Using community-based system dynamics modeling to understand the complex systems that influence health in cities: The SALURBAL study

We discuss the design, implementation, and results of a collaborative process designed to elucidate the complex systems that drive food behaviors, transport, and health in Latin American cities and to build capacity for systems thinking and community-based system dynamics (CBSD) methods among diverse research team members and stakeholders. During three CBSD workshops, 62 stakeholders from 10 Latin American countries identified 98 variables and a series of feedback loops that shape food behaviors, transportation and health, along with 52 policy levers. Our findings suggest that CBSD can engage local stakeholders, help them view problems through the lens of complex systems and use their insights to prioritize research efforts and identify novel solutions that consider mechanisms of complexity.

[1]  Julian Arellana,et al.  From restricting the use of cars by license plate numbers to congestion charging: Analysis for Medellin, Colombia , 2017 .

[2]  D. Lobell,et al.  The Influence of Climate Change on Global Crop Productivity1 , 2012, Plant Physiology.

[3]  Carlos Augusto Monteiro,et al.  Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil , 2010, Public Health Nutrition.

[4]  G. Mills,et al.  How is ozone pollution reducing our food supply? , 2012, Journal of experimental botany.

[5]  Jim Armstrong,et al.  A Framework for Improving Health in Cities: A Discussion Paper , 2006, Journal of Urban Health.

[6]  George P. Richardson,et al.  Group model building: adding more science to the craft , 1997 .

[7]  Cathy Macharis,et al.  Linking modal choice to motility: a comprehensive review , 2013 .

[8]  José G. Siri,et al.  Sustainable Transport and Urban Health: Lessons from Latin American Cities , 2017 .

[9]  Simón Barquera,et al.  Nutrition transition in Mexico and in other Latin American countries. , 2004, Nutrition reviews.

[10]  Sharmila Devi Wellcome Trust launches Our Planet, Our Health initiative , 2015, The Lancet.

[11]  Mark Stevenson,et al.  City planning and population health: a global challenge , 2016, The Lancet.

[12]  R. Uauy,et al.  Structural responses to the obesity and non‐communicable diseases epidemic: the Chilean Law of Food Labeling and Advertising , 2013, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[13]  María Isabel Maldonado García,et al.  The Political Economy of the 2016 Tobacco and Proposed Sugar-Sweetened Beverage Tax Increases in Colombia , 2017 .

[14]  Flavia Mori Sarti,et al.  Marketing of food and beverage in Brazil: scientific literature review on regulation and self-regulation of advertisements , 2017 .

[15]  Jac A. M. Vennix,et al.  Group model building effectiveness: a review of assessment studies † , 2002 .

[16]  X. Basagaña,et al.  Urban and Transport Planning Related Exposures and Mortality: A Health Impact Assessment for Cities , 2016, Environmental health perspectives.

[17]  M. Petticrew,et al.  The need for a complex systems model of evidence for public health , 2017, The Lancet.

[18]  J. Rivera,et al.  Beverages Sales in Mexico before and after Implementation of a Sugar Sweetened Beverage Tax , 2016, PloS one.

[19]  Anabelle Bonvecchio,et al.  Barreras y oportunidades para la regulación de la publicidad de alimentos y bebidas dirigida a niños en México , 2013 .

[20]  A. Kaczynski,et al.  Social ecological influences on work-related active commuting among adults. , 2013, American journal of health behavior.

[21]  Diez Roux Av,et al.  Health in cities: is a systems approach needed? , 2015 .

[22]  José G. Siri,et al.  Food and Urban Health: Lessons from Latin American Cities , 2018 .

[23]  B. Neal,et al.  Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries , 2013, The Lancet.

[24]  B. Popkin,et al.  Are neighbourhood food resources distributed inequitably by income and race in the USA? Epidemiological findings across the urban spectrum , 2012, BMJ Open.

[25]  Melissa Bopp,et al.  An examination of the relationship of interpersonal influences with walking and biking to work. , 2013, Journal of public health management and practice : JPHMP.

[26]  Daniel Ferrante,et al.  Alimentos y bebidas publicitados en canales infantiles de Argentina: frecuencia, duración y calidad nutricional , 2017 .

[27]  Barry M. Popkin,et al.  Urbanization, Lifestyle Changes and the Nutrition Transition , 1999 .

[28]  Barry M. Popkin,et al.  Implementing A Sugar-Sweetened Beverage Tax In Mexico , Evidence Of Sustained Consumer Response Two Years After , 2017 .

[29]  C. Hawkes,et al.  Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. , 2016, The lancet. Diabetes & endocrinology.

[30]  George P. Richardson,et al.  Teamwork in group model building , 1995 .

[31]  Robert Cervero,et al.  Built environments and mode choice: toward a normative framework , 2002 .

[32]  R. Cervero,et al.  BRT TOD: Leveraging transit oriented development with bus rapid transit investments , 2014 .

[33]  Michael S Koehle,et al.  The Health Effects of Exercising in Air Pollution , 2014, Sports Medicine.

[34]  L Suzanne Suggs,et al.  High-quality health systems: time for a revolution in research and research funding. , 2019, The Lancet. Global health.

[35]  Laura K Brennan,et al.  Systems thinking in 49 communities related to healthy eating, active living, and childhood obesity. , 2015, Journal of public health management and practice : JPHMP.

[36]  Lawrence D. Frank,et al.  The Built Environment and Human Activity Patterns: Exploring the Impacts of Urban Form on Public Health , 2001 .

[37]  B. Popkin,et al.  Global nutrition dynamics: the world is shifting rapidly toward a diet linked with noncommunicable diseases. , 2006, The American journal of clinical nutrition.

[38]  Waleska Teixeira Caiaffa,et al.  A Novel International Partnership for Actionable Evidence on Urban Health in Latin America: LAC‐Urban Health and SALURBAL , 2018, Global challenges.

[39]  D. Ferrante,et al.  Food and beverage advertising on children's TV channels in Argentina: Frequency, duration, and nutritional quality. , 2017, Archivos Argentinos de Pediatria.

[40]  Peter S. Hovmand,et al.  Community Based System Dynamics , 2013 .

[41]  K. Evenson,et al.  A systematic review of fast food access studies , 2011, Obesity reviews : an official journal of the International Association for the Study of Obesity.

[42]  A. Drewnowski,et al.  The nutrition transition: new trends in the global diet. , 2009, Nutrition reviews.

[43]  Dov Jaron,et al.  Health and wellbeing in the changing urban environment: complex challenges, scientific responses, and the way forward , 2012 .

[44]  K. McLeroy Thinking of Systems , 2006 .

[45]  Eyal Oren,et al.  Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, Lancet.

[46]  D. Andersen,et al.  Using Visual Representations as Boundary Objects to Resolve Conflict in Collaborative Model-Building Approaches , 2012 .

[47]  Dirk Heinrichs,et al.  Public Transport and Accessibility in Informal Settlements: Aerial Cable Cars in Medellín, Colombia , 2014 .

[48]  J. Sterman Learning from evidence in a complex world. , 2006, American journal of public health.