India’s Total Lockdown — Systems Thinking for Public Health
Are we asking the right questions?
In the 1950s, the Dayak people of Borneo, an island in Southeast Asia, were suffering from an outbreak of malaria, so they called the World Health Organization for help. The World Health Organization had a ready-made solution, which was to spray copious amounts of DDT around the island. With the application of DDT, the mosquitoes that carried the malaria were knocked down, and so was malaria.
There were some interesting side effects, however. The first was that the roofs of people’s houses began to collapse on their heads. It seems the DDT not only killed off the malaria-carrying mosquitoes, but it also killed a species of parasitic wasp that up to that point had controlled a population of thatch-eating caterpillars. Without the wasps, the caterpillars multiplied and flourished, and began munching their way through the villagers’ roofs.
That was just the beginning. The DDT affected a lot of the island’s other insects, which were eaten by the resident population of small lizards called geckos. The biological half-life of DDT is around 8 years, so animals like geckos do not metabolize it very fast, and it stays in their system for a long time. Over time, the geckos began to accumulate pretty high loads of DDT, and while they tolerated the DDT reasonably well, the island’s resident cats, which dined on the geckos, did not. The cats ate the geckos, and the DDT contained in the geckos killed the cats. With the cats gone, the island’s population of rats came out to play, and we all know what happens when rats multiply and flourish. Pretty soon, the Dayak people were back on the phone to the World Health Organization, only this time it wasn’t malaria they were complaining about. It was a plague and the destruction of their grain stores caused by the overpopulation of rats. This time, though, the World Health Organization didn’t have a ready-made solution and had to invent one: they decided to parachute live cats into Borneo. “Operation Cat Drop” occurred courtesy of the Royal Air Force and eventually stabilized the situation.
Source: Sustainability illustrated and https://en.wikipedia.org/wiki/Operation_Cat_Drop
Well, I don’t know how the events unfolded thereafter. But this is what happens when we fail to practice systems thinking. If we don’t understand how different systems work together, the so-called solutions can create more damage than the problem itself.
In today’s COVID-19 crisis here in India, our country is locked down for three weeks. I can’t be sure if that is the right solution or not. Yes, there is a sense of urgency, but that does not overwrite the fact how systems work. I am just writing this to help us ask the right questions. As a product designer, I put systems thinking hat at work.
The goal of systems thinking is to become less and less wrong in the outcomes and become more and more effective. It is to have a vision of how all these things come together.
Systems are complex and interconnected. When we talk about ecosystems, we see how everything is connected, and one erroneous change can bring unintended consequences, as we saw in the above example. When we talk about public health, we don’t just study human health; we see the environment, animal health, socioeconomic conditions, and many other systems.
If we focus on only one aspect of the problem, the ramification could be very costly. Here are a few questions we can ask in our current scenario. First set of questions on what we are doing. We need to frame the problem with an expansive set of boundaries.
What are the current trends in our nation? Our unemployment situation, poverty, economy, healthcare system, and others?
How will this affect people who need health care due to ailments other than COVID-19? Over 50,000 women deliver babies every day. How will they manage?
How are our decisions going to impact these systems? How about agriculture systems, will the farmers’ produce reach the consumers on time?
What would be the future price we want to pay?
How do we want the future to play out?
Do we have a dynamic vision?
The second set of questions is about the big-picture view.
How will this impact more than the area of interest? Will it impact the agriculture sector and our real-estate sector?
Who else is concerned?
If we make a change here, where else will there be a change? How will it affect the daily wagers or the homeless? There are around 450 million daily wage workers in informal sectors.
The third set of questions is on the science of how systems work. For example, health-care systems or business or governance.
What are the necessary conditions and how they arise and change?
What is accumulating, and what is the rate of change?
What if another virus breaks out shortly. What if this COVID-19 reoccurs?
How does the corruption in the system affect implementation? Just because something worked in one context or country does not mean it will work in the other. The conditions may be different.
The final set of questions is about feedback after implementing the solution. What is the feedback mechanism?
Is there a virtuous or a vicious cycle?
Is there a push back in the system?
Is it trying to stay in equilibrium?
If we only focus on the immediate result and fail to look into the ramifications carefully, we may cause greater damage than the problem itself. We need to approach with an expansive set of boundaries. We should understand that no one system has all the answers; therefore, we need to collaborate with people from diverse backgrounds in humility. And finally, we need clear communication. Clear communication of the vision and plan to all people in the scope of influence is crucial. That can clear confusion and encourage positive participation from all sectors.
If you have any suggestions do comment below.
Links for further information.
