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"Systems Thinking" Needed to Tackle Children's Environmental Health Inequities

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Two Black children sit outside during summer looking happy with arms in the air
Devon C. Payne-Sturges

When it comes to health officials and experts evaluating environmental health risks among populations, what has been the norm isn’t enough, and a shift is needed to better protect children and other vulnerable groups, according to Devon Payne-Sturges, an assistant professor of Applied Environmental Health in the University of Maryland School of Public Health. 

She is the leading author of a new research paper in Environmental Health Perspectives titled “Defining and Intervening on Cumulative Environmental Neurodevelopmental Risks: Introducing a Complex Systems Approach.” 

‘“The question isn’t ‘Can we measure these effects better?’ but ‘What are we going to do about it?”’

Payne-Sturges said her article models a new “systems thinking” approach that challenges the traditional, linear way that health experts and regulatory agencies have tackled health issues. 

“We are trained to think linearly and short term, not trained to think of long term impacts, unintended consequences or how a decision in one sector can have an impact in another sector,” Payne-Sturges said.

For years, she has researched cumulative risks and impacts of environmental toxins/pollutants across populations, particularly, children’s neurodevelopment. 

Her co-authors, including School of Public Health professors Stephen B. Thomas and Robin C. Puett, are all mentors who have worked with Payne-Sturges since she received her National Institutes of Health (NIH) K01 Career Development Award. 

Over the last three years, she has focused on how combined exposure to environmental and social stressors affects child neurological development. The paper is a product of the 2018 K01 grant, Payne-Sturges said. 

It discusses the effects of air pollution and its impact on the brain, specifically from lead, which can poison kids and lead to negative consequences for education, employment, earnings and lead to impacts on the generations to follow. 

Populations are overburdened with multiple pollution exposures that contribute to health disparities, according to Payne-Sturges. Additionally, these communities experience poverty and psychosocial stressors including racism. 

These factors combined heighten the risk of adverse health impacts and differences in health across populations, she said. 

“The evidence is pretty clear in my mind,” she said. “It is not something that just happened, we’ve known about it. But there’s been no action taken to address the conundrum, maybe because it is complicated but maybe because it requires a different orientation - by regulatory agencies and public health.” 

Implementing a systems approach can provide some clarity about what to do, and hopefully, prevent adverse “feedback loops,” which are cycles that can have long-term effects and impacts on the next generation like poverty, Payne-Sturges added.

The paper highlights shortcomings like the risk assessment framework, which is quantitative and “best used to look at single chemical agents.” However, it isn’t set up to “address multiple exposures or stressors that aren’t chemicals,” she said. 

What’s missing for risk assessment is asking why and how something is happening. This is what the system approach provides, both qualitative and quantitative aspects, according to Payne-Sturges. Looking at broader systems, such as social and political structures, can help identify the root causes of these environmental exposures and risks, she explained. 

Payne-Sturges said the systems modeling has been used to address issues, including obesity, suicide risks and natural resource management. Environmental health, however, hasn’t been touched.

“That then helps to illuminate where there could be these leverage points that we can apply a policy change that could reduce these exposures,” she said.

Health is created and influenced by several factors beyond health care and public health, requiring a “cross-sectoral interaction” among public sectors, Payne-Sturges said.

“One thing from this systems qualitative approach is helping all the different stakeholders recognize that there is a system that they’re all playing a role in that forces them to break out of their silos, their little bubbles and bounded realities.” 

Recently, Payne-Sturges held a group model-building workshop with stakeholders around children’s environmental health and neurodevelopment. She introduced them to the systems concepts, and they created a causal map.

“We could then begin to see what are those structures and relationships between different factors that are all impinging on children’s neurodevelopment,” she explained. 

The paper, published March 10, was focused on demonstrating the insights the systems approach offers. The next paper will focus on applying it in a collaborative modeling building context to inform solutions.

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