in the social sciences, especially focused on social systems associated with SUD. The classic introduction to the field is provided by Peter Senge who defines systems thinking as “a way to see interrelationships rather than things ... patterns of change rather than static snapshots.” He calls it a sensibility for subtle interconnectedness that is increasingly necessary in a world fraught with complexity.

• A summary of work in changing social systems can be found in the work of David Stroh.

• The World Health Organization promotes systems thinking as a way to mitigate negative behaviors, anticipate positive synergies, and create system-ready policies.