Systems thinking and public health

Use of the terms “public health system” and systems thinking has become commonplace in the public health literature and in many initiatives in public health regulation, education, planning, research, and management. This paper presents: an overview of systems thinking, a summary of several of its more prominent disciplines, examples of the use of the term in recent public health literature and practice, proposed or attempted applications in public health systems research, and a discussion of the specific organizational leadership discipline recommended by Peter Senge in The Fifth Discipline (Senge's work is often cited in the public health management literature). The paper will provide a critique of systems thinking (its value and its weaknesses) generally and of Senge's concepts in particular. It proposes an approach recommended by Ralph Stacey and others, complex responsive processes, as an alternative or complement to systems thinking. Stacey's approach seems more consistent with the day to day experiences of public health managers and empirical management studies and provides important insights into critical aspects of public health organizations, including power, ethics, communication, leadership, and organizational politics. The approach of Stacey and others has important implications for public health systems research.