So, welcome to Section B, in this section we're going to talk about how we apply systems thinking in a top down mode for policymaking. So the standard top down policymaking frame is one that we're all familiar with, where we go to John's Hopkins, we get these degrees, and then we become these smart, beneficient, skilled policymakers and we go out and save lives millions at a time. So the fact is, this is not I'm making fun of it but it's true, there are big problems in the world, they need big solutions, and then they need skilled policymakers. The problems faced by the Food and Drug Administration, Centers for Disease Control, National Institutes for Health, Medicare, you name it. Even in Global Health WHO and the Gates Foundation in USA ID. They all have big problems. And the big problems need systems thinking to illuminate the choices. But the problem of able woman in illumination is the same that the policy makers need to have their problems framed in language they can understand, but involving stakeholders that matter. So the conventional role of technocrats in this Standard Policy Frame is to analyze the complex problems facing the top-down decision maker. And in order to understand the model, understand the problem, they'll make a model that identifies the best thing to do. After going into our computers or into our laboratory and then thinking through the problem, the next step in this conventional role is to communicate our model to the policy maker, and then to allow the policy maker to select the best course of action. And the policy maker will then thank the technocrat for their great model, and go off and solve the problem, and everybody's happy. That's sort of the textbook version of what this looks like. And it's true that many people who do systems modeling practice their craft exactly this way. They go to a policymaker who says I'm facing this terrible problem. I wish you could make a model of it. The systems engineer makes the model and everything works right according to this plan. This is what is true and it works and there's really nothing wrong with it. However, it's incomplete. The challenges faced in this top down application of systems thinking are to make sure that you've eliminated the policymaker about unanticipated threats. Telling them the things that they should monitor, the benchmarks that will let them know that their solution is working properly. And to notify the policymaker about the political levers that matter. Just like Walman identified the property owners and their taxes were an important political lever, this has to go on in the current systems models that we offer policymakers. It's not enough to tell the Obama administration. This is a great way to cover Americans against the problem of uninsurance. One would actually have to model the political backlash that one might face in order to help the policy maker be illuminated. Now you've seen enough in this class of how challenging the complex models are for ourselves to understand that brings about the challenge of communication as well. Complex models, like we provide in systems dynamics or agent based modeling, they're really hard to explain and it's really hard to get policymakers to develop a lot of trust in them. So a lot of the time the people working in systems modeling will co-develop the model using participatory strategies. They don't sit shoulder to shoulder with the policymaker at the terminal writing the code, but they will iteratively go back and forth to the policymaker to make sure that they've understood the problem well and develop a model that encompasses all of the considerations of the policymaker. So what's coming in illumination is to broaden the scope of policy models to extend the elimination to the political landscape. And this, in and of itself can shift the ecostructure of power and control as Wolman understood, the mayor didn't hold all the cards. The mayor couldn't just raise taxes. And Wolman didn't just tell the mayor to get the political support. Wolman built the political support himself. That's important. So often, we come as public health technocrats and we say to the governor or the mayor here's the solution, you get the politics done. Wolman didn't do that. And I think he'd made a great example for us. He was the one who sold the plant to the landlords and engaged them in the decision directly. So this brings me to a really important concept in your training in public health which I call the public health triumvirate. I didn't invent this concept, it's a very old concept in the practice of public health. And it's the idea that in all public health problem solving, one requires three groups at the table. You have to have your technocrat, let's say your Abel Wolman. Somebody who understands the epidemiology and the public health practice, that's the technocrat, combine them with the professional politician, the mayor, the governor, the legislator, and combine them with the civic leader. All three have to be at the table, and all three have to illuminated about the nature of their problem. So very common strategic error is the leave one out problem. If you leave one of the three out, it doesn't work well. Imagine if we leave out the politicians or we leave out the civic leaders. So, if you imagine if the technocrat just goes right to the mayor and says mayor, here is the solution but doesn't provide the political will by engaging the civic leaders. The mayor might just give up and say look I have to run for office. I'm not doing this crazy tax on tobacco or tax on soda, I can't sell it to the voters. So by engaging all three you've solved that problem. Or imagine if the policy maker goes right to the civic leader and doesn't get informed by the technocrat. We've seen that all over the world where they don't have the epidemiological facts and they simply solve public health problems without an understanding of what has worked in the evidence based literature. And finally we do this a lot in public health. We don't work with the local health department or with the elected officials and we go straight to the civic leaders and do our own thing without engaging the government. We do this a lot. We say look you guys need vitamin A or vaccinations, we will build our non-governmental organizations that do public health. But by failing to engage the local government we don't get the sustainability. So the concept of building the public health triumvirate is something that is going to give sustainability and inclusiveness to all public health policy. So we need to build an inclusive top-down ecostructure. And this sounds like a contradiction. How can it be top-down? And be inclusive. Well, top-down policies that are not inclusive run into obstacles. You have to make sure you're dealing with the civic leaders, but by reaching down from the top with the civic leaders and the technocrats, you'll be on firmer territory and have a much more sustainable approach to your public health problem solving. So the analogy that I'd like to suggest for you is a parenting analogy. One that should be familiar to those of you who are parents. But the parent of course in this analogy is akin to the policy maker. And in child development and pediatrics we describe four different categories of parenting. There are neglectful parents that really have other problems in their life besides parenting and they communicate through word or action that they really don't care about their children. The child gets the message that they are not loved and their parents say basically do whatever you want. Unfortunately, our world is full of parents like this and the outcomes are horrendous. There's another version called the authoritarian parent who communicates love and concern for the child but gives them no latitude for any independent decision making. The authoritarian parent says I love you. Do exactly as I say or face my punishment and consequences, and that is a form of parenting that we see a lot of too, it works on it's own terms, but it squelches the development of independent decision making. It can work but it has these criticisms. There are permissive parents who say I love you, do exactly whatever you want. I won't form any standards, I won't really talk to you, but I really care about you and I think you're great. So those children develop self esteem but are given no guidance into what works and the outcomes can be chaotic as well. So the authoritative parenting style is what pediatricians and developmental psychologists are endorsing. Which is the communication to the child that, I love you, I am concerned about your welfare. Let's work together to illuminate our shared problem. Let's look at the consequences of your actions, and then basically you as a child, if you're able to see the way I see it can make decisions. And the authoritative parents, and the authoritative parenting style is the style that is the one that has the most stability. Now, I hope you can make your own analogy to policy making, but let's just say that the authoritative policy maker is concerned about the consequences of their policy but has decided not to be authoritarian in saying well I'm so smart, you've got to do it my way. But let's work together to find a solution. That is the authoritative talk down style that is inclusive, requires great communication skill, and requires the ability to sit back and allow involvement for the people that one is making policy for. This goes back a long time in political philosophy. Back at the beginning of the USA in the 1700's, we started a debate and we're still not done with this debate between the Federalists and the anti-Federalists. Alexander Hamilton, who wrote of the Federalist Papers and is on the $10 bill, believed that most Americans are self-centered rabble and they shouldn't be trusted. According to Hamilton and the Federalists who follow him, we really need enlightened gentleman to run things to get things right. And under Hamilton, there was a movement to strengthen the hand of the national government. And to control things from Washington DC. In contrast, there were anti-federalists. Thomas Jefferson would have been their leader back in early history of the United States. Jefferson believed in the inherent dignity and responsibility of everyone and his approach would have been to trust the locals and to build America based on gentleman farmers making town hall decisions as the basic approach to policy and local control. And if you'll think about current debates in politics not just in America but around the world. This idea between who should be in charge, Washington or the locals, Geneva or local governments, continues. This idea of, can we really trust people to make decisions, or don't we need really smart people with complex, adaptive systems models to develop the policy prescription that we need? So these ideas are hopefully going to help inform how we use our systems thinking as we engage top down policy makers. So the road ahead in this space is to make sure we engage all three parts of the public health triumvirate. But engage them in participatory model building to bring the technocrat into the room with the policy maker and the civic leaders to show them their model of the system that they're concerned with. And use the model, and this could be a causal loop diagram or a more complicated model, but it has to be communicated well in order to have everybody share their understanding. What we've seen in this course on systems thinking is that we can motivate attention on the key levers and the benchmark things we want to measure. This happens when we do system dynamics and causal loop diagrams, as well as net logo based, agent based models. It helps us see what matters the most. In the next section we'll talk about how we can apply systems thinking to bottom up modeling.
