New ways for occupational scientists to tackle wicked problems impacting population health

Transcription

1 New ways for occupational scientists to tackle wicked problems impacting population health Alison Wicks and Maggie Jamieson Alison Wicks, PhD, Associate Professor in Occupational Therapy, Faculty of Health, University of Canberra, Canberra, Australia Maggie Jamieson, PhD, Associate Professor in Public Health, University of Canberra, Canberra, Australia Correspondence to: Introduction Solutions to wicked problems impacting the health of populations and the planet have not been found using traditional research approaches (Brown, Harris, & Russell, 2010, p. 4). Therefore, to tackle these issues we urge occupational scientists to adopt new ways of doing research. We advocate that occupational scientists develop new transdisciplinary research partnerships, align with public health s fifth wave (Hanlon & Carlisle, 2012) and adopt the Three Horizons framework (Sharpe 2013). Over the past 25 years occupational science research has focussed primarily on occupation, the relationship between occupation and health and the influence of context on occupation (Rudman, 2013). Context is a key part of population health, yet research by occupational scientists on the impact of occupation on socio-environmental contexts is quite recent (Ikiugu, 2008; Persson & Erlandsson, 2002; Whiteford & Wright St-Clair, 2005). Indeed, the slow uptake of a focus on population health in occupational science is somewhat surprising, given the founders of occupational science maintained that it be an interdisciplinary science, with potential to address problems associated with contemporary lifestyles (Wilcock, 1996; Yerxa et al., 1990).

2 Our Comment was stimulated by participation in the 6 th Australasian Occupational Science Symposium in Canberra. The theme of the 2012 Symposium, Occupation for Population Health, was woven through the papers that were presented, highlighting for each of us not only the inextricable links between our respective disciplines, occupational science and public health, but also the lack of collaboration between them to date. Over the past 12 months we have become aware that both disciplines are concerned with what people do and how and where they live. In fact, the constructs of person, place and time and how they impact on each other are basic to both. Sharing literature, engaging in dialogue and attending a diverse range of presentations on topics such as obesity, climate change and sustainable foods have cemented our collegial relationship. Together, we are exploring the big issues affecting the health of people, populations and the planet, by adopting a population health approach. Three particular books have been instrumental in the development of our views expressed in this Comment: Tackling Wicked Problems Through Transdisciplinary Imagination (Brown et al., 2010) The Future Public Health (Hanlon & Carlisle, 2012) and Three Horizons: The Patterning of Hope (Sharpe, 2013). All provide timely and indeed inspirational theoretical frameworks to guide thinking and action on current and emerging population health problems threatening humanity s future. These books have shaped our proposal on strategies occupational scientists should adopt to research how human occupation has contributed and is contributing to wicked problems and the implications of wicked problems on human occupation. Wicked problems

3 Complex socio-environmental issues resulting in health problems are wicked problems (Brown et al., 2010). They are considered wicked, not because they are morally bad, but because they defy all the usual attempts to solve them. Some argue these problems are beyond the capacity of a single person, organisation or profession to understand or respond to (Blackman et al., 2006). Moreover there are no clear solutions for wicked problems as any resolution could possibly create more issues (Rittel & Webber as cited in Brown et al., 2010, p. 4). Brown et al. (2010) maintain such problems have been created from previous narrow solutions involving traditional methodologies while Hanlon and Carlisle (2012) suggest that modernity has been the cause of many of society s current ills, such as the obesity epidemic, due to over-consumption and lifestyle. Whatever the cause of wicked problems, humanity is confronted by issues that are daunting, with complex interdependencies, where the effort to solve one aspect of a wicked issue may in fact reveal or create other problems. Wicked problems seem impossible to address effectively. They defy attempts to treat them in the traditional, rational and objective manner which involves actioning what is known and then engaging in further research on what is unanswered. We agree the biggest global population health problem is climate change. According to Rifkin (2009), climate change is the disorder caused by human reliance on fossil fuels to propel industrial and urbanised ways of life. But not only has industrial, consumer-driven living caused harm to the planet on which humans live and rely, but this way of life also harms humans. The disorder is not simply environmental. It appears that ever increasing consumption in modern societies not only impacts on resources, but also on societal values, plus planetary, community, and individual well-being (Kasser, 2002).

4 Socio-environmental problems persist, despite considerable work by academics, political activists and others who have identified their impacts and threats. Their persistence prompts questions about the traditional approaches being adopted and a search for new, alternative ways of dealing with them. We propose three new ways for occupational scientists who are seeking to generate understanding about the role of human occupation in population health. Being part of transdisciplinary teams We have been convinced by Brown et al. (2010) that the way forward to a just and sustainable future is through transdisciplinary inquiry. They describe transdisciplinary as the collective understanding of an issue; it is created by including the personal, the local and the strategic, as well as specialised contributions to knowledge (p. 4). In addition, they maintain that transdisciplinarity: can tackle complexity and challenge knowledge fragmentation; is contextspecific; implies collaboration; and is often action-oriented (p. 18). Others refer to transdisciplinarity as a fusion of disciplines (Lawrence, 2004) that involves giving up sovereignty over knowledge, and uses the know-how of laypersons as well as professionals (Thompson Klein, 2004). According to Ramadier (2004), when applied effectively, the outcome of transdisciplinary approaches is knowledge coherence. Brown et al. (2010) also believe transdisciplinarity fosters imagination. They agree imagination is a key ingredient in any recipe to tackle wicked problems as it provides the creative spark for scientific inquiry (Midgely as cited in Brown et al., 2010, p. 5) and is required to overcome the current cultural limitations to the way we think (p. 5).

5 Aligning with the fifth wave The second part of our proposal for occupational scientists working in the field of population health is alignment with public health s fifth wave. As a relatively nascent discipline, occupational science can learn from other, older disciplines about how they are exploring today s complex issues impacting population health. Indeed, occupational science can learn much from public health which has been established for more than 150 years. Recently there is a growing sense in some parts of the public health community that current public health sciences are overly reliant on reductionist approaches and there is a need to embrace new ways of thinking that capture ethics and aesthetics. It has been argued that public health needs a new approach, a fifth wave (Hanlon, Carlisle, Reilly, & Lyon, 2011). Hanlon et al. (2011) have stated that current complex challenges including obesity, inequality and loss of well-being, together with the broader problems of exponential growth in population, money creation and energy usage, require a fifth wave of public health development. They have maintained that the future public health focus needs to be radically different from the previous four phases which have addressed, in turn, public works, medicine as science, welfare and disease control. The fifth wave is based on the proposition that cultural change and re-integration are necessary components of a more sustainable and equitable society (Hanlon et al., 2011b, p. 340). Its integrative model of health encompasses the major dimensions impacting on health: the inner world of the individual; the material world of the physical body; social structures; and cultural belief systems and values (2011, p. 340). Essentially, this model views health and well-

6 being in a very holistic way, and Hanlon et al. argue that this perspective is required to successfully navigate the future and its associated complexity and wicked problems. We believe that occupational scientists can comfortably align with fifth wave thinking as it resonates with an occupational perspective of health (Wilcock, 2006) and a transactional perspective of occupation (Cutchin & Dickie, 2013) and is appropriate for understanding the complexity of occupation in the 21 st century (Whiteford, Klomp, & Wright St Clair, 2005). Hence, our proposed alignment does not require occupational scientists to take a major leap of faith. Embracing the Three Horizons Framework And finally we encourage occupational scientists to embrace the Three Horizons (Sharpe, 2013), a simple and intuitive framework for thinking about the future and how to bring about positive change. Developed over several years by members of the International Futures Forum ( this framework creates an awareness of the future potential of the present, a future consciousness (Sharpe, 2013, p. 8), enabling a mind set to create a future that society needs and wants. A simple description of the Three Horizons model is as follows. Three horizons always exist in the present moment. The first horizon is the current dominant system consisting of established patterns. The third horizon is the landscape of new ways of doing things that arises from changing conditions, new knowledge and new societal priorities and values (Sharpe, 2013, p. 20). The second horizon is the zone of innovation where new ways of doing things are appearing (p. 23), in response to limitations of the first horizon and opportunities.

7 As illustrated by the case studies The Three Horizons framework has been used effectively by various groups to create transformative change and innovation (Sharpe, 2013, pp ). According to Sharpe, transformative change results from re-patterning the way people do things rather than merely extending current patterns. Given the nature of the wicked problems impacting on population health, we believe occupational scientists need to investigate ways and means of initiating transformative change as their contribution to research on the uncertain future that lies ahead. We believe that to tackle wicked problems such as climate change, occupational scientists and others need to do research differently and re-conceptualise the future. The Three Horizons framework can assist in enabling members of research teams to start conversations about innovative ways of creating a transformed future. Conclusions Whilst recognising disciplinary similarities and differences, we advocate more transdisciplinary collaboration as a means of creating a future where well-being of people, populations and the planet is valued. We argue that in order to meaningfully address the wicked problems negatively impacting on individual, community and global health, it is important to begin discourses within and across disciplines to move people from their rational, comfortable standpoints to challenge and be challenged as to what can be done to address these problems. Our goal is to encourage transdisciplinary research where team members become creative facilitators, who freely share knowledge and are open to being educated by others.

8 In addition, we propose occupational scientists ride the fifth wave, viewing health as encompassing inner and material worlds of individuals as well social structures and cultural beliefs and values. And finally, we propose that occupational scientists acknowledge the potential of the present to contribute to healthy futures. We hope that this Comment will encourage discussion and stretching of imaginations. Imagination is associated with creativity, vision and insight, elements that are required to face the wicked challenges of the twenty first century. Imaginative occupational scientists and public health practitioners are among those needed to foster the development of new ways of engagement and thinking about how we tackle these wicked problems. The time has come, we say, to do things differently.

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