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.

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.

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.




Arts Humanities and Complex Networks final call for papers March 28, 2014

Invitations for submissions for

Arts, Humanities, and Complex Networks
— 5th Leonardo satellite symposium at NetSci2014

taking place in Berkeley at the Clark Kerr Campus of the University of California,
on Tuesday, June 3, 2014.

Deadline for submission: March 28, 2014.





Course offering: mathematical sciences in obesity research UAB

The mathematical sciences including engineering, statistics, computer science, physics, econometrics, psychometrics, epidemiology, and mathematics qua mathematics are increasingly being applied to advance our understanding of the causes, consequences, and alleviation of obesity.  These applications do not merely involve routine well-established approaches easily implemented in widely available commercial software. Rather, they increasingly involve computationally demanding tasks, use and in some cases development of novel analytic methods and software, new derivations, computer simulations, and unprecedented interdigitation of two or more existing techniques. Such advances at the interface of the mathematical sciences and obesity research require bilateral training and exposure for investigators in both disciplines. This course on the mathematical sciences in obesity research features some of the world’s finest scientists working in this domain to fill this unmet need by providing nine topic driven modules designed to bridge the disciplines.

For full details of the course, please refer to the application & draft agenda on our website at http://www.soph.uab.edu/energetics/shortcourse/first.  You may apply online at http://www.soph.uab.edu/energetics/shortcourse/first/application.

Limited travel scholarships are available to young investigators.

Please apply prior to Fri 3/28/2014. Accepted applicants will be notified no later than Fri 4/04/2014.  Women, members of underrepresented minority groups and individuals with disabilities are strongly encouraged to apply.

NEW DEVELOPMENT for Orgcomplexity- I have a book coming out this year!

I have actually been approached as to why I have not posted on Orgcomplexity as much in recent months.

There is actually a very good reason.

I am ready to announce that my single-authored book that brings systems thinking to health policy and ethics is under contract with Springer. It will be a part of the inaugural SpringerBriefs series in Public Health Ethics. I will keep everyone updated with the publication details in the next few months. The target for publication is mid-2014.

Thank you for supporting Orgcomplexity and I hope that you will continue to follow my book progress over the coming months.

All the best,

Michele Battle-Fisher

Bertalanffy Center- European Meetings on Cybernetics and Systems Research 2014, 22-25 April- Vienna


The Bertalanffy Center for the Study of Systems Science proudly presents the upcoming European Meetings on Cybernetics and Systems Research 2014, 22-25 April 2014 in Vienna. It is the second time they are responsible for the co-production of the most distinguished systems organizations and communities in the world, in addition connecting member organizations of the International Federation for Systems Research. The EMCSR create a hub for showcasing the advancement of systems approaches that contribute solutions to the complex challenges of today, the focus is on “Civilisation at the Crossroads: Response and Responsibility of the Systems Sciences.” 

The call for papers and participation is still open until 28th of February. If you want to join and contribute to the vibrant community we were able to connect already, do not miss this opportunity to submit your extended abstract and get published in the EMCSR book of abstracts 2014.


UKHLS and social connections data


Michele Battle-Fisher:

UK Household Longitudinal Study (UKHLS) includes the first module on social networks- repost of blog from Dave Griffiths of Stirling (UK)

Originally posted on Pulling Apart:

The latest wave of Understanding Society , or the UK Household Longitudinal Study (UKHLS), includes the first module on social networks. The UKHLS was first run in 2009, emerging from the previous 1991-2008 British Household Panel Survey (BHPS) , providing detailed information on all individuals in 30,000 UK homes. Those individuals in Wave A, or who entered from the BHPS, are tracked every year and interviewed along with all others within their household. Therefore, when households are stable across time (i.e., a married childless couple who always live together)  the same individuals are interviewed each year. But, when  households change (i.e., a married couple whose grown-up children move out of the parental home and have flatmates, partners and children of their own) different people become eligible for inclusion.

Individuals are interviewed annually, covering a wide range of subjects including, amongst others, employment, politics, health, income and education. In addition, there…

View original 720 more words

Time to get a piece of the modeling pi

But there is another pi that some may be less aware of – the theoretical formalism of pi calculus in process algebra. Thank Robin Milner, the brain behind the theory of pi calculus, that approaches systems as fundamentally able to reorganize themselves through interaction (see Milner, 1999). Jeannette Wing (2002) explained the utility of pi calculus in a way that I found highly approachable (or as cuddly that process calculus can be). The process is that mysterious force based on inputs that control a system (see Wing, 2002). The channels tie together through some mode of communication (or relationship) (see Wing, 2002).

 Systems are made of components that are interdependent. Also the process can involve any number of balancing and reinforcing factors that loop together. Displaying a recognized connection to another agent is, at its center, systemic. For example, when using pi calculus theory within computer code modeling, what is of interest is the process calculus of the messaging (connections) that may be measured asynchronously (with a time delay) or synchronously (at the same time). The computer code using pi calculus is an approximation, replicating the nature of the concurrent inputs/outputs into the system. Students in software engineering class accept, perhaps with unabashed relief, that approximation of “truth” of such calculus and move on to get their modeling done. Maybe policy needs another definition of truth.

What can policy learn from this theory of pi?


1.      There should be an accounting of the systemic process underlying the policy. This may include looking at the interdependence and feedbacks among elements of the system, ongoing assessments of the past policy successes and failures, as well as changing landscape of epidemiological evidence.

2.      Dynamic changes in inputs/outcomes are debated beyond the mental models offered around the table (e.g. use of formal modeling).

3.      Overlap (concurrence) of different systems at play in the policy should be explored.



Milner, R. (1999). Communication and Mobile Systems: The Pi Calculus. Cambridge: Cambridge University Press.

Wing, J. (2002). FAQ on pi-calculus. Retrieved on February 18, 2014 from http://www.cs.cmu.edu/~wing/publications/Wing02a.pdf.


Arts, Humanities, and Complex Networks — 5th Leonardo satellite symposium at NetSci2014

Arts, Humanities, and Complex Networks

— 5th Leonardo satellite symposium at NetSci2014

taking place in Berkeley at the Clark Kerr Campus of the University of California,
on Tuesday, June 3, 2014.

For submission instructions please go to:

Deadline for submission: March 28, 2014.
Notifications of acceptance will be sent out by April 7, 2014.

For the fifth time, it is our pleasure to bring together pioneer work in the overlap of arts, humanities, network research, data science, and information design. The 2014 symposium will follow our established recipe, leveraging interaction between those areas by means of keynotes, a number of contributions, and a high-profile panel discussion. In our call, we are looking for a diversity of research contributions revolving around networks in culture, networks in art, networks in the humanities, art about networks, and research in network visualization. Focusing on these five pillars that have crystallized out of our previous meetings, the 2014 symposium again strives to make further impact in the arts, humanities, and natural sciences. Running parallel to the NetSci2014 conference, the symposium provides a unique opportunity to mingle with leading researchers in complex network science, potentially sparking fruitful collaborations. As in previous years, selected papers will be published in print, both in a Special Section of Leonardo Journal and in a dedicated Leonardo eBook MIT-Press: http://www.amazon.com/dp/B007S0UA9Q

Confirmed Keynote:
Lada Adamic, Associate Professor, University of Michigan & Data Scientist, Facebook, USA

As in previous years, we will feature three high-profile keynote speakers from the areas of cultural data science, network visualization, and network art.

Best regards,
The AHCN2014 organizers,
Maximilian Schich*, Roger Malina**, Isabel Meirelles***, and Meredith Tromble****

*    Associate Professor, ATEC, The University of Texas at Dallas, USA
**   Executive Editor at Leonardo Publications, France/USA
***  Associate Professor, Dept. of Art + Design, Northeastern University, USA
**** School of Interdisciplinary Studies, San Francisco Art Institute, USA

Complex Systems, Health Disparities & Population Health: Building Bridges February 24-25, 2014 National Institutes of Health

[The University of Michigan Network on Inequality, Complexity, & Health presents Complex Systems, Health Disparities & Population Health: Building Bridges. February 24-25, 2014. Natcher Conference Center. NIH Campus, Bethesda, Maryland.]

The University of Michigan Network on Inequality, Complexity, & Health presents

Complex Systems, Health Disparities &
Population Health: Building Bridges
February 24-25, 2014
Natcher Conference Center
Bethesda, Maryland
Deadline to register: February 14, 2014
Deadline to submit a poster (through the registration form): January 15, 2014
Register at: https://www.regonline.com/complexitydisparitiespophealth
Visit Conference Website at: http://conferences.thehillgroup.com/UMich/complexity-disparities-populationhealth/
Improving population health and eliminating health disparities is a critical task, yet our efforts are stymied by the complexity of the task, involving as it does causes of poor health that range from public policy to the nature of our neighborhoods to how we behave to biology.
On February 24-25, 2014, at the National Institutes of Health Natcher Conference Center in Bethesda, Maryland, join scholars and practitioners from the United States and abroad to learn about and see examples of how complex systems science can help guide our research and policy efforts to eliminate health disparities and improve the health of our population.
You’ll learn about the methods and tools of complex systems and how they can be used to address critical determinants of health and health disparities over the life course, including those that involve the health care system, socioeconomic status and mobility, institutions, neighborhoods, behavior, cognitive processes, and neurosciences.
This ground-breaking conference, organized by the University of Michigan Network on Inequality, Complexity & Health with sponsorship from the National Institutes of Health Office of Behavioral and Social Sciences Research, will be of interest to those from public and health sciences, social sciences, computer and engineering sciences, complex systems, health and social policy, government agencies, and funding agencies who are interested in eliminating health disparities and improving population health.