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 counterintuitive 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 interaction of processes occurring at multiple scales, across social and environmental dimensions, with a particular emphasis on linkages and feedback among these processes. https://doi.org/10.1289/EHP7010

中文翻译：

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全球环境健康研究的系统科学方法：加强家庭空气污染 (HAP) 和水、环境卫生和个人卫生 (WASH) 计划的干预设计和实施

 抽象的

 背景：

全球疾病的两个最重要原因属于环境健康领域：家庭空气污染（HAP）和不良的水、环境卫生和个人卫生（WASH）条件。清洁炉灶、家庭水处理和改善卫生设施等干预措施在减少疾病负担方面具有巨大潜力。然而，在最近的试验和实施工作中，改善 HAP 和 WASH 条件的干预措施几乎没有取得预期的健康收益，这对当前的方法提出了根本性的质疑。

 目标：

我们描述了如果不考虑表征不同现实世界条件的复杂系统，可能会导致有前途的新方法过早失败。我们提供了系统方法（包括系统动力学、网络分析和基于主体的建模）在 HAP 和 WASH 研究和项目的全球环境健康优先事项中的应用示例。最后，我们提供有关如何研究系统科学的建议。

 方法：

应用于环境健康的系统科学可以通过以下方式应对重大挑战： a ) 增强对加速或阻碍目标的现有系统结构和行为的理解； b ）在利益相关者之间建立对问题的理解和共识； c ) 指导干预和政策制定。当系统科学应用于涉及研究人群、政策制定者和实施者的参与过程时，有助于确保研究响应当地优先事项并反映现实世界的条件。系统方法还可以通过揭示由于变量之间的相互作用而产生的系统的新兴特性，从而产生复杂的行为，有时甚至是违反直觉的结果，从而帮助解释意外的结果。

 讨论：

系统科学提供了强大但未充分利用的工具，以提高我们识别环境健康干预措施成功的障碍和促进因素的能力。这种方法在实施研究的背景下特别有用，因为它明确地解释了在多个尺度、跨社会和环境维度发生的过程的相互作用，特别强调这些过程之间的联系和反馈。 https://doi.org/10.1289/EHP7010