Exploring Systems Theory in a Place-Based Preventive Health Project

Tasmania has some of Australia’s worst potentially preventable hospitalisation (PPH) rates linked to chronic illness. This means that people are living with increasing pain and incapacity. PPHs are also an unnecessary social and financial cost and signal a failure to address the drivers of chronic illness, disproportionally experienced by people with poor access to the social determinants of health. Systems thinking (ST) is increasingly being applied to understanding such problems and designing solutions from a whole system perspective. This case study describes a novel, exploratory application of ST tools in four communities with high chronic disease risk to better understand and develop place-based interventions in the prevention approach known as ‘Anticipatory Care’ (AC). With community members, recruited through four community bodies, we used causal loop diagrams (CLDs) to implement three of the WHO’s recommended steps to ST in health systems: collectively brainstorm, conceptualise effects, and adapt and redesign. Community stakeholders developed CLDs to understand the locally relevant AC system, determine boundaries and priorities, and identify barriers to and opportunities for change. Opportunities focused on the relationship between safe access, place, belonging, relationships and culture, health information, and health services. At the project’s end, a second set of CLDs identified indicators of changes to local AC systems. Given a ‘blank slate’ for chronic disease prevention, communities developed unique, place-based responses orientated towards strengthening resources, connections, and collaboration. We argue that ST can be used to support community understanding of the behaviour of the local chronic disease prevention system, surface the interdependence of system parts, and identify formerly unrecognised opportunities for and consequences of intervention. The impact of place-based approaches is constrained by structural forces, including policies, norms, institutions, and resourcing.