Systems Science Approaches for Global Environmental Health Research: Enhancing Intervention Design and Implementation for Household Air Pollution (HAP) and Water, Sanitation, and Hygiene (WASH) Programs

• Type of Material: Article
• Authors: Joshua Rosenthal, National Institutes of Health; Raphael E. Arku, University of Massachusetts; Jill Baumgartner, McGill University; Joe Brown, Georgia Institute of Technology; Thomas Clasen, Emory University; Joseph N.S. Eisenberg, University of Michigan; Peter Hovmand, Case Western Reserve University; Pamela Jagger, University of Michigan; Douglas A. Luke, Washington University in St. Louis; Ashlinn Quinn, National Institutes of Health; Gautam N. Yadama, Boston College
• Language: English
• Date: 2020-10-01
• Publisher: US DEPT HEALTH HUMAN SCIENCES PUBLIC HEALTH SCIENCE
• Publication Version: Final Published Version
• Copyright Statement: EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.
• License: Creative Commons Universal : Public Domain Dedication
• Final Published Version (URL): http://dx.doi.org/10.1289/EHP7010
• Title of Journal or Parent Work: ENVIRONMENTAL HEALTH PERSPECTIVES
• Volume: 128
• Issue: 10
• Start Page: 1
• End Page: 12
• Grant/Funding Information: Financial support from the NIH Common Fund’s Global Health program for the Clean Cooking Implementation Science Network and from the Boston College School of Social Work enabled the 2018 workshop where these ideas were initially developed. The findings and conclusions in this report are those of the authors and do not necessarily represent the official views of the U.S. National Institutes of Health or Department of Health and Human Services.
• Keywords: Public, Environmental & Occupational Health; DISEASE; COOKING; DIARRHEA; MIDDLE-INCOME COUNTRIES; NUTRITIONAL INTERVENTIONS; COOKSTOVE INTERVENTION; Science & Technology; CHILD GROWTH; Life Sciences & Biomedicine; Toxicology; PUBLIC-HEALTH; Environmental Sciences; DRINKING-WATER; Environmental Sciences & Ecology; STOVE USE
• Research Categories: Health Sciences, Toxicology; Health Sciences, Public Health

Abstract

BACKGROUND: Two of the most important causes of global disease fall in the realm of environmental health: household air pollution (HAP) and poor water, sanitation, and hygiene (WASH) conditions. Interventions, such as clean cookstoves, household water treatment, and improved sanitation facilities, have great potential to yield reductions in disease burden. However, in recent trials and implementation efforts, interventions to improve HAP and WASH conditions have shown few of the desired health gains, raising fundamental questions about current approaches. OBJECTIVES: We describe how the failure to consider the complex systems that characterize diverse real-world conditions may doom promising new approaches prematurely. We provide examples of the application of systems approaches, including system dynamics, network analysis, and agent-based modeling, to the global environmental health priorities of HAP and WASH research and programs. Finally, we offer suggestions on how to approach systems science. METHODS: Systems science applied to environmental health can address major challenges by a) enhancing understanding of existing system structures and behaviors that accelerate or impede aims; b) developing understanding and agreement on a problem among stakeholders; and c) guiding intervention and policy formulation. When employed in participatory processes that engage study populations, policy makers, and implementers, systems science helps ensure that research is responsive to local priorities and reflect real-world conditions. Systems approaches also help interpret unexpected outcomes by revealing emergent properties of the system due to interactions among variables, yielding complex behaviors and sometimes counterin-tuitive results. DISCUSSION: Systems science offers powerful and underused tools to accelerate our ability to identify barriers and facilitators to success in environmental health interventions. This approach is especially useful in the context of implementation research because it explicitly accounts for the interac-tion of processes occurring at multiple scales, across social and environmental dimensions, with a particular emphasis on linkages and feedback among these processes.