Using Community-Based System Dynamics to Address Structural Racism in Community Health Improvement

Abstract

Context: Structural racism is a profound determinant of health resulting in pervasive health inequities for people of color. Despite the recognition of structural racism as a complex, dynamic system, we lack a shared vision of the system that would enable identification of solutions for equitable systems transformation. Policy: Through a public health-led community health improvement planning process, a cross-sector consortium implemented community-based system dynamics to provide a systems science lens to guide efforts to eliminate structural racism. Implementation: In group model building sessions involving diverse stakeholders, community-based system dynamics was used to bring together cross-sector stakeholders to create causal loop diagrams of the system of structural racism. Participants identified potential leverage points for actionable focus to eliminate structural racism. Evaluation: Causal loop diagrams of structural racism generated through group model building demonstrate complex dynamics in the areas of criminal justice, education and economic opportunity, health and health care, quality of life, racial trauma and healing, and a promising system transformative solution through perspective transformation. Discussion: Community-based system dynamics, employed in the context of local community health improvement planning, engages stakeholders in systems thinking through sharing lived experience to create system maps of structural racism and identify leverage points and transportable solutions that foster health equity. These informal maps serve as the foundation for formal computer simulation models that will guide systemic action on high-yield, community-driven solutions to eliminate structural racism.

Evaluation of the First Year of the Cross-Sector Innovation Initiative: Lessons Learned in Advancing Cross-Sector Alignment

“…Sites' activities directed at developing or strengthening governance included creating or updating collaborative charters and memoranda of understanding and establishing steering committees or other similar governance structures. To center community voice and participation in governance, community stakeholders attended collaborative meetings, served on steering committees, participated in decisions about funding, and held other decision-making roles 2…”

Applications of Participatory System Dynamics Methods to Public Health

“…29 One of the more powerful advantages of applying a systems thinking lens to public health problems is the ability of SD and system diagrams to demonstrate and communicate complexity effectively. [30][31][32][33][34][35] By utilizing stakeholder input to develop system diagrams, PSD methods allow for the explicit acknowledgment of the complexity of wicked public health problems. [30][31][32][33][34][35] Several articles described PSD methods as approachable tools for understanding and communicating complex concepts into understandable stories accessible to a wide variety of professionals and laypersons alike.…”

“…[30][31][32][33][34][35] By utilizing stakeholder input to develop system diagrams, PSD methods allow for the explicit acknowledgment of the complexity of wicked public health problems. [30][31][32][33][34][35] Several articles described PSD methods as approachable tools for understanding and communicating complex concepts into understandable stories accessible to a wide variety of professionals and laypersons alike. 30,31 The collective act of creating CLDs in PSD methods facilitates a visual storytelling practice that not only accessibly communicates complex concepts H. Decker and M. Wendel…”

“…The process of engaging in PSD methods increases communication, collaboration, and idea sharing among diverse stakeholders from multiple sectors. 31,38,46,52,58,[60][61][62][63] Engaging in PSD allows for stakeholders to collaborate on issues with shared interest, rather than work in silos and compete for resources, and allows for organizations to work together on aligned objectives through coordinated initiatives, strengthening potential for intervention impact. 31,64 PSD methods bring together diverse stakeholders, each with their own "mental database" from which they perceive and navigate the central issue.…”

How Aligning Sectors Builds Resilient, Equitable Communities

“…There are many opportunities to ensure that multisector collaborations prioritize and integrate equity,9 and communities across the nation are doing so in myriad ways. No single organization or sector can solve the deep-rooted issues of systemic racism that America faces10; addressing this requires trusting, honest conversations,11 intentional work, and structural change.…”