Systems Thinking for Public Health: A Case Study Using U.S. Public Education

Abstract

The initial response to the COVID-19 pandemic in the United States largely focused on addressing the immediate health consequences from the emergent pathogen. This initial focus often ignored the related impacts from the pandemic and from mitigation measures, including how existing social determinants of health compounded physical, social, and economic impacts on individuals who have historically been marginalized. The consequences of decisions around closing and reopening primary and secondary (K—12 in the United States) public schools exemplify the complex impacts of pandemic mitigation measures. Ongoing COVID-19 mitigation and recovery efforts have gradually begun addressing indirect consequences, but these efforts were slow to be identified and adopted through much of the acute phase of the pandemic, mirroring the decades-long neglect of contributors to the overall health and well-being of populations that have been made to be vulnerable. A systems approach for decision making and problem solving holistically considers the effects of complex interacting factors. Taking a systems approach at the start of the next health emergency could encourage response strategies that consider various competing public health needs throughout different sectors of society, account for existing disparities, and preempt undesirable consequences before and during response implementation. There is a need to understand how a systems approach can be better integrated into decision making to improve future responses to public health emergencies. A wide range of stakeholders should contribute expertise to these models, and these partnerships should be formed in advance of a public health emergency.