A Whole Systems Approach
- How can the framework set out by Foresight be best translated into a ‘Whole Systems Approach’ appropriate for the local system?
- What does it mean in practice for Local Authorities (LAs)? What does it look like and what are the key principles?
- How can LAs create a whole systems approach and what benefits can it bring?
This programme aims to support the vital leadership role of LAs in tackling obesity by working collaboratively with them. It will help equip LAs with approaches to make headway in what is an increasingly complex and challenging landscape involving many sectors with competing priorities and resource pressures. A whole systems approach seeks to link together many of the influencing factors on obesity and will require co-ordinated action and integration across multiple sectors including health, social care, planning, housing, transport and business to bring about major change to combating obesity, making better use of resources and improving wellbeing and prosperity.
Foresight in its ‘Tackling Obesities: future choices’ report outlined that the underlying environmental and behavioural drivers perpetuating obesity exist in a complex and multifaceted system. Tackling obesity effectively will therefore require the development of a sustained ‘whole systems approach’. This approach joins up the many influences on obesity that promotes transformative, coordinated action across a wide variety of sectors, many of whom are outside what has traditionally been referred to as the health sector. By working across multiple disciplines, this will help us to identify the opportunities to support individuals at key points throughout their lives to help reduce the occurrence and impact of obesity.
There is no single approach for bringing about major system change. Instead, success depends on identifying the most crucial components and having a strong understanding of what is needed to create and implement the culture, networks and environment for them to flourish. At the heart of this are our colleagues working in LAs and within communities. This programme will seek to explore their experiences, share learning and help to maximise promising practice on the ground.
As part of our research, we will engage with partners from every sector highlighted in the Foresight map and draw on best practice for taking a whole systems approach to tackling obesity. To facilitate discussion and networking, we will establish a ‘Community of Learning’ to enable us to share emerging ideas and findings as they arise, seek views, evidence and case studies from others and to sense check our emerging findings. If you would like to be involved, please register your interest here.
Our aim is to put LAs first and work in partnership with Public Health England, the Local Government Association, the Association of Directors of Public Health and other partners to translate Foresight’s vision into practical processes and tools. We will co-produce a roadmap which will make a real difference for Local Authorities in tackling and preventing obesity.
What is a Whole Systems Approach?
We have been analysing the different ways in which terminology about whole systems approaches and systems thinking are used, with a view to identifying what is most likely to work and have meaning in the national system, finding the right balance between utilising the theories and practice elsewhere so that we take learning from them but nonetheless create a route map that is meaningful and feasible for LAs, and which is workable for the specific circumstances of obesity.
This work is on going but so far suggests that a whole systems approach has the following characteristics:
- Recognises that obesity is the product of a complex web of interacting and changing causes and influences and as such requires a cross sector approach, not just a public health response
- Combines bringing together all the partners that can have a bearing on obesity with using “systems thinking” to identify the most important factors and make sense of changing dynamics – passage of time, multiple levels, complex influence
- For significant improvements to be made, we need to look at not just the individual contributions of each organisations but also how the whole system works together and can be “more than the sum of its parts”
- Creates a map of moving and interacting drivers and recognises that tackling a single driver in isolation cannot work
- Acknowledges the need for both individual and organisational action
- By moving the interventions upstream, it creates the environment for more effective societal change
Why do we suggest a Whole Systems Approach may work?
This suggests that it has advantages over our previous ways of trying to tackle the issues, because it moves from:
- Silo working, to an integrated, whole systems approach
- Generalising - rather than thinking in general terms about what might work – to solutions tailored to the specific local context. It does not assume that what works in one area necessarily works somewhere else, and it asks what matters here?
- Individual, isolated initiatives, whose combined impact is unpredictable, to considering different potential scenarios and looking at how the system works as a whole, and how each action can contribute
- Focusing on linear cause and effect – setting out a direction and moving forwards and then looking back to see whether it has worked or not which means it can be difficult to respond to changing circumstances and it takes a long time to see results, and even then it is not always clear which elements have worked, particularly with so many changes influencing the landscape and contact – to using dynamic feedback loops, keeping up with the changes and flexing the system to keep actions relevant – recognising and using the living system
- Top down control – to reflecting the new ways local authorities are working, showing local leadership by “holding the ring” and working with and through an extensive range of stakeholders, including communities, facilitating the system and being part of it alongside other stakeholder
What would it look like in practice
Work to date also suggests that a successful whole systems approach would have these features:
- Time is allowed to develop and maintain
- Considers the wider determinants of health and the complex web of drivers and influences
- Joined up co-ordinated action across range of partners in both design and implementation
- Maximises opportunities throughout life course
- Grounded in LA’s wider priorities and policies
- Gathers/uses local intelligence to understand options and how change impacts on others in the system
- A comprehensive portfolio of effective policies and interventions of all sizes combining to maximum effect
- Includes actions in the short, medium and longer term
- Identifies and fills gaps across breadth of system
- Universal – tackling the wider environment – but also addressing the vulnerabilities of key groups
- Dynamic element – goes beyond collaboration and focuses on how the system works as a whole
- Maintains and nurtures relationships, creating a robust, owned and sustainable approach, that refreshes thinking to reflect passage of time and new influences and opportunities
- Includes methods to provide on going feedback into the system