Perspectives in Public Health: Systems thinking for grades K-4

There's an on-going discussion on the systems dynamics society list-server about what might be taught to youth in grades K-12, which would be ages 6-18, roughly, in the US. One reason for that focus is a sense that older people seem to get more set in their ways.

On a parallel path, I'm still working on the question of how to teach basic "systems thinking" concepts to such older students, starting with MPH students, who now have a whole section of their curriculum labeled "systems thinking." The reality is that the School of Public Health faculty have not yet figured out how to operationalize that, i.e., teach it and test it and expect it as core knowledge past some point in the curriculum.

And, a good fraction of "The Toyota Way" is getting out of localized, parochial thinking and switching to global, longer-term thinking. In hospitals, many people have heard that "the system" makes mistakes, not people, but this is weakly implemented in practice and most people don't really understand what it means. Pretty much any collection of more than 4 boxes connected by at least 3 lines or arrows is called "a system." That's not an empowering concept.

But most wisdom can be broken down somewhat into concepts and more basic concepts and even more fundamental concepts, and education then takes the reverse path and starts trying to teach the fundamental concepts early. Usually this will take multiple passes over multiple years to get it to "sink in."

So, what are the fundamental concepts of systems? Here are a few thoughts I had of some basics, akin to "Don't run with scissors!"

...I feel strongly that there are technologies that can simplify teaching concepts... By "simplify" I mean by an order of magnitude, or convey the concept at all versus not at all.

The first example of this I came across in my own teaching was trying to convey the concept of mean and standard deviation of a normal bell-shaped curve. One approach was to use words and equations and writing on the black or green board (Yes, I'm showing my age.) The other was to put a computer in front of the student with two controls, or sliders that involve significant motion of an arm and hand - where one control changed the mean and the other control changed the standard-deviation, in real time, as you slide them around.
The first approach took 1-2 weeks, and had maybe 50% retention a month later, if that. The second approach took 1-2 minutes, and I think had more like a 95% retention rate.
Moral of the tale - humans are cybernetic creatures and can relate very easily to something if it can connect to their body or through their body to their brain. I feel pretty secure in my observation of that, but I'm open to someone quoting Piaget back at me saying I'm all wet.

So, as you can imagine, I was immensely sad to see that the "flight simulator" mode of Vensim, for example, is reserved to the expensive version. That's a rational business approach, as there is great value in that for "persuading" managers of what you're talking about, so they can "see" and "believe" it, but it is truly wretched for educational purposes and reaching much wider audiences. We need the basics of this in open course-ware.

Looking at the crucial concepts of "perspective", I think Piaget pegs this around 12-adolescence, and too many adults I know have no ability to even imagine there is another valid way to look at something than the one that is obvious to them. But, Piaget precedes video games, with multiple window views and "zoom" controls. With those, I think, you can put player one's view in a window above his head, and player two's view in a window above her head, and you can quick see that they see the world differently, but equally validly. ( The soup can looks round from above but rectangular from the side, etc.)

One can imagine a scene where there is one world visible at a small scale, but as you zoom outwards and get a wider view you realize that you weren't seeing the whole picture.

Again, if this was done methodically with clear educational goals, I think these concepts could be "taught" (or realized without much teaching and reinforced by success in the game) in a few hours of play time. "Play" is important.

Similarly cause and effect with delay, or cause and effect in a loop, can be modeled in a game scenario, or in Second Life of some equivalent virtual world, so that people could quickly realize that some effects are delayed, but if they "fly up" and look down they can see why, as the effect is heading around the long track and finally comes back in from the other direction, via animation and participation.

I learned many of the necessary concepts when I was in 7th grade, reading the Radio Amateur's Handbook and building Heath-Kit radios and playing around with analog circuit components that quickly get more complex than most SD models. I think I "got it" since I taught an Adult Ed course in Radio and TV repair, and was an electronics technician for 5 years, repairing multi-stage amplifiers, etc. Again, hacking around on a "breadboard" with signal generators and lights was sufficient to overcome a lack of mathematical background, or more precisely, to give me real world insight I could relate the math to.

Then there is recent work in "hybrid images" which look angry if close, but smiling far away, or vice versa, or look like Einstein if viewed at 2 feet but like Marilyn Monroe if viewed at 15 feet, that are very persuasive of what differences can occur among perfectly competent observers.

(See my post on conflict-resolution and hybrid images here: and a picture that is of Einstein viewed close up but of Marilyn Monroe viewed far away at the U Fla. site here or at larger scale on my weblog here: )

So, all this says, I think many core concepts here are analog and non-verbal, and can be introduced as early as Kindergarten, or sooner, via computer imaging and video-game technology and game playing. I suggest we get that much in place as a basis for building on from there.

Reflecting on a discussion on that list-server of whether it gets harder and harder to teach systems concepts as students get more "educated", I wonder if some of these concepts are either sub-cognitive or super-cognitive, that is, situated in our next lower or next higher level in the hierarchy of life -- our body or our social context ("emotional intelligence") respectively.

It was obvious from my prior work in automating image processing that there are some concepts that are trivial to capture in images that are almost impossible to put in words, and vice versa. In fact, there is quite a religious war in Artificial Intelligence between those who believe in symbol strings (words, numbers, equations) and those who believe in images as better primitives for intelligence. Carnegie Mellon descendants of Simon and Newell go with symbol strings and Turing's Theorem, which seems OK to me in a perfect world with infinite space and time and perfect "tape". I myself go with images as having far more utility and power in a world where there is finite space and time, everything is noisy, and what exists decays over time, since images are almost impervious to spot noise in a few pixels, or even ten percent of them, but symbol strings can be easily damaged if a key symbol is lost.

That aside, some concepts are primitive analog signals and don't require words, such as running to catch a ball. Words really don't help, and in fact, like thinking about one's fingers when typing, may get in the way. Some concepts are interactive feedback loops with others, and similarly are obvious primitives not helped by words, such as, say, a kiss or a loving touch.

Maybe as people get more "educated" they tend to reject both their bodies below their minds and the outside social world above their minds, and become, well, more taken with themselves and their ego, which, like science, shuts itself off from the parts of the world it has trouble encompassing, while minimizing or demonizing those parts to avoid facing it's own limits.

True teamwork and leadership in some ways involve the Christian metaphor of the death of self to self and rebirth of self encompassing the "us" instead, a dissolution of limits and opening up to outside influence and non-self. For a manager, realizing staff exist and matter is like a brain accepting that the body exists and matters. The illusion of a complete "self" at any given level, and the disappearance of lower levels entirely is very powerful, similar to the green dot illusion I gave in the last post and repeat here:

This visual illusion of a moving green dot is great!

A recent interview in Forbes with GE's Jack Welch reveals an incredible ego in which he boasts about things that "he" did, even though, in fact, a hundred thousand other people did the heavy lifting. Still, to him, I'm sure it appears that "he" did the work, and the employees were just mostly in the way.

Successful true teams are similarly scary, because it's not clear "who" did the work, since the emergent life-form of the team did the work, and we poor humans, and poorer human resources compensation departments, have no slot in which to put "meta-humans" as actors. When a meta-actor, or "system" takes some action, we keep insisting that some "person" must have done it. It's scary to us that multiple humans can host feedback loops that take actions on their own accord, with a "life of their own." We expect volition to be at the cognitive level, not below us in the body, or above us in peer-pressure or feedback loops that we are at the mercy of.

So, despite the fact that it is increasingly clear that LIFE is a multi-level hierarchy, where all the levels matter, both proximate and distal, it is hard on our "ego" or this-level consciousness to recognize that part of "us" is actually operating at those other levels.

It may be OK if those levels "interact" with "us", but it is scary if those levels interact so strongly that we move from the self-energy dominated end of the spectrum to the interaction end, and those levels turn out to be part of "us." Women, especially, often feel that part of themselves has been chopped off when a mate departs or dies. All of us have dramatic downturns in "our" physiology and "biomedical self" outcomes when our social ties to others are severed. Still, as adults, we insist on drawing a sphere around our bodies and demanding that the "individual" is paramount and everything else outside that sphere is just sort of impinging noise or "environment." To be part of the same living meta-body or system is frightening, all the more so from political marketing of any sort of communal self as "the Borg" or "communist" or "socialist" or some four letter word.

Maybe children, with fewer preconceptions of how it "should be" have an easier time with the concept that "I" and "we" are only loose approximations of what really is. Coaches can sometimes temporarily bridge the gap, and get many individuals to become a single entity, a team that acts and moves and thinks ahead as one, but it is a rare event, and one we don't usually look for in a highly fractured and fragmented workplace of "competing individuals."

In a true multi-level world that is dense with cross-level feedback and phase-lock loops, these distinctions vanish. There is no "me" and "you", only "us."

This data point is so inconvenient that even credible researchers tend to delete it from the dataset before publication because it "doesn't fit" and it messes up the rest of the analysis. A few years back there was a conference here at the University of Michigan on "Self determination of Health Behaviors" with all the big names from around the globe, Prochaska, etc. They also had copies of their latest papers in binders. Seventy percent of the USA's health costs were due to behavior or life-style actions we were told. Fine. We were given example after example of what was tried and what worked, to change behavior.

So, at the end there was a panel discussion. I raised my hand and asked if I was mistaken, or hadn't every one of them given as their most successful intervention one in which a social group was the active agent of change, not the individual. (For example, paying a woman's children $5 for every kilogram of weight she lost, instead of paying her.) Well, after a brief deliberation, yes, they agreed with that.

Well, I continued, then why were none of these social interventions, that they said were the most powerful, even mentioned in their papers about this crucial problem in public health, breaking the budget? They conferred again, briefly, and said, basically, that none of them knew how to compute p-values for interacting teams ... so they left that part out of their papers.

My jaw dropped to the floor. I had no further questions. What do you say to that? The unconscious bias against recognizing this effect is phenomenal.

A similar unconscious bias seems to exist regarding the impact of our body on our behavior, again, some sort of legacy from the prevalent belief that mind and body were totally separate that dominated thinking for centuries, and that required huge effort and billions of dollars at stake to break through in the last decade or so in mental health. A marvelous paper on that bias is David Rosembaum's "The Cinderella of Psychology - The Neglect of Motor Control in the
Science of Mental Life and Behavior", American Psychologist, May-June 2005, p308-317.

From our compensation systems to our legal systems, we have so much predicated on the concept of "individual" entities that larger scale entities that have volition and senses and take actions is massively inconvenient and discordant. We've barely adjusted to the existence of "microbes" that live somewhat independently inside us, and don't really want to deal with the existence of "macrobes" that we live somewhat independently inside. It really messes up the equations.

And that's probably the biggest reason why "systems thinking" has been kicking around for 50 years and just can't get into the mainstream. We don't want to be entangled, multi-level beings. The billiard-ball model was so much easier on the ego. But all the equations and social data point to the fact that, like it or not, there isn't really "I" there is only "we".

If we do accept that concept, it really changes the nature of health and health care and mental health, as well as teams and teamwork and relationships and marriage and family and peer-groups and microsystems. If "I" versus "we" is a continuum, not a dichotomy, the models all need to be revised, our justice system is disrupted, and even concepts of "who" owns something or "did" something are disturbed if not overturned.

But that's the end point of where this trail of multi-level behavioral and health data is leading.

Our interactions and relationships have independent existence and lives of their own, our teams and corporations have persistent existence above and beyond the people who make them up, etc. The "white space" between the boxes on the org-chart of life turns out to be as important as the boxes. Or sometimes more important.

Which puts everything we knew in an entirely new light.

Adults have a lot of "stake" in the model of life of clearly distinct individuals, the billiard-ball model of life. Children don't, and see life as it is, not as it "should be."