harry rutter

12/6/16

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Obesity, systems and complexity

Harry Rutter@harryrutter

Evidencetrajectories

Time

Hunch-based

Levelofactivity

Evidence-based

All possible interventionsEvidence of cost-effectiveness

Evidence of effectiveness

Thedangerousoliveofevidence…

Source: Swinburn et al, Lancet 2011

+ research difficulty

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Obesitystrategyanalysis

Source: Johnston, Matteson, Finegood, Simon Fraser University: personal communication

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GeoffreyRose

ChangeintheadultBMIdistributionHealthSurveyforEngland1991to1993and2011to2013

Adults aged 18+ population weighted

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http://en.wikipedia.org/wiki/File:Colosseum_in_Rome,_Italy_-_April_2007.jpg

2014SurgeonGeneral’sReport,Fig2.1.ThankstoCliffDouglas@cdoug

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Source: Swinburn et al, Lancet 2011

Evidencebase

Public/media/politicaldiscourse

Politicalmandate

Source: Swinburn et al, Lancet 2011

Evidencebase

Public/media/politicaldiscourse

Politicalmandate

Conclusions

• Don’ttreatcomplexsystemsassimple:ofcoursemanythingsappearnotto'work’,we'rejudgingthemonthewrongcriteria

• Linearcauseandeffectis(relatively)easytolookfor,butthatdoesn’tmeanit’salwayshelpfultodoso

• Shiftfromreductionist,linear,singleperspectivethinkingtotransdisciplinary,non-linearsystemsthinking

• Don’tforgetthelessonsofRose:populationlevelpreventioninvolvesshiftingthepopulationcurveinwaysthatmaybeindiscernibleatindividuallevel

• Conceptualiseactionsasdrivingperturbationswithinsystems,notashammersappliedtonails

• Movefrom‘doesitwork?’to‘doesitcontribute?’