The whole systems approach to obesity and non-communicable diseases: Implications for research, policy and practice

Obesity and non-communicable diseases (NCDs), significant threats to population health, are widely understood to be embedded in complex systems of interdependent causal factors. As such, researchers, policymakers and practitioners have become increasingly interested in systems-wide approaches that have the potential to reduce the burden of these diseases. Outcomes of this trend include the development and application of new systems science methods, and a turn towards multi-sectoral collaborative engagement as a key directive for influencing systems. This dissertation explores these aspects of the whole systems approach to obesity and NCDs through three original research papers. In the first, a novel systems science framework is employed to analyze recommendations drawn from 12 documents aimed at influencing obesity planning. Results show that many of the documents focus on changing the determinants of energy imbalance and lack planning at higher levels of system function, such as interconnections between system elements and goal setting. This paper demonstrates the utility of systems science frameworks for introducing systems thinking into policy-level planning in a manner accessible to public health stakeholders. The second and third papers turn to the subject of multi-sectoral partnerships. The first of these represents a review of the role of public health partnerships with the private sector in addressing obesity and NCDs. Contemporary challenges around working with the food and beverage sector are considered through a systems-informed lens that pushes traditional thinking about conflict of interest and the role of monitoring and evaluation activities related to partnership engagement. The following chapter presents an exploratory qualitative study of federal governmental public health staff's experiences working to develop co-funded multi-sectoral partnerships. Findings highlight the opportunities and challenges that emerge from government efforts to shift relations with traditional and novel partners in an effort to leverage partnerships for system change. Suggestions for how program implementers can take dynamic system attributes such as capacity, trust, and power relations into account when implementing multi-sectoral partnership programs are also offered. Finally, this dissertation concludes with a critical reflection on the research findings in light of the whole systems imperative and its implications for the public health response to obesity and NCDs.