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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用于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，卫生与卫生（WASH）计划的干预设计和实施

摘要

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。诸如清洁炊具，家庭水处理和改善的卫生设施等干预措施，具有减轻疾病负担的巨大潜力。但是，在最近的试验和实施工作中，改善HAP和WASH状况的干预措施并未显示出所需的健康益处，这引发了有关当前方法的根本问题。

目标：

我们描述了未能考虑到表征各种现实世界条件的复杂系统如何可能注定过早提出新方法的命运。我们提供了将系统方法（包括系统动力学，网络分析和基于代理的建模）应用于HAP和WASH研究与计划的全球环境健康优先事项的示例。最后，我们提供有关如何处理系统科学的建议。

方法：

应用于环境健康的系统科学可以通过以下方式解决主要挑战：）增进对现有系统结构和行为的理解，这些结构和行为会加速或阻碍目标；b）在利益相关者之间发展对问题的理解和共识；和Ç）引导介入和政策制定。当系统科学用于参与研究人群，决策者和实施者的参与过程时，系统科学有助于确保研究对当地优先事项做出反应并反映现实情况。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紧急特性，产生复杂的行为以及有时违反直觉的结果来帮助解释意想不到的结果。

讨论：

系统科学提供了强大而未被充分利用的工具，可加快我们发现环境卫生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，因为它明确说明了跨社会和环境维度在多个规模上发生的流程之间的相互作用，并特别强调了这些流程之间的联系和反馈。https://doi.org/10.1289/EHP7010