Why Systems Thinking Is Needed to Center Trust in Health Policy and Systems Comment on "Placing Trust at the Heart of Health Policy and Systems".

The editorial by McKee and colleagues is an important call to action to put a spotlight on trust and its role in the function of health systems. The authors make a good case for this focus considering how trust in health systems seems to have eroded in recent years, an erosion accelerated by the COVID-19 pandemic. They recognize that trust is complex given the many forms of trust, the importance of context, and its dynamic and unpredictable nature.

Leadership for systems change: Researcher practices for enhancing research impact in the prevention of chronic disease.

Introduction: Strengthening systems for chronic disease prevention is essential. Leadership for systems change is an important key to strengthening systems. Leadership in prevention research for supporting systems change remains a relatively abstract concept and there is limited empirical information about the leadership practices of prevention research teams when viewed through a complexity lens.

The Promise of Science, Knowledge Mobilization, and Rapid Learning Systems for COVID-19 Recovery.

The health, economic, and social crises created by the coronavirus disease 2019 (COVID-19) pandemic have been global in scope and inequitable in impact. The global road to recovery can be enhanced with robust, relevant, and timely scientific evidence. This commentary seeks to illustrate the power of science, scientific collaboration, and innovative research funding programs to inform pandemic recovery and inspire transformational changes for a more equitable, resilient, and sustainable future.

Can We Build an Evidence Base on the Impact of Systems Thinking for Wicked Problems? Comment on "What Can Policy-Makers Get Out of Systems Thinking? Policy Partners' Experiences of a Systems-Focused Research Collaboration in Preventive Health".

The published literature on the application of systems thinking to influence policies and programs has grown in recent years. The original article by Haynes et al and the subsequent commentaries have focused on the upstream connection between capacity building for systems thinking and systems informed decision-making. This commentary explores the downstream connection between systems-informed decision-making and broader impacts on the health system, the health of the population and other economic and social benefits.

Developing co-funded multi-sectoral partnerships for chronic disease prevention: a qualitative inquiry into federal governmental public health staff experience.

Background: Multi-sectoral partnerships (MSPs) are frequently cited as a means by which governments can improve population health while leveraging the resources and expertise of the private and non-profit sectors. As part of their efforts in this area, the Public Health Agency of Canada (the Agency) introduced a novel funding programme requiring applicants to procure matched resources from private sources to support large-scale interventions for chronic disease prevention. The current literature on MSPs is limited in its applicability to this model of multi-sectoral engagement.

What role should the commercial food system play in promoting health through better diet?

consider that the commercial food system has the potential to show leadership and support for dietary public health, but systemic change is needed first and this is likely to require governmental action

Cross-sector partnerships and public health: challenges and opportunities for addressing obesity and noncommunicable diseases through engagement with the private sector.

Over the past few decades, cross-sector partnerships with the private sector have become an increasingly accepted practice in public health, particularly in efforts to address infectious diseases in low- and middle-income countries. Now these partnerships are becoming a popular tool in efforts to reduce and prevent obesity and the epidemic of noncommunicable diseases. Partnering with businesses presents a means to acquire resources, as well as opportunities to influence the private sector toward more healthful practices.

Systems science and obesity policy: a novel framework for analyzing and rethinking population-level planning.

Objectives: We demonstrate the use of a systems-based framework to assess solutions to complex health problems such as obesity.

Methods: We coded 12 documents published between 2004 and 2013 aimed at influencing obesity planning for complex systems design (9 reports from US and Canadian governmental or health authorities, 1 Cochrane review, and 2 Institute of Medicine reports). We sorted data using the intervention-level framework (ILF), a novel solutions-oriented approach to complex problems.

Health communication cards as a tool for behaviour change.

Individuals seeking healthcare treatment in the context of obesity often experience difficulty engaging in discussions around their health and face challenges finding consensus with practitioners on care plans that best suit their lives. The complex set of biological, social, and environmental variables that have contributed to the higher prevalence of obesity are well illustrated in the foresight obesity system map. Effectively understanding and addressing key variables for each individual has proven to be difficult, with clinicians facing barriers and limited resources to help address patients' unique needs.

Obesity, Complexity, and the Role of the Health System.

As obesity continues to increase throughout the world, there is still no well-defined solution to the issue. Reducing obesity poses a significant challenge for the health care system because it is a complex problem with numerous interconnections and elements. The complexity of obesity challenges traditional primary care practices that have been structured to address simple or less complicated conditions.

The importance of systems thinking to address obesity.

Obesity is clearly a complex problem for both the individual and for society. Complex or 'wicked' problems have common characteristics such as heterogeneity, nonlinearity, interdependence, and self-organization. As such they require solutions appropriate for complex problems, rather than a reductionist search for the causes.

Changing the future of obesity: science, policy, and action.

The global obesity epidemic has been escalating for four decades, yet sustained prevention efforts have barely begun. An emerging science that uses quantitative models has provided key insights into the dynamics of this epidemic, and enabled researchers to combine evidence and to calculate the effect of behaviours, interventions, and policies at several levels--from individual to population. Forecasts suggest that high rates of obesity will affect future population health and economics.

The global obesity pandemic: shaped by global drivers and local environments.

The simultaneous increases in obesity in almost all countries seem to be driven mainly by changes in the global food system, which is producing more processed, affordable, and effectively marketed food than ever before. This passive overconsumption of energy leading to obesity is a predictable outcome of market economies predicated on consumption-based growth. The global food system drivers interact with local environmental factors to create a wide variation in obesity prevalence between populations.

Quantification of the relationship between glycemia and beta-cell mass adaptation in vivo.

Beta-cell mass dynamics play an important role in the adaptation to obesity, as well as in the pathogenesis of type 2 diabetes. Here we used a 24-hour modified hyperglycemic clamp protocol to investigate the effect of increasing glucose concentrations (15, 20, 25, or 35 mmol/L) on beta-cell mass and rates of beta-cell replication, death, and neogenesis in 6-week-old Sprague Dawley rats (n = 40). During the first 4 h of glucose infusion, plasma insulin levels rose to an approximate steady state in each group, but by the end of 24 h, there was no difference in insulin levels between any of the groups.

International perspectives on the physical inactivity crisis--structural solutions over evidence generation?

Many programs to increase physical activity have been evaluated in developed countries, where 'leisure time physical activity' is the most frequent domain for interventions. In developing countries, and also with reference to global obesity prevention, different kinds of interventions targeting 'total physical activity' are needed. This requires efforts across agencies and sectors, and in the domains of work, active transport, reduced sitting time, as well as leisure time physical activity promotion.

Places to Intervene to Make Complex Food Systems More Healthy, Green, Fair, and Affordable.

A Food Systems and Public Health conference was convened in April 2009 to consider research supporting food systems that are healthy, green, fair, and affordable. We used a complex systems framework to examine the contents of background material provided to conference participants. Application of our intervention-level framework (paradigm, goals, system structure, feedback and delays, structural elements) enabled comparison of the conference themes of healthy, green, fair, and affordable.

Getting from analysis to action: framing obesity research, policy and practice with a solution-oriented complex systems lens.

Public policy aimed at reducing obesity is just one of many avenues that must be pursued to address the still-growing obesity pandemic. The complexity of the problem is illustrated in ecological frameworks and system maps of the determinants. These conceptual maps illustrate the complexity by acknowledging the influence of many different factors such as social norms and values; sectors of influence such as the food and beverage industries, media and transportation; behavioural settings including home and family, school and community; and individual factors such as genetics, psychosocial and other personal elements.

A quantitative comparison of rates of phagocytosis and digestion of apoptotic cells by macrophages from normal (BALB/c) and diabetes-prone (NOD) mice.

Macrophages play an important role in clearing apoptotic debris from tissue. Defective or reduced clearance, seen, for instance, in non-obese diabetic (NOD) mice, has been correlated with initiation of autoimmune (Type 1) diabetes (T1D) (O'Brien BA, Huang Y, Geng X, Dutz JP, Finegood DT. Diabetes 51: 2481-2488, 2002).

Dynamics of insulin sensitivity, -cell function, and -cell mass during the development of diabetes in fa/fa rats.

Both male Zucker Fatty (mZF) and lower-fat-fed female Zucker diabetic fatty (LF-fZDF) rats are obese but remain normoglycemic. Male ZDF (mZDF) and high-fat-fed female ZDF rats (HF-fZDF) are also obese but develop diabetes between 7 and 10 wk of age. Although these models have been well studied, the mechanisms governing the adaptations to obesity in the normoglycemic animals, and the failure of adaptation in the animals that develop diabetes, remain unclear.

Pronounced cytosolic aggregation of cellular prion protein in pancreatic beta-cells in response to hyperglycemia.

Cellular prion protein (PrP(C)), an N-linked glycoprotein, is expressed in a variety of tissues, but its functions remain unclear. PrP(C) is abundantly expressed in the endocrine pancreas, which regulates blood glucose homeostasis. Therefore, we investigated whether the expression of PrP(C) was altered in islets of Langerhans in a model of spontaneous type 1 diabetes, the diabetes-prone BioBreeding (BBdp) rat and a model of beta-cell adaptation to hyperglycemia, the chronic glucose-infused Sprague Dawley rat.