Is being liquid enough to innovate toward policy success?

Comparison of requirements of the liquid network to the mathematical requirements of Social Networks

Comparison of requirements of the liquid network to the mathematical requirements of Social Networks

Steven Johnson (2010), the popular author of “Where Good Ideas Come From- The Natural History of Innovation”, wrote that innovation is structure based. A cornerstone of Johnson’s (2010) book is this idea of an informal, liquid network in which ideas collide. Johnson (2010) visualized the liquid network as the Hogarth’s painting “Humours of an Election”. Ideas generate from informal meetings not that company annual retreat in Florida ac-cording to Johnson (2010). The closer the people’s ideas are in space and time, the better the chance for the ideas to collide with a few new (idea) bonds formed along the way. Johnson’s use of network would better be labeled as idea management rather than being complexity driven. But for policy to be able to account for the long-term implications of idea management, ethical deliberation drives the complexity of organization. The included table compares the offerings of the liquid network of Johnson (2010) to the social networks for idea management. Collision unfortunately lacks the formality and accountability afforded by the structural relationships of social networks. Broadening idea generation beyond a “bump” illustrates the immensity of the effect of the social and political reach of policy.
People connect within a social space. According to Alba and Kadushin (1976), the measure of proximity is concerned with pairs of individuals and how “distant” they are. Traditionally, proximity is all what diffusion of social commodities, often defined by information sharing, as a flow (Alba and Kadushin 1976). In a liquid network of Johnson’s conceptualization, ideas bump into each other due to the act of discourse as an event. First, there must be connections to other people and the environment supports the development of ties. Johnson concurs. There are the things colliding in a network which in Johnson’s (2010) case is the idea. Discourse turns that “private solid state to a (public) liquid network” (Johnson 2010). In what Johnson (2010) called the state of adapting exaptation, people can informally engage due to the “bump factor” of these chance meetings (Johnson 2010). To Johnson (2010), innovations linger in a “slow hunch” countering the eureka moment. The power of leverage points values the ability to find a small change that can make a huge impact. This is not the same as the epiphany. Systems that undulate slowly can be most frustrating to the urgency placed on having policies work.
The liquid network is mildly bound enough to be a network but not enough to strangle innovation with rigidness. Ideas are innovative because of the people that offer them with their skills and prestige. Some ideas are drowned out or flatly ignored. Connecting the ideas as a structure is often descriptive. Which idea (or person with the idea) was most connected? Which idea structurally demonstrated power in the network of ideas? Then this whole idea of playing with private ideas within a public space by basing it on the structure of the irrational agents is the more interesting, and fruitful question to pose.
Johnson (2010) proposed that platforms, or orchestrated spaces, may foster innovation. Within these platforms, liquid networks which do not restrict movement within an organization and their innovation ideas may be better supported to thrive. The ideas take on a fluid state without outside restriction. Does the event become more consequential than the interaction supported by the event? Networks are systems in which the nodes (the things that are connected) are connected by ties. When one is interested in reasons for why people affiliate over an idea, two mode networks could be employed (Borgatti and Everett 1997). The people would be agents (set 1 mode) while the IDEAS serve as a “series of events” (set 2 mode) that they are sharing. In a two-mode network, both the idea and agent indicates the elements of the network. The idea becomes an element to be weighted with the agents and chance meetings. So there is a tie be-tween the agent and the event. The tie formation could be due to “bump factor”:
1) to accept the chance meeting and
2) engage in the innovating chance meeting.
Both nodes engage in it since Johnson (2010) is basing adapting exaptation on engagement not its possibility. But a concern with approaching such two-mode networks, which mode takes the primary position? For instance, Johnson (2010) does not divorce the person from the idea and but for his paradigm the idea is element of focus. The idea is the primary node. The idea comes from the person (secondary node). The argument would also be made that if innovation is viewed as a dynamic, social experiment, the person as the primary mode may say more about why that idea even came to be in the first place. While the platform may be nature be useful in revisiting existing resources such as ideas in a liquid network, the problem often uncovered in policy is the lack of new ideas and continued reliance on existing ideas that may lead to attribution errors. To Johnson (2010), the ideas are used as bonding agents. Two-mode networks deal with the nature of affiliation. The idea is no longer just assumed but is now used as a means to investigate the structure in which ideas are embedded within the ties connecting the author of the idea (see Smith and Christakis 2008). The approach of Johnson (2010) had ideas brought “together” by its messengers as one frame. I do not believe that Johnson (2010) is marginalizing the person behind the idea of the liquid network. By stressing the network, the structure at two mode levels appears to capture the reality of how innovation in a liquid network more likely occurs.
To Johnson (2010) removing boundaries to the liquid network leads to chaos. This may be wise as any chaotic system does not return back to original state before the spiraling began. This chaos could hamper innovation by changing the new starting point and disrupting the momentum started in creating the innovative (see Feigenbaum 1983). As Johnson (2010) was intending avoiding chaos for a malleable liquid state, there is no history of events connected with a state of chaos. When things are chaotic, the past matters far less, only the energies running amok are important. What significance might this hold for developing innovation? Unlike chaotic systems, complexity is tied to its history of events upon which the system was built (see Buchanan 2000).
What is applicable to policymakers under liquid networks, according to Johnson, is less promising. In offering the example of Howard Dean’s Presidential Campaign “supernova”, Johnson (2010) admitted that “political leadership involves some elements (decision making and oratory) that aren’t best outsourced to a liquid network.” So how do policymakers innovate and think creatively under political stressors? Using Wasserman and Faust (1994) taxonomy, two-mode networks have three possible purposes under Johnson’s (2010) liquid networks:

(1) The affiliation is the tie of the person/ideas (node) to the informal chance meetings (event).
(2) The “bump factor” (if it supports interaction) may make interaction, therefore innovation, more likely.
(3) In order to framing the adapting exaptation realistically, the measurement of homophily is required.
The two mode network is difficult to interpret, let alone analyze. But how ever said that policymaking was easy? People tend to clique around policy issues, perhaps based on the process of idea generation or even bunch out due to personal access due to co-location. Two modes capture this bunching up as cliques that overlap, perhaps by party affiliation or side of a legislative issue. But the point of this methods tale is not the complicated analysis but that that coming together to work policy out that on the surface can be deceivingly simplistic. This is a great example of how the mental model of a liquid network does not apply neatly to policymaking but still has a place in the discussion. Unlike the informal liquid network, the innovation required by policy must translate into proper strictures under governance. The chaos of a liquid network must be operationally linked to the structural nature of complexity. But this fact does not mean that networks, whether liquid or mathematically understood, are not useful in discerning policy. While the informal ideas that are eventually brought to the policy table may utilize adapting exaptation, the policymaking process strips away the lacquer of casualness.

References

Alba R, Kadushin C (1976) The intersection of social circles- a new measure of social prox-imity in networks. Socio Meth Res 5(1): 77-101
Borgatti S, Everett M (1997) Network analysis of 2-mode data. Soc Network 19: 243-269
Buchanan M (2000) Ubiquity- The Science of History…Or Why the World is Simplier Than We Think. Weidenfeld & Nichols, London
Feigenbaum M J (1983) Universal behavior in nonlinear systems. Physica 7: 16-39
Johnson S (2010) Where Good Ideas Come from. Riverhead-Penguin, New York
Smith K, Christakis N (2008). Social Networks and Health. Annual Review of Sociology 34: 405-429

Invitation to Participate in the 58th Meeting of the International Society for the Systems Sciences late July- early August 2014

The George Washington University, Washington, DC.
July 27 – August 1, 2014

Theme: Learning Across Boundaries: Exploring the Variety of
Systemic Theory and Practice

CALL FOR PAPERS
The International Society for the Systems Sciences (ISSS) was founded in 1956 as a section of the AAAS, to “encourage the development of theoretical systems which are applicable to more than one of the traditional departments of knowledge”. There are now many thousands of systems thinkers, complexity scientists and cyberneticians worldwide. As more and more new application areas, practices, systems methodologies, theories and philosophies are developed, the number of research communities continues to increase. Fragmentation is the inevitable result of the proliferation of new systems ideas in response to new issues and contexts. While this might, at first, appear to be a negative consequence of our success, it brings with it an enormous opportunity: mutual learning from each other to enhance systems, cybernetic and complexity theories and practices in all our diverse domains. It is this opportunity that provides the focus for our 2014 conference.
This conference will reach out to all the diverse systems communities and provide a forum for mutual learning across their boundaries.
This year we will innovate in three ways:

* Not centrally determining all the conference streams. While the ISSS ‘special integration groups’ (SIGs) will each have their own stream (as in previous years), we also encourage anyone with an interest not already represented by the SIGs to put forward their own ideas for streams.

* Inviting thought leaders from as many research communities as possible.

* Designing hour-long boundary-spanning workshops where a single theory or practice, developed in a given research community, will be presented.
This conference represents a tremendously exciting learning opportunity, and we warmly welcome your participation, whether you are a long-standing member of the ISSS or have never heard of us before. We particularly welcome systems, cybernetics and complexity researchers who have knowledge of a particular domain of theory, methodology or practice, and want to expand their understanding of what else might be available. We invite abstracts and papers in all areas of systemic thinking and practice, and details of possible SIG streams and Exploratory groups are listed on the ISSS website.
This year, the American Society for Cybernetics (ASC) meeting “Living in Cybernetics” will also be held at GWU in the week following the ISSS meeting (3-9th August). There will be a discount for those attending both conferences, and details are on each society’s conference web pages.
Note that the conference fee includes free membership of the ISSS for a year, including electronic access to our journal, Systems Research and Behavioral Science.
Important dates:
May 31, 2014 End of Early Discount Rate on ISSS conference
May 31, 2014 Deadline for Workshop Proposals
June 30, 2014 Last date for Abstracts to be included in the Conference Programme. Full Papers may be submitted at any point, but people must first submit an abstract for review. See website for further details on publications, and all conference information is available at http://www.isss.org/world or by emailing: enquiryisss@gmail.com<mailto:enquiryisss@gmail.com

Building on What We’ve Started- Disney World, Gorillas and Oval Pegs in Square Policy Holes

Social policies are, more often than not, framed with the traditionalist rationalization of human intentionality. Be that as it may, policy tenders the protocols that are then acted up-on publically to bring social impact. Of course, a well-intended health policy must take into account on courses of action as well as funding priorities and constraints. I argue that socially based complexity puts into question the probability of purely rational public action. Social elements activated or retarded in a public policy can shift burden from one part of a healthcare system to another. In its most simple explanation, increased positive screening for disease within the safety net can lead to the probable increased usage of acute care treatment for individuals requiring more complicated care. While some level of desired social and health satisfaction may be experienced in the short term by shifting policy priorities, it is also probable that no tangible value is achieved toward to the overarching desire to elicit system wide impact. Will the positive changes last? I purport that living an illness with a public further complicates policy issues of keeping anything that is personally health related purely private.
According to network theory, naming a network is powerful. According to Trotter (1999), the existence of a boundary is defined by the rules of exit and entry. However, complex systems call for more intricate examinations of such boundaries. Unnamed groups are often identified by the observer and the boundaries are often most not agreed upon by the group members (Kadushin 2012). How might this idea work for special interests groups in making cohesion? According to Kadushin (2012), “a collectivity is structurally cohesive to the extent that the social relations of its members hold it together.” Further there are two mechanisms that support and disrupt this happy state of togetherness. First, if a “disruptive force” acts upon the group, will the network survive? Second, complexity is bound also to the health of its network. Like a game of Ker Plunk, disruption in a complex system occurs when one or more people are removed from the group (Kadushin 2012). The cohesion may or may not be able to survive. Then the process of community starts all over again with new set of actors and new structural relationships.
I do not recall an ICD code for attending family barbeques or activating one’s “social network” for staying healthy. Health care is not directly rewarded for healthy patients’ visits to Disneyland and the strength of the social support ties that keep patients well. More often than not, healthy patients demand less utilization of an already expensive and taxed health care system. Patients have social networks of confidantes of differing yields and compositions, but each member by association has the ability to persuade and dissuade if they wish. Often this network is an 800-pound gorilla in the examining room. This gorilla is a relative that has diabetes and complains of diabetic neuropathy while carefully sectioning the pecan pie with a surgeon’s precision. The sorority sister is a helpful “gorilla” that caresses your hand as you await medical results.
Failure is picking up a socially expected square peg after the innovative oval one fails to fit a conventional hole. If you really “need” the oval to work (and the world is not yet with the program), check out the board again. If there is no oval hole, darn it and chuck that board. Find a reamer and create your own or perhaps ask for a refund with no return shipping. Failure is the incessant attempt to satisfy others by hiding that socially acceptable square peg behind your back and asking for a few more days (in dog years) to work it out. Whittling that square peg with that dull pocket knife into a misshapen imposter of an oval peg serves no god. That imposter peg is not flush to the side of the hole. It is surrounded by slight flashes of open space. That open space created around the non-flush peg should extract with a slight tug. Trust me, that tug will be less taxing than the linear process that got that wrong peg there in the first place. Policy has little tolerance for misshapen pegs that bring with them unintended effects. Use a policy that works until it does not or admit that it never worked at all. Then make it work without the attribution errors gumming up the machinery. What works may not be the most apparent or popular choice.
At its simplest denominator, a citizen is by principle afforded the right of being included in a group’s decisions. But there is a special place for those who serve as policy experts. Sure, we could discuss until we are blue in the face how much a weight a vote in a representative democracy really holds. When I think of my job of being a citizen of any group, I am accountable in some manner to the group if I am not gerrymandered out of the process. Not unlike the idiom “we are in this together”, this cannot be truer in terms of health burden. The solidarity means that all of us have culpability in the collectives’ improving health. But each of our investment in this solidarity differs in our (re)actions, invocations and values. This knowledge should, in theory, affect the role that each of us plays in bettering health out-comes. But can and will citizenship overcome the medical reality that years of collective neglect have brought? How do we get people to give a darn and become a card-carrying Norma Rae? Those in policy hold a special role that should not be understated. A policy has the power to guide and mold the direction of societal movements or evade an unfortunate set-back. We are accountable but that job responsibility came with the rocky terrain. Necessary insights are gained from this systems approach. What is called for is the acknowledgement of the ligand and substrate nature of the two. In that regard, often a slanted pairwise comparison of objectivity to systems demonstrates the bias toward linearity. It is time for systems thinking to no longer be relegated to the kids’ table, peering around the corner and straining and wishing to bring its expertise to policy discussions. 

References
Kadushin C (2012) Understanding Social Networks. Oxford, New York
Trotter R (1999) Friends, Relatives and Relevant Others: Conducting Ethnographic Network Studies. In: Schensul J, LeCompte, M, Trotter R, Cromley E, Singer M (eds.) Mapping social networks, spatial data and hidden populations. AltaMira Press. Lanham, MD

Subject: Article of interest: Using systems thinking in state health policymaking


I am pleased to announce this article as an interview based on this research is highlighted in my book!!!

Using systems thinking in state health policymaking: an educational initiative
Karen J Minyard, Rachel Ferencik, Mary Ann Phillips and Chris Soderquist
Health Systems advance online publication 17 January 2014; pp. 1-7.         doi: 10.1057/hs.2013.17
In response to limited examples of opportunities for state policymakers to learn about and productively discuss the difficult, adaptive challenges of our health system, the Georgia Health Policy Center developed an educational initiative that applies systems thinking to health policymaking. We created the Legislative Health Policy Certificate Program – an in-depth, multi-session series for lawmakers and their staff – concentrating on building systems thinking competencies and health content knowledge by applying a range of systems thinking tools: behavior over time graphs, stock and flow maps, and a system dynamics-based learning lab (a simulatable model of childhood obesity). Legislators were taught to approach policy issues from the big picture, consider changing dynamics, and explore higher-leverage interventions to address Georgia’s most intractable health challenges. Our aim was to determine how we could improve the policymaking process by providing a systems thinking-focused educational program for legislators. Over 3 years, the training program resulted in policymakers’ who are able to think more broadly about difficult health issues. The program has yielded valuable insights into the design and delivery of policymaker education that could be applied to various disciplines outside the legislative process.

http://www.palgrave-journals.com/hs/journal/vaop/ncurrent/abs/hs201317a.html

HIV risk taking among homeless teens- The complexity of it for policy

Let us begin with the pressing policy issue of HIV risk taking behavior among homelessness teens to take home this point of social bond (de)construction. In the work of Rice et al.’s (2012) study of HIV risk behavior, homeless adolescents were located within the core (that dense ball of spaghetti in the middle of the network graph), were more likely to be female and were more likely to have been homeless for at least 2 years. The longer the teen, particularly for the young woman, is outside of the family unit, the teens form strong, compact ties with a new “family”. Surprisingly, being on the outside of this tight “family” that is found in the periphery of the network was protective against HIV risk taking. Highly connected, dense core are great for galvanizing information within that group. But a dense group may be more difficult to infiltrate. If the dense ball of teens are passing misinformation and reinforcing risky HIV behaviors, it is best to go your own way. But where can a young person go with such marginalized circumstances?
If the public policy being developed pertains directly to HIV risk taking reduction, perhaps targeting the core network to diminish risk could be a first step. But in the work of being connected to other people, the low risk teens may help each other or could transfer into the high risk group. But policymakers must remain mindful of what systemic changes can flow from targeting that portion of the network. People come and go into each other’s lives. Policy must be mindful that the longer the teen is outside of a traditional household, human connections will be made with the people that they have the most contact with. Could the teens in periphery have formed cliques that supported less risk taking? This may help these teens. Keep the periphery teens supported in their low-risk behavior. In the world of networks, there is something called homophily (birds of a feather). This means more than living in the same place. Above that shared space, the teens are ties together by something stronger: love, support, shared values, shared behaviors (see Feld & Carter, 1998; Kadushin, 2012). In other world, people live by forming bonds wherever they land.
If the policy lumps the new cliques (core and periphery) together, network membership can change over time. Teens that tie together two completely separate networks are called bridges. By theory, the networks would not have connected if not for this new bridge. Often the bridge has enough prestige and power to convince two divergent groups to join forces (Granovetter, 1973). Will the new members from the outside possess adequate social currency to offset the peer influence of the core members? Thus we have complexity. Can one policy that is meant to affect teens as if they share the same life chances and social embeddedness work? Most likely answer is no. While there may be an overarching goal set up the policy, parse out how different attributes of the teens may affect how the proposed policy works.
The longer a teen is away, it becomes more likely that their family will be in the same dire social straits and may not be protective in navigating good social choices and decisions. But the longer a teen is away, human nature requires connection and closeness, a family broadly defined. Being on the outside (periphery) of the homeless core protects against HIV risk-taking. Let us not forget a social purgatory between the instability of homelessness and the perceived caustic environment that the teen desperately calls to escape. The peripherals may be at risk in other ways that may lead to a greater risk of HIV risk taking once the teen is in the core. But if that teen has the ability to persuade those at risk, there is a possibility that the low risk taking of a strong teen could start to cascade low risk attitudes and values. But there is also a possibility that the teen will become enveloped and become high risk himself. It may be too much to ask of that teen to work to overhaul the collectively held value of higher risk sexual practices (Long et. al., 2013).

So in using the research on social networks, I propose systemic factors that should be accounted when attacking HIV among homeless teens:
1. Every homeless teen is not the same and each with present a different set of connections.
2. Being deeply connected in the homeless culture may place these teens at higher risk for unsafe sexual behaviors.
3. Targeting low risk teens on the periphery will require a different intervention to support the low risk behavior.
4. While there may be opportunities to use low-risk teens as “bridges” to the high-risk teens, this should only be done with extreme care and oversight. The bridge is more susceptible to falling into the activities of the core and may suffer from burn-out for the heightened sense that change is on that teen’s shoulders.
5. Watch the movement of teens from the core to periphery (and back again). This movement brings a whole new set of structural realities both for the teen as well as the network.

Social networks are powerful and are often underutilized in uncovering the underlying structure of health policies. But the policy work that we should hold dear must account for the power to combatting ecological gaps and failures, such as the personal and societal failing of just one homeless teen.

References

Feld, S. & Carter, W. (1998). “Foci of Activities as Changing Contexts for Friendship.” In

Placing Friendship in Context, eds. Rebecca G. Adams and Graham Allan. Cambridge,

UK: Cambridge University Press.

Granovetter, M. (1973). The strength of weak ties. American Journal of Psychology. 78 (9),
1360-1380.

Kadushin, C. (2012). Understanding Social Networks. New York: Oxford.

Long, J., Cunningham, F. & Braithwaite, J. (2013). Bridges, brokers and boundary spanners in collaborative networks: a systematic review BMC Health Services Research 2013, 13:158

Rice, E., Barman-Adhikari, A., Milburn, N. & Monro, W. (2012) Position-Specific HIV Risk in a Large Network of Homeless Youths. American Journal Of Public Health. 102(1), 141-147.

NOTE: This white paper is a revision of a blog written by the author. An early version was originally posted on the Orgcomplexity Blog (Orgcomplexity.wordpress.com) on February 28, 2013.

Letting the Body of Evidence Speak Volumes for Policy

It is hard to be strong in fortitude based solely on principle when you making that action alone. We co-exist with others. Policy is there to help orchestrate a health strategy to support these socially accepted goals of better health outcomes. The point of better health is to reduce pain and cheat death as long as possible. In this quest, is a clinically imperfect body one owned or owed to society? We in health policy need to take a moment to ponder this question. Whose body is it anyway that the policy is built around? What can be held as private when the collective’s health is at stake? People are embodied. Simply, each person has an acknowledged connection to his or her body. The sum of those bodies comprises the target populations that public health sets out to help. Our public health initiatives affect the whole “body” of society. Torjman (2005) put it succinctly, “At the end of the day, the formulation of public policy involves a process of making good decisions – for the public good”. Public health by nature deviates from clinical medicine in the sense that now public health is the overseer in your home, with the hopes of paternally people to leading more healthful lifestyles and improved quality of life. The narrative and public outcries can give perspective and requirement to act but above all we must make sure the policy priorities cannot be divorced from accepted evidence (Niessen et al. 2000). We in health policy are in the business of working magic to usher legislative and political changes while leapfrogging with human agency. Policy is called to strike the perfect balance between finessing risk in its favor with the most economically reasonable actions with the least of amount of societal discord. Under these terms, policy is considered effective (Nagel 1986).

Hovland (2007) warns of the gap of influence that peer reviewed research may have on policy that must be responsively more rapidly. As Hovland (2007) said, it is all about impact. I add that it is all about systemic impact over time. There are policy outfits that are more the research institute and may have more comfort in this call for evidence. Sentiment drives policy. However, data framing must ground our policy in response to social sentiment and political pressure. Calculated risk may fail to not account for are the specific systemic factors such as special interests, social media blitz or dwindling National Institutes of Health (NIH) public health funding are blockages that policy people know all too well.
The dinged battle armor of policymakers continues to be tested at every turn in this regard. Policy acknowledges the system working with supportive and against opposing social issues. Sometimes the opportunity is not taken or afforded to reintroduce the public to what policy does. In the arduous work in policy making, public health burdens change as it should in tandem with changing policy. Public health data is our friend and should remain so but sometimes policy needs an epidemiologist on speed dial. Then it is off to the races, the policy races, that is. There is no Derby Horseshoe Wreath and throngs of adorning fans at the finish. There is only a sneaky reposition of the finish line and some incremental improvements and setbacks in the state of public health along the way.

Public health calls for the judicious selection of targeted priorities. The U.S. Department of Health and Human Services’ 10-year “Healthy People” assessments tell us so and we heed the foreboding .There are times when the public require action on a health issue, that while worthwhile, that may not jive with the personal or even collective wants or the scientific evidenced priorities. Policies may react to an outcry of an event or issue that merits immediate action to a risk factor (reactive policy) (see Torjman 2005). Policies may be made for the short term or the long term concerns. We often hear of an Act being passed “in response to” an acute problem in hopes of reversing and/or reducing any residual effects of an acute event. The exigency of a particular situation demanding does not excise the fact that care must be taken in its development and implementation. However, network research by Crane (1991) has shown that if a problem from sparse to more populated problems may more quickly spread than anticipated. Health policy has to worry about medical as well as systemic spread.

“… if the incidence [of the problem] reaches a critical
point, the process of spread [within a network] will explode.” (Crane 1991)

The magnitude of the coverage of the health policy in part is defined with epidemiological evidence over time or proof of an emergent need happening now. Often in the aftermath of activating the existing policy, new developments that make evident the need for tweak or overhaul appear during the act of its use. Assessment while doing (such as outcome evaluation) is often necessary, good business. System based assessment for future policy allows for simulation of ready data to anticipate “what ifs” versus real-time trials where it is baptism by fire with no safety harness.

If a policy is afforded the liberty to be worked out over time without duress, policy stakeholders may relish in the ability to break down and reassess the policies before implementing them into action. But public health always has fires to put out. The epidemiology continues to shift and react to health actions and reactions, outdating the numerator. Often that urgency, which warranted, can cloud perception and impair the ability to notice critical issues undergirding the health emergency. Which public health issue cuts to the front of the line, the funded research priority or one seizing social outcry?
Health is grounded in the reducible epidemiological data and irreducible private experiences of the patients. The requirement to ground proactive policy in peer reviewed or trusted evidence is not without merit. Evidence is non-negotiable. I insist that enlisting the available evidence and observations into models. A model uses cadres of data to represent more simply what could occur in a system. There is a system beyond the static rates.

References
Crane J (1991) The epidemic theory of ghettos and neighborhood effects on dropping out and teenage childbearing. Am J Sociol 96: 1226-1259
Hovland, I. (2007). Making a Difference: M&E of Policy Research. Overseas Development Institute. http://www.odi.org.uk/sites/odi.org.uk/files/odi-assets/publications-opinion- files/2426.pdf. Accessed 10 April 2014
Nagel S (1986) Efficiency, effectiveness and equity in public policy evaluation. Rev Pol Res 6(1): 99-120
Niessen LW, Grijseels EW, Rutten FF. (2000) The evidence-based approach in health policy and health care delivery. Soc Sci Med. 51(6):859-869
Rose G (1985) Sick individuals and sick populations. Int J Epidemiol 14: 32–38
Torjman, S. (2005). What is policy? http://www.caledoninst.org/publications/pdf/544eng.pdf.
Accessed on 5 December 2013

(Anti-) Smoking, Complexity and U.S. Public Law 111-31

Using The United States’ The Family Smoking and Prevention Act (Public Law 111-31) as an example, complexity is inherent to anti-tobacco policy and how unexpected factors emerge once such a divisive policy is enacted. Passed during President Barack Obama’s first administration, The Family Smoking and Prevention Act (Public Law 111-31) became the most sweeping regulatory support in combatting a leading cause of preventable death in the United States that have been scientifically linked to tobacco use. The Family Smoking and Prevention Act did not take away access to tobacco to consumers of age. Tobacco is sold legally, under the continued regulatory oversight from the Federal Food and Drug Administration. Newly ‘strengthened’ regulatory powers supplied by this act works to ensure the “safest” possible tobacco products sold to U.S. consumers using the most ethical forms of marketing to the public. Safe is certainly used loosely here. The sale of tobacco as ethical is another question. But tobacco is legal to use for those of age to use the product. What is allowed from a regulatory standpoint by this Act is targeting sales, marketing and distribution channels.
Upon maximization, the virtuous goal is to optimize the desired benefit of tobacco control policy, thereby saving lives and improving quality of life from morbidity and mortality related to tobacco use.

“This legislation will not ban all tobacco products, and it will allow adults to make their own choices…We know that even with the passage of this legislation, our work to protect our children and improve the public’s health is not complete.”, President Barack Obama during the signing of the Family Smoking Prevention and Tobacco Control Act (2009)

“Deliberate or orderly steps are not an accurate portrayal of how the policy process actually works. Policy making is, instead, a complexly interactive process without beginning or end.” (Lindblom & Woodhouse, 1993).

President Obama’s statement illustrates the depth and limitations of the powers of policy and portends systemic mess that could possibly ensure even under the most noble of intention. From his statement, we can take away that the following issues are central to the prescript of the law.

1. Increasing regulation of a legal product, in this case, tobacco.
2. Blocking tobacco advertisements from children within a specified distance of schools and parks.
3. Making flavored tobacco distribution illegal. Menthol is excluded from this ban.
4. All harmful chemicals must be fully disclosed to the smoker along with graphic fear appeals on the labelling.
5. Public Safety overrides autonomous actions of the consumer. Some elements of the society, such as children, require higher ethical safeguards which require the power of policy behind it.
Is an advertisement on the way home from the park that falls outside of the banned quadrant acceptable? By the letter of the policy, it is allowed. Is it ethical at the point of exposure to the ad or to the mere possibility of exposure to the marketing? Menthol is exempt from federal ban. Menthol would be a gustatory nightmare that does not leave a smoker’s breath or lungs minty fresh. I would rethink a pint of vanilla bean and menthol ice cream, but the immense popularity of the menthol flavor in tobacco does not require a sugar cone. It requires demand. Do we have enough room on the carton? It is going to have to be microscopic font and some gory images.
I am a never-smoker but that reality does coat my social and intellectual observations of the “smoker”. When I have stood behind someone purchasing tobacco, I have marveled at the specification given by the customer when requesting a cigarette. The customer recalls with exact precision of the colors on the box, the shelf location, and the nature of acrid, intoxicating smell wafting from the creases of the box.

Nope…Yes, the box right there on the second shelf next to the Ultra non-filtered. I want those menthol non-filtered buy one, get one. It will be debit card. And a lighter.

Cigarette smokers have been found to have very high levels of brand loyalty (see Dawes, 2013). The smoker knows the brand, down to the flavor, even recalling the specifications of the box that they want. At times, perhaps another perceived equivalent cigarette will do just this once and buy a comparable brand if the requested one is not available (Dawes, 2013). For others, not having their brand is a game breaker. Dawes (2013) in his analysis of U.S. cigarette consumer panel data uncovered the strong power of perception in cigarette branding.
1. A smoker that purchases high end cigarettes most likely will not lower the expectation of the quality perception by buying a generic brand.
2. If there is a female aesthetic on the box, men will not bite at all even when the call of nicotine gnaws. They will look for a cowboy or something testosterone driven in marketing appearance.
3. Price point does matter.
4. If you want overwhelming consumer loyalty, market to a smoker.
(Dawes, 2012)
But is packaging the end of the story? It is only one of parameters churning.
Voluntarily taking the smokes off of the shelves is a different animal altogether. What if a pharmacy decides to no longer sell tobacco which in 2014 was being tried? The smoker may choose to patronize a competing pharmacy that still sells the desired product. In order to offset the loss of sales in tobacco, what other measures will be set in place by the corporation to keep the smoker in their pharmacy a happy customer for other durable goods or leverage opportunities to bring in more new customers to offset the effects of losing smokers’ business? From a public health standpoint, good job for removing tobacco. From a business standpoint, will that smoker decide to move his prescriptions to a rival pharmacy? From a system dynamics view, a business move that diminishes returns is a negative feedback while increasing returns is positive (see Sterman, 2000). While there are standalone pharmacies that only dispense medication, many pharmacies double as quick convenience stores. A smoker is a goldmine. There will be medications on the horizon, if not filled already, to treat the morbidities related to smoking.
How can the tobacco removal spin work, really? Will the spiel from the CEO announcing the policy to remove the tobacco products lose resonance once the Twitter frenzy ensues farther diluting the intended corporate message. Once a message is viral on social media, the more removed the policy machine becomes and the message becomes more susceptible to distortion and emotion. Does the removal of tobacco tricked to higher prices across all products in order to make up for the projected loss of profit? Does a nonsmoker care about using a tobacco free business if he never bought or consumed the product at that time of service? What effect, in the long term, will removing tobacco from one chain have on tobacco related outcomes? Will other pharmacy chains follow suit? As you can see, these policy tentacles overlap and intertwine.
References

Dawes, John G., Cigarette Brand Loyalty and Purchase Patterns: An Examination Using US Consumer Panel Data (August 9, 2012). Available at SSRN: http://ssrn.com/abstract=2126951 or http://dx.doi.org/10.2139/ssrn.2126951.

Lindblom, Charles E. and Edward J. Woodhouse. 1993. The Policy Making Process, 3 Edition.Upper Saddle River, NJ: Prentice Hall.

Sterman, J. (2000). Business Dynamics-Systems Thinking and Modeling for a Complex World. Boston: The McGraw-Hill Companies.

 

FYI- FAMILY SMOKING PREVENTION AND TOBACCO CONTROL AND FEDERAL RETIREMENT REFORM (US Public Law 111-31)

http://www.gpo.gov/fdsys/pkg/PLAW-111publ31/pdf/PLAW-111publ31.pdf.